Abstract
Metastatic pathological fractures of the proximal femur are increasingly treated by endoprosthetic proximal femoral replacement. We report the results and the costs incurred performing these procedures at our supra-regional sarcoma unit. Sixty-two patients underwent 63 proximal femoral replacements for metastatic bone disease over a seven-year period. Breast cancer was the most common primary pathology. One patient underwent a revision procedure for infection. Twenty-two patients suffered dislocations, most commonly those undergoing a conventional arthroplasty articulation. The estimated cost of a proximal femoral replacement is £18,002 at our centre. Less than half of this is reimbursed under Payment by Results. Endoprosthetic replacement of the proximal femur is an effective treatment of metastases, but is poorly reimbursed under current funding arrangements.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
British Orthopaedic Association (2001) Metastatic bone disease: a guide to good practice. British Orthopaedic Association, London
Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res (442):223–229
Gainor BJ, Buchert P (1983) Fracture healing in metastatic bone disease. Clin Orthop Relat Res (178):297–302
Gerrand CH, Currie D, Grigoris P, Reid R, Hamblen DL (1999) Prosthetic reconstruction of the femur for primary bone sarcoma. Int Orthop 23(5):286–290
Grimer RJ, Carter SR, Pynsent PB (1997) The cost-effectiveness of limb salvage for bone tumours. J Bone Joint Surg 79-B(4):558–561
Heisel C, Kinkel S, Bernd L, Ewerbeck V (2006) Megaprostheses for the treatment of malignant bone tumours of the lower limbs. Int Orthop 30(6):452–457
Menendez LR, Ahlmann ER, Kermani C, Gotha H (2006) Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res (450):46–51
Ogilvie CM, Wunder JS, Ferguson PC, Griffin AM, Bell RS (2004) Functional outcome of endoprosthetic proximal femoral replacement. Clin Orthop Relat Res (426):44–48
Orlic D, Smerdelj M, Kolundzic R, Bergovec M (2006) Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment. Int Orthop 30(6):458–464
Park DH, Jaiswal PK, Al-Hakim W, Aston WJ, Pollock RC, Skinner JA, Cannon SR, Briggs TW (2007) The use of massive endoprostheses for the treatment of bone metastases. Sarcoma 2007:62151
Sarahrudi K, Hora K, Heinz T, Millington S, Vecsei V (2006) Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop 30(6):519–524
The Breast Speciality Group of the British Association of Surgical Oncology (1999) British Association of Surgical Oncology Guidelines: the management of metastatic bone disease in the United Kingdom. Eur J Surg Oncol 25(1):3–23
Author information
Authors and Affiliations
Corresponding author
Conflict of interest
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Ashford, R.U., Hanna, S.A., Park, D.H. et al. Proximal femoral replacements for metastatic bone disease: financial implications for sarcoma units. International Orthopaedics (SICOT) 34, 709–713 (2010). https://doi.org/10.1007/s00264-009-0838-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-009-0838-6