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Surgery for femoral metastases
Atsushi Tanaka1, Hirohisa Katagiri2, Hideki Murata2
1Division of Orthopaedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan; Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
The Bone & Joint Journal
|March 3, 2020
Summary
For femoral metastases, endoprosthetic replacement (EPR) offers better survival and local control than internal fixation (IF) in patients with good expected survival. Internal fixation is suitable for those with shorter survival expectations.
Area of Science:
- Orthopedic Oncology
- Surgical Oncology
- Musculoskeletal Metastases
Background:
- Femoral metastases present complex treatment challenges.
- Surgical intervention aims to improve quality of life and prognosis.
- Patient survival and risk stratification are crucial for treatment selection.
Purpose of the Study:
- To evaluate clinical outcomes of surgical interventions for femoral metastases.
- To assess the impact of patient prognosis on surgical strategy selection.
- To compare different operative approaches based on risk assessment.
Main Methods:
- 148 patients with femoral metastases were analyzed (2002-2017).
- Prognostic risk was assessed using Katagiri and revised Katagiri scoring systems.
- Surgical strategies included endoprosthetic replacement (EPR) and internal fixation (IF) based on risk stratification.
Main Results:
- Endoprosthetic replacement (EPR) showed significantly higher one-year survival (71% vs. 15%) and local failure-free survival (93% vs. 67% at one year) compared to internal fixation (IF).
- Ambulatory rates were higher with EPR (99% vs. 60%), though time to ambulation was shorter with IF.
- Systemic complication rates were similar between EPR and IF groups.
Conclusions:
- Endoprosthetic replacement (EPR) provides favorable long-term results for patients with good expected survival from femoral metastases.
- Internal fixation (IF) is a less invasive option with a shorter treatment period, suitable for patients with limited survival prognosis.
- Prognostic assessment is a key factor in selecting the optimal surgical procedure for femoral metastases.
Keywords:
Bone metastasisEndoprosthetic replacementFemoral metastasisInternal fixationPrognosisSurgical procedure
