Survival and ambulatory function after endoprosthetic replacement for metastatic bone tumor of the proximal femur

The purpose of this study was to clarify the ambulatory functional and oncological outcomes of tumor excision and endoprosthetic reconstruction for a metastatic lesion of the proximal femur. Subjects comprised 40 patients (18 women, 22 men; average age 63.4 years). The mean follow-up periods were 15.2 months for patients dying of the disease, and 38.7 months for survivors. Seven patients were lost to follow-up for 1.9 to 13.1 months. Endoprosthesis was performed after intralesional aggressive curettage in 20 patients and following excision of the lesion with a clear margin, in another 20. Postoperative radiation therapy was carried out on 27 limbs (intralesional 13, marginal 6, wide 8). Chemotherapy was administered to 19 patients after discussion with the medical oncologist. The cumulative survival rates at 6 and 12 months were 60% and 35%, respectively, while the rates with ambulant status were 48% at 6 months and 34% at 12 months. An analgesic effect was achieved for all patients. Ambulatory function was restored in 34 patients with a mean ambulant period of 17.8 months; however, the other 6 patients remained non-ambulatory. The ambulant period expressed as a percentage of survival time averaged 75.9%. Though there was local recurrence in 4 of 40 patients, ambulant function was not affected. Postoperative ambulatory function was inferior in patients with a short life expectancy; those with moderate or long life expectancy are good candidates for endoprosthetic replacement after tumor excision and can regain ambulant function for as long as nearly 80% of the survival period.