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Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

  • Symposium: 2010 Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages.

Questions/purposes

We determined whether function, complications, and survivorship differed between the two approaches.

Methods

We retrospectively reviewed 158 patients with 159 proximal femur metastatic lesions treated with surgical stabilization. Forty-six were stabilized with IMN and 113 were treated with EPR. The minimum followup was 0.25 months (mean, 16 months; median, 17 months; range, 0.25–86 months).

Results

The mean Musculoskeletal Tumor Society score was 24 of 30 (80%) after IMN and 21 of 30 (70%) after EPR. There were 12 complications (26%) in the IMN group, including 10 nonunions, six of which went on to mechanical failure. There were complications in 20 of 113 (18%) of the EPR group, which consisted of 10 dislocations (9%) and 10 infections (9%). There were no mechanical failures with EPR. Both implants remained functional for the limited lifespan of these patients in each group at all time intervals. EPRs were associated with increased implant longevity compared with IMNs (100% versus 85% 5-year survival, respectively) and a decreased rate of mechanical failure (0% versus 11%, respectively) when compared with the intramedullary devices.

Conclusions

Patients with metastatic disease to the proximal femur may live for long periods of time, and these patients may undergo stabilization with either IMN or EPR with comparable functional scores and the implant survivorship exceeding patient survivorship at all time intervals. Endoprostheses demonstrate a lower mechanical failure rate and a higher rate of implant survivorship without mechanical failure than IMN devices.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Stacy R. Collen, PhD, for her statistical analysis of the data in this study.

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Authors and Affiliations

  1. Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA, USA

    Norah Harvey MD, Elke R. Ahlmann MD, Daniel C. Allison MD, MBA, Lingjun Wang PA & Lawrence R. Menendez MD, FACS

  2. Department of Orthopedics, Division of Musculoskeletal Oncology, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA

    Daniel C. Allison MD, MBA

  3. Department of Orthopedics, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA

    Lawrence R. Menendez MD, FACS

Authors
  1. Norah Harvey MD
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  2. Elke R. Ahlmann MD
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  3. Daniel C. Allison MD, MBA
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  4. Lingjun Wang PA
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  5. Lawrence R. Menendez MD, FACS
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Corresponding author

Correspondence to Daniel C. Allison MD, MBA.

Additional information

One author certifies that he (LRM) has or may receive payments or benefits, in any 1 year, an amount in excess of $10,000 from a commercial entity (Stryker Orthopaedics, Rutherford, NJ) related to this work.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and informed consent for participation in the study was obtained.

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Harvey, N., Ahlmann, E.R., Allison, D.C. et al. Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases. Clin Orthop Relat Res 470, 684–691 (2012). https://doi.org/10.1007/s11999-011-2038-0

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  • DOI: https://doi.org/10.1007/s11999-011-2038-0

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