gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2022)

25. - 28.10.2022, Berlin

Proximal femur replacement in metastatic bone disease: Is previous surgical intervention associated with higher revision rates and increased risk of infection?

Meeting Abstract

  • presenting/speaker Thomas Haider - Royal Orthopaedic Hospital Birmingham, Birmingham, United Kingdom
  • Raja Bhaskara Rajasekaran - Royal Orthopaedic Hospital Birmingham, Birmingham, United Kingdom
  • Scott Evans - Royal Orthopaedic Hospital Birmingham, Birmingham, United Kingdom
  • Jonathan Stevenson - Royal Orthopaedic Hospital Birmingham, Birmingham, United Kingdom

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB25-845

doi: 10.3205/22dkou133, urn:nbn:de:0183-22dkou1334

Published: October 25, 2022

© 2022 Haider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Proximal femur replacement (PFR) is done routinely in cases of metastatic bone disease (MBD) as a primary procedure or as a salvage procedure following a failed surgical intervention. This study aimed to analyse if salvage PFR following failed previous osteosynthesis were associated with increased risks of revision and/or infection compared to primary PFR for MBD.

Methods: Retrospective analysis of 143 patients with a mean age of 60 (±13) years who underwent PFR for MBD was performed. Of these, 122 patients (85%) underwent PFR as the primary procedure, and 22 patients (15%) after a failed previous surgical intervention. Breast carcinoma (40%) was the most common primary malignancy, followed by renal carcinoma (20%). In patients who had a previous intervention, progression of disease (45%), metal failure (32%), and non-union (23%) were the causes for conversion to PFR.

Results and conclusion: Overall mortality was 76% at a mean follow-up of 51.2 months with a mean survival of 4.3 (±4.0) years. In patients who had a previous intervention, the median time to failure was 13.5 months (range 4 to 168 months). The overall revision rate was 5.6%. Kaplan-Meier analysis revealed that PFR without previous intervention was associated with a significantly higher revision-free survival (95% vs. 74% at 3 years, p<0.01). Previous surgical intervention resulted in a significantly increased risk of infection (2% vs. 18% p<0.01).

This study revealed significantly higher rates of infection and lower revision-free survival in patients with metastatic disease who underwent PFR following failed previous surgical intervention. In patients estimated survival of greater than 12 months, PFR should be considered primarily. All patients should undergo routine post-operative follow-up for disease progression, metal failure and non-union until death.