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Comparison of Percutaneous Interventional Ablation-Osteoplasty-Reinforcement-Internal Fixation (AORIF), Long Intramedullary Nailing, and Hemiarthroplasty for the Treatment of Focal Metastatic Osteolytic Lesions in the Femoral Head and Neck

  • Clinical Investigation
  • Musculoskeletal Interventions
  • Published:
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Abstract

Purpose

Osteolytic metastatic lesions in the femoral head and neck are traditionally treated with intramedullary long nailing (IM) or hemiarthroplasty (HA). Recovery, surgical complications, and medical co-morbidities delay oncologic care. This study sought to elucidate the comparative efficacy of percutaneous ablation-osteoplasty-reinforcement-internal fixation (AORIF), IM, and HA in stabilizing osteolytic lesions in the femoral head and neck.

Methods

A retrospective study of 67 patients who underwent IM, AORIF, or HA for osteolytic femoral head and neck lesions was performed. Primary outcome was assessed using a combined pain and ambulatory score (Range 1–10: 1 = bedbound, 10 = normal ambulation) at first follow-up (~ 2 weeks). Surgical complications associated with each treatment were compared.

Results

Sixty-seven patients (mean age, 65 ± 13, 36 men and 31 women) underwent IM (40), AORIF (19), and HA (8) with a mean follow-up of 9 ± 11 months. Two patients in the IM group (5%), three in the AORIF group (16%), and none in the HA (0%) group required revision procedures. AORIF demonstrated superior early improvement in combined pain and ambulatory function scores by 3.0 points [IQR = 2.0] (IM p = 0.0008, HA p = 0.0190). Odds of post-operative complications was 10.3 times higher in HA than IM (95% confidence interval 1.8 to 60.3). Future revision procedures were not found to be statistically significant between AORIF and IM (p = 0.234).

Conclusions

A minimally invasive interventional skeletal procedure for focal femoral head and neck osteolytic lesions may serve as an effective alternative treatment to traditional surgical approaches, conferring a shorter recovery time and fewer medical complications.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA

    Will Jiang, Gary Friedlaender, Dieter Lindskog & Francis Y. Lee

  2. Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale Interventional Radiology, 47 College Pl., New Haven, CT, 06510, USA

    Igor Latich

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  1. Will Jiang
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  2. Gary Friedlaender
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  5. Francis Y. Lee
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Correspondence to Francis Y. Lee.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This study was approved by Yale’s Institutional Review Board.

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Jiang, W., Friedlaender, G., Lindskog, D. et al. Comparison of Percutaneous Interventional Ablation-Osteoplasty-Reinforcement-Internal Fixation (AORIF), Long Intramedullary Nailing, and Hemiarthroplasty for the Treatment of Focal Metastatic Osteolytic Lesions in the Femoral Head and Neck. Cardiovasc Intervent Radiol 46, 649–657 (2023). https://doi.org/10.1007/s00270-023-03425-x

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