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

Abstract

Background: 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.

Patients and methods: 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.

Results: 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.

Conclusion: 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.

Figure 1.

Upper panels. A patient suffering from breast cancer and left hip pain because of multiple osteolytic metastases of the left hip and acetabular region (left panel); postoperatively, after resection of the proximal femur and insertion of a total hip replacement using an MP reconstruction hip stem (middle panel) and status 4 years later (right panel). Lower panels. A patient with previous cancer of the bladder, suffering from knee pain because of a solitary metastasis of the medial femoral condyle (left panel); status 4 months postoperatively after resection of the distal femur and reconstruction with a GMRS prosthesis (middle and right panels).

Figure 2.

Cumulative survival rate (solid line) and 95% confidence interval (dotted lines) for 130 patients who had 1 or more joint replacements because of metastatic bone disease during the period 2003–2008.

Figure 3.

Cumulative survival rate (solid line) and 95% confidence limits (dotted line) for all 140 joint replacements inserted because of metastatic bone disease during the period 2003–2008. The probability of survival was calculated with either all kinds of surgery of the affected joint (left panel) or removal of at least 1 prosthetic component anchored to bone (right panel) as endpoint in the Kaplan-Meier analysis.