Patient and implant survival following joint replacement because of metastatic bone disease

Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint replacement as the treatment for bone metastasis or hematological diseases of the extremities.

130 patients (mean age 64 (30-85) years, 76 females) received 140 joint replacements due to skeletal metastases (n = 114) or hematological disease (n = 16) during the period 2003-2008. 21 replaced joints were located in the upper extremities and 119 in the lower extremities. Clinical and survival data were extracted from patient files and various registers.

The probability of patient survival was 51% (95% CI: 42-59) after 6 months, 39% (CI: 31-48) after 12 months, and 29% (CI: 21-37) after 24 months. The following surgical complications were seen (8 of which led to additional surgery): 2-5 hip dislocations (n = 8), deep infection (n = 3), peroneal palsy (n = 2), a shoulder prosthesis penetrating the skin (n = 1), and disassembly of an elbow prosthesis (n = 1). The probability of avoiding all kinds of surgery related to the implanted prosthesis was 94% (CI: 89-99) after 1 year and 92% (CI: 85-98) after 2 years.

Joint replacement operations because of metastatic bone disease do not appear to have given a poorer rate of patient survival than other types of surgical treatment, and the reoperation rate was low.