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A Long Femoral Stem Is Not Always Required in Hip Arthroplasty for Patients With Proximal Femur Metastases

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

During hip arthroplasties for treating proximal femur metastases, a long femoral stem frequently is used, presumably protecting the entire femur against progression of the existing lesions or development of new lesions. However, it is unclear whether a long stem is really required.

Questions/purposes

We therefore determined in patients with proximal femur metastases (1) the reoperation rate related to different stem lengths after hip arthroplasty, (2) the risk of tumor progression in the same femur (the progression of preexisting lesions and the development of new distal femur lesions), and (3) complications.

Methods

We retrospectively reviewed 203 patients (206 femurs) with proximal femur metastases treated with hip arthroplasty. These femurs were divided into three groups based on femoral stem length: short stem (SS), 12 to 14 cm; medium stem (MS), 20 to 24 cm; and long stem (LS), 25 to 35 cm. We reviewed reoperations, disease progression in the same femur, and complications. Minimum followup was 2 days (median, 487 days; range, 2–4853 days), with most patients followed to their death.

Results

Only three femurs were revised owing to tumor progression, with no difference among the SS, MS, and LS groups. Two SS prostheses were revised for nononcologic reasons. Tumor progression in the same femur was uncommon during the patient’s survival, with 11 femurs showing progression of the proximal lesion and five femurs showing new distal lesions. The complication rate was higher in the LS group (28%) than the combined rate in the MS and SS groups (16%), especially acute cardiopulmonary complications (18% versus 7.5%).

Conclusions

Reoperation after hip arthroplasty for proximal femur metastases is uncommon and not correlated with femoral stem length. Considering the high complication rate associated with a LS hip prosthesis, we do not believe its routine use is justified.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of South Alabama College of Medicine, Mobile, AL, USA

    Zhiqing Xing MD, PhD

  2. Department of Orthopaedic Oncology, Unit 1448, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA

    Bryan S. Moon MD, Robert L. Satcher MD, PhD, Patrick P. Lin MD & Valerae O. Lewis MD

Authors
  1. Zhiqing Xing MD, PhD
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  2. Bryan S. Moon MD
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  3. Robert L. Satcher MD, PhD
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  4. Patrick P. Lin MD
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  5. Valerae O. Lewis MD
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Corresponding author

Correspondence to Valerae O. Lewis MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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Xing, Z., Moon, B.S., Satcher, R.L. et al. A Long Femoral Stem Is Not Always Required in Hip Arthroplasty for Patients With Proximal Femur Metastases. Clin Orthop Relat Res 471, 1622–1627 (2013). https://doi.org/10.1007/s11999-013-2790-4

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  • DOI: https://doi.org/10.1007/s11999-013-2790-4

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