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. 2022 Sep 13;22(Suppl 2):1069.
doi: 10.1186/s12891-022-05728-5.

Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study

Raffaele Vitiello  1   2 , Carlo Perisano  3 , Tommaso Greco  3   4 , Luigi Cianni  3   4 , Chiara Polichetti  3   4 , Rocco Maria Comodo  4 , Ivan De Martino  3 , Vincenzo La Vergata  3 , Giulio Maccauro  3   4
Affiliations

Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study

Raffaele Vitiello et al. BMC Musculoskelet Disord. .

Abstract

Background: Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis.

Methods: We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1-6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05.

Result: Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis.

Conclusion: Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.

Keywords: Megaprosthesis; Metastasis; NLR; Nailing; PLR; Proximal femur; Trochanteric.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

Fig. 1
Fig. 1
VAS Score. VAS score trend at the various follow-ups. Blue line for IN group, red line for HM group
Fig. 2
Fig. 2
MSTS Score. MSTS score trend at the various follow-ups. Blue line for IN group, red line for HM group
See this image and copyright information in PMC

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