Risk of complications and implant survival of surgical treatment of proximal femoral metastasis: a meta-analysis

Konstantina Solou; Monica Cosentino; Ahmed Atherley O'Meally; Ayano Aso; Hisaki Aiba; Davide Maria Donati; Barbara Bordini; Costantino Errani

doi:10.1007/s00590-024-03930-w

Risk of complications and implant survival of surgical treatment of proximal femoral metastasis: a meta-analysis

Eur J Orthop Surg Traumatol. 2024 Apr 5. doi: 10.1007/s00590-024-03930-w. Online ahead of print.

Authors

Konstantina Solou^{1

2}, Monica Cosentino³, Ahmed Atherley O'Meally^{1

4}, Ayano Aso^{1

5}, Hisaki Aiba^{1

6}, Davide Maria Donati¹, Barbara Bordini³, Costantino Errani⁷

Affiliations

¹ Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy.
² University of Patras, Patras, Greece.
³ Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
⁴ Department of Orthopaedic Surgery, Complejo Hospitalario Metropolitano CSS, Panama, Panama.
⁵ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁶ Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan.
⁷ Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy. costantino.errani@ior.it.

PMID: 38578441
DOI: 10.1007/s00590-024-03930-w

Abstract

Purpose: The patients with femoral metastasis in the inter- or subtrochanteric area could be treated with intramedullary nailing or prosthetic reconstruction, however, it is controversial which surgical treatment could offer less complications and implant failure. Our purpose was to define the risk of complications and implant survival in patients treated with intramedullary nailing or prosthetic reconstruction.

Methods: We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients treated with intramedullary nailing, hemiarthroplasty, arthroplasty or megaprosthesis.

Results: We analyzed 27 studies (1346 patients) reporting patients treated with intramedullary nail (51%), hemiarthroplasty (15%), arthroplasty (2%), megaprosthesis with (25%) or without (7%) acetabular component. No difference was found in the overall risk of complications between patients treated with intramedullary nailing 6%, hemiarthroplasty or total hip arthroplasty 7% and megaprosthesis 11% (p = 0.23). However, patients treated with megaprosthesis had increased risk of reoperation due to infection (70%), compared to the patients treated with intramedullary nail (13%), and patients treated with hemiarthroplasty or total hip arthroplasty (23%) (p = 0.02). Revision due to disease progression was required in 61% of the patients treated with intramedullary nail, but not in patients treated with hemiarthroplasty, total arthroplasty, and megaprosthesis (p = 0.03).

Conclusion: Patients treated with megaprosthesis had higher risk of reoperation due to infection, while patients treated with intramedullary nailing had higher risk of revision due to disease progression. Regarding patients treated with megaprosthesis, the risk of reoperation due to dislocation was higher in those treated with acetabular component.

Keywords: Complication; Intramedullary nailing; Prosthetic replacement; Proximal femoral metastasis; Revision; Surgical treatment.

Publication types

Review