Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail?

  title={Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail?},
  author={Rikard Wedin and Henrik C. F. Bauer},
  journal={The Journal of bone and joint surgery. British volume},
  volume={87 12},
  • R. WedinH. Bauer
  • Published 1 December 2005
  • Medicine
  • The Journal of bone and joint surgery. British volume
We report positive and negative factors associated with the most commonly-used methods of reconstruction after pathological fracture of the proximal femur. The study was based on 142 patients treated surgically for 146 metastatic lesions between 1996 and 2003. The local rate of failure was 10.3% (15 of 146). Of 37 operations involving osteosynthetic devices, six failed (16.2%) compared with nine (8.3%) in 109 operations involving endoprostheses. Of nine cases of prosthetic failure, four were… 

Tables from this paper

Implant survival and functional results of endoprosthetic reconstruction for proximal femoral metastases with pathological fractures

Endoprosthetic replacement can provide a durable fixation with high implant survival rate and good clinical and functional results in extensive proximal femoral metastases associated with a pathological fracture.

Complications After Surgical Management of Proximal Femoral Metastasis: A Retrospective Study of 417 Patients

Implant-specific complications and their timing should be considered in the choice of surgical strategy and analysis of secondary outcomes and risk factors for systemic complications could aid in surgical decision making.

Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients.

The data showed that intramedullary stabilization and endoprosthetic replacement to be safe, and equivalent alternatives to treat complete pathologic fractures of the femur in patients with advanced metastatic disease.

The use of a femoral revision stem in the treatment of primary or secondary bone tumours of the proximal femur: a prospective study of 31 cases.

The Wagner SL femoral revision stem offers an alternative to special tumour prostheses for the treatment of primary and secondary tumours of the proximal femur and the mid-term results are very promising, but long-term experience is necessary.

Endoprosthetic Treatment is More Durable for Pathologic Proximal Femur Fractures

Endoprosthetic reconstruction is associated with fewer treatment failures and greater implant durability, and Prospective studies are needed to determine the impact of operative strategy on function and quality of life.

Surgery for proximal femur metastases: endoprosthesis reconstruction or intramedullary nailing?

As the complication rates and functional outcome of patients with both implants are comparable, endoprosthetic reconstruction can be safely used to provide better durability even in patients with a shorter life span to obtain the best quality of life.

Surgical treatment of metastatic femoral fractures: achieving an improved quality of life for cancer patients.

FHP is indicated for metastases in the femoral head to neck region and IM nailing is best indicated when the lesion is located in the proximal to mid shaft and the patient's life expectancy is <6 month.

Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement.

EPR has the advantage of better functional outcomes and higher life quality in the long term, with lower complication rates in treating metastatic lesions of the proximal femur with pathological fractures.



Failures after operation for skeletal metastatic lesions of long bones.

This study was based on 192 patients treated surgically for 228 metastatic lesions of the long bones from 1986 through 1995 and concluded that endoprosthetic reconstructions are preferable to osteosynthetic devices.

Metastatic Disease of the Femur: Surgical Treatment

Modular oncology-type arthroplasty systems offered a viable salvage option in both groups and internal stabilization of impending pathologic fractures before the completion of the fracture seems to be reasonable and appropriate.

Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: A prospective randomized study of 100 hips

It is concluded that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands.

Intramedullary fixation of pathological fractures and lesions of the subtrochanteric region of the femur.

The Zickel intramedullary appliance was used without methylmethacrylate in forty-six patients to stabilize thirty-five fractures and eleven impending fractures associated with osseous lesions in the

Fracture healing in metastatic bone disease.

In 123 cancer patients with metastatic disease, 129 pathologic fractures of long bones were assessed to determine the rate of osseous union and no patient with a pathologic fracture secondary to lung carcinoma demonstrated bony repair, and none of these patients lived for more than six months after fracture.

Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases.

In 323 patients with 375 pathological fractures or impending fractures, local tumor resection and internal fixation supplemented by intramedullary methylmethacrylate proved highly successful, and 90% of the patients who were ambulatory before fracture regained the ability to walk.

Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic Fractures

  • H. Mirels
  • Medicine
    Clinical orthopaedics and related research
  • 1989
A weighted scoring system is proposed to quantify the risk of sustaining a pathologic fracture through a metastatic lesion in a long bone and it is suggested that all metastatic lesions in long bones be evaluated prior to irradiation.

The adjunctive use of methylmethacrylate in fixation of pathological fractures.

Methylmethacrylate was used adjunctively in the internal fixation of thirty-five pathological fractures and in sixteen patients in whom fractures were imminent and in twenty procedures associated with extensive destruction that would not have achieved satisfactory fixation.

Femoral fractures associated with total hip arthroplasty.

Methods of prevention of complications of intraoperative and postoperative fractures of the femur during total hip arthroplasty are highlighted but there still exists a risk of femoral fracture in many clinical settings.