Percutaneous Long Bone Cementoplasty for Palliation of Malignant Lesions of the Limbs: A Systematic Review

Abstract

Purpose: Percutaneous cementoplasty (PC) is rarely applied to long bone tumours, since cement is not considered to be sufficiently resistant to torsional forces. We reviewed the literature to understand the effects of percutaneous long bone cementoplasty (PLBC) in terms of analgesia, limb function and complications.

Materials and methods: This study followed the Cochrane's guidelines for systematic reviews of interventions. Inclusion criteria were (1) prospective/retrospective studies concerning PC; (2) cohort including at least ten patients; (3) at least one patient in the cohort undergoing PLBC; (5) published in English; (6) results not published by the same author more than once.

Results: One thousand five hundred and ninety-eight articles were screened and 13 matched the inclusion criteria covering 196 PLBC patients. Pain improvement was high in 68.2% patients (σ = 0.2) and mild in 27.4% (σ = 0.2). Functional improvement was high in 71.9% patients (σ = 0.1) and mild in 6% (σ = 0.1). Use of PLBC correlated with pain reduction (P < 0.001). Secondary fractures occurred in 16 cases (8%, σ = 2.5); other complications in 2% cases. Percutaneous stabilisation (PS) was coupled with PLBC in 17% of cases without any subsequent fracture. PS was not associated with absence of secondary fracture (P = 0.08).

Conclusion: PLBC is safe, offering good pain relief and recovery of impaired limb function. Secondary fractures are uncommon and PS may reduce their occurrence. However, no evidence is currently available to support PS plus PLBC as compared to PLBC alone.

Keywords: Long bone; Pathological fracture; Percutaneous cementoplasty.