Proximal femoral replacements for metastatic bone disease: financial implications for sarcoma units.
Metastatic pathological fractures of the proximal femur are increasingly treated by endoprosthetic proximal femoral replacement. We report the results and the costs incurred performing these procedures at our supra-regional sarcoma unit. Sixty-two patients underwent 63 proximal femoral replacements for metastatic bone disease over a seven-year period. Breast cancer was the most common primary pathology. One patient underwent a revision procedure for infection. Twenty-two patients suffered dislocations, most commonly those undergoing a conventional arthroplasty articulation. The estimated cost of a proximal femoral replacement is 18,002 pounds at our centre. Less than half of this is reimbursed under Payment by Results. Endoprosthetic replacement of the proximal femur is an effective treatment of metastases, but is poorly reimbursed under current funding arrangements.
Ashford
Robert U
RU
East Midlands Sarcoma Service, Department of Orthopaedics, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. Robert.ashford@sky.com
Hanna
Sammy A
SA
Park
Derek H
DH
Pollock
Rob C
RC
Skinner
John A
JA
Briggs
Timothy W R
TW
Cannon
Stephen R
SR
D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005266:Femoral Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000209:etiology / Q000473:pathology / Q000601:surgery; D017048:Health Care Costs; D006622:Hip Prosthesis / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D012509:Sarcoma / Q000150:complications / Q000556:secondary / Q000601:surgery*