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Review
. 2023 Jun;127(7):1196-1202.
doi: 10.1002/jso.27236. Epub 2023 Mar 16.

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Joseph K Kendal  1   2 , Christopher D Hamad  1 , Annalise G Abbott  2 , Danielle Greig  1 , Rishi Trikha  1 , Alexander B Christ  1 , Lauren E Wessel  1 , Shannon K T Puloski  2 , Michael J Monument  2 , Nicholas M Bernthal  1
Affiliations
Review

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Joseph K Kendal et al. J Surg Oncol. 2023 Jun.

Abstract

Background and objectives: Given advances in therapies, endoprosthetic reconstruction (EPR) in metastatic bone disease (MBD) may be increasingly indicated. The objectives were to review the indications, and implant and patient survivorship in patients undergoing EPR for MBD.

Methods: A review of patients undergoing EPR for extremity MBD between 1992 and 2022 at two centers was performed. Surgical data, implant survival, patient survival, and implant failure modes were examined.

Results: One hundred fifteen patients were included with a median follow-up of 14.9 months (95% confidence interval [CI]: 9.2-19.3) and survival of 19.4 months (95% CI: 13.6-26.1). The most common diagnosis was renal cell carcinoma (34/115, 29.6%) and the most common location was proximal femur (43/115, 37.4%). Indications included: actualized fracture (58/115, 50.4%), impending fracture (30/115, 26.1%), and failed fixation (27/115, 23.5%). Implant failure was uncommon (10/115, 8.7%). Patients undergoing EPR for failed fixation were more likely to have renal or lung cancer (p = 0.006).

Conclusions: EPRs were performed most frequently for renal cell carcinoma and in patients with a relatively favorable survival. EPR was indicated for failed previous fixation in 23.5% of cases, emphasizing the importance of predictive survival modeling. EPR can be a reliable and durable surgical option for patients with MBD.

Keywords: bone neoplasms; endoprostheses; metastasis; orthopedic surgery.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Nicholas M. Bernthal has or may receive payments or benefits from the National Institutes of Health. Nicholas M. Bernthal is also a consultant for Zimmer Biomet and Onkos. Shannon K. T. Puloski is a consultant for Depuy-Synthes and has received research funding for unrelated work. Alexander B. Christ is a consultant for Smith and Nephew and Onkos. Other authors decalre no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Endoprosthetic reconstruction after intramedullary nail implant failure performed for renal cell carcinoma. (A) Lytic subtrochanteric metastatic deposit was initially managed with debulking, cementation and intramedullary nail fixation (B). Eight months later the patient developed an intraprosthetic fracture (C) and ultimately underwent implant removal and proximal femoral replacement (D).
FIGURE 2
FIGURE 2
Kaplan–Meier survival estimates performed for (A) implant survival and (B) overall patient survival. Shaded areas represent a 95% confidence interval.
FIGURE 3
FIGURE 3
Primary tumor type distribution for those undergoing endoprosthetic reconstruction for the indication of failed previous surgical fixation and those undergoing primary endoprosthesis. “Other” tumor types summarized in Table 1.
FIGURE 4
FIGURE 4
PathFx v3.0 survival estimates at the time of surgical fixation for patients who ultimately required endoprosthetic reconstruction for failure of fixation. Of 12 patients, 4 had an estimated survival of ≥50% at 6 months, demarcated by the dashed line.
See this image and copyright information in PMC

References

    1. Johnson CN, Gurich RW Jr, Pavey GJ, Thompson MJ. Contemporary management of appendicular skeletal metastasis by primary tumor type. J Am Acad Orthop Surg. 2019;27(10):345–355. - PubMed
    1. Barton KI, Hazenbiller O, Freeman G, et al. Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals. Supp Care Cancer. 2021;29(2):1111–1119. - PubMed
    1. Wedin R, Bauer HCF. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br. 2005;87(12):1653–1657. - PubMed
    1. Scolaro JA, Lackman RD, Scolaro JA, Lackman RD. Surgical management of metastatic long bone fractures: principles and techniques. J Am Acad Orthop Surg. 2014;22(2):90–100. - PubMed
    1. Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR. Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res. 2012;470(3):684–691. - PMC - PubMed