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Application of Endoprosthetic Replacement in Old Patients with Isolated Proximal Femoral Bone Metastases

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Abstract

Background

Due to radical resection, endoprosthetic reconstruction (EPR) is more invasive and increases the risk of dislocation. Therefore, the suitability of EPR for elderly patients with metastatic tumor needs further investigation.

Methods

Seventy-one adult patients with isolated proximal femoral bone metastases who underwent EPR were retrospectively analyzed and stratified into two groups: elderly age group (≥60 years, n = 31) and younger age group (<60 years, n = 40). The effect of age on prognosis was analyzed to determine whether EPR is beneficial in elderly patients with proximal femoral metastatic tumor. Cox regression modeling was used to evaluate the effect of different factors on postoperative survival outcomes.

Results

Ten (32.26%) and 9 (22.50%) cases of perioperative complications were recorded in the elderly and younger age groups, respectively, with median survival times of 22.00 ± 4.61 months and 23.00 ± 2.85 months, respectively; a log-rank test showed that the difference was not statistically significant (p = 0.657). A Cox regression model was established with patient age as the covariable to evaluate whether it affected postoperative survival. The risk of death due to age was not significant (p = 0.649), but malignancy and femoral metastasis type were significantly associated with postoperative survival (p = 0.001 and p = 0.019).

Conclusion

Although older patients have a slightly higher incidence of postoperative complications than younger patients, they do not experience severe adverse consequences. With rigorous selection and careful preparation, EPR is appropriate for the treatment of proximal femoral metastases in older patients, including those with Harrington type I–II acetabular invasion.

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Acknowledgment

The study protocol was approved by the Institutional Review Board at Sichuan Provincial People’s Hospital, and written informed consent was obtained from all patients for publication of this study.

Funding

This article was supported by Chengdu Municipal Science and Technology Project, 2019-YFYF-00093-SN.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China

    Peng Liu MD, PhD, Zhuan Wang MD, Shiyuan Zhang MD, Guoqiang Ding MD, Ke Tan MD & Ji Zhou MD

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  1. Peng Liu MD, PhD
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Correspondence to Ji Zhou MD.

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Peng Liu, Zhuan Wang, Shiyuan Zhang, Guoqiang Ding, Ke Tan, and Ji Zhou have no conflicts of interest to declare.

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Liu, P., Wang, Z., Zhang, S. et al. Application of Endoprosthetic Replacement in Old Patients with Isolated Proximal Femoral Bone Metastases. Ann Surg Oncol 29, 8623–8630 (2022). https://doi.org/10.1245/s10434-022-11912-7

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  • DOI: https://doi.org/10.1245/s10434-022-11912-7

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