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Proximal Femoral Replacement or Revision Stem Hemiarthroplasty for Metastatic Disease of the Proximal Femur-Is There
Jan Lesensky1, Ondrej Blecha, Josef Vcelak
1From the Department of Orthopaedics, First Medical Faculty, Charles University, University Hospital Na Bulovce, Prague, Czech Republic (Dr. Lesensky, Dr. Blecha, and Dr. Vcelak) and the Orthopaedic Surgery Department, University of Missouri, Columbia, MO (Dr. Belzarena).
Background:
The incidence of metastatic cancer continues to increase, becoming a prevalent condition in oncology orthopaedic practice. The proximal femur is the third most common site of skeletal metastases. Two possible options for endoprosthetic reconstruction of proximal femur metastasis include proximal femur resection and replacement with megaprosthesis and hemiarthroplasty with a long-cemented revision stem.
Methods:
To facilitate better decision making, we conducted a retrospective study comparing these alternatives. This is a single-institution, retrospective, observational study. Patients with metastatic disease of proximal femur who had a reconstruction with either a proximal femoral replacement (group A, 27 patients) or reconstruction using a hemiarthroplasty with long revision cemented stem (group B, 31 patients) were included for analysis.
Results:
Group A was associated with higher estimated blood loss than group B (1027.8 vs. 491.9 mL, P = 0.007). Group A was associated with higher surgical time (148.9 vs. 116.6 minutes, P = 0.04). More patients were associated with intense care unit transfer in group A (P = 0.04). Group B was associated with a shorter average time to full weight-bearing (6.2 vs. 11.5 weeks, P = 0.03). Group B was associated with shorter time to discharge (9.4 vs. 17.0 days, P = 0.04). Group A was associated with more postoperative complications (n = 5, 18.5% vs. n = 0, 0%), (P = 0.02).
Conclusion:
In patients with metastatic disease of the proximal femur, reconstruction with a long revision stem hemiarthroplasty was associated with better performance regarding surgical outcomes (estimated blood loss, surgical time, transfer to intensive care unit vs. regular floor). Furthermore, patients with hemiarthroplasties presented an association with shorter rehabilitation time and less complications.
