Advances and challenges in the surgical treatment of metastatic bone disease

There are numerous challenges facing the orthopaedic surgeon who treats metastatic bone disease in the twenty-first century. The orthopaedic surgeon must be familiar with the indications for surgical intervention, the available implants for fixation of a given anatomic lesion, the appropriateness of fixation versus resection and replacement, and the viability of newer, less invasive treatment options for a given lesion. Determination of the best surgical candidates still is controversial, especially in the arena of prophylactic treatment. Recent advances have made fixation with intramedullary devices and standard plates simpler and more rigid. The advent and improvement of megaprostheses has made complex joint reconstructions more durable. Advances in interventional radiology such as radiofrequency ablation and percutaneous vertebroplasty and acetabuloplasty with polymethylmethacrylate (PMMA) continue to be promising options for future treatment. Better methods are necessary to evaluate the status of the patients preoperatively and postoperatively, to classify functional improvement after surgical treatment, and to determine the impact of treatment on the quality of life.