title: Modular megaprosthesis in metastatic bone disease of the femur.
abstract: The treatment of bone metastases is frequently palliative, aiming to achieve satisfactory pain control and to prevent or treat pathological fractures. For lesions involving the femur, internal fixation frequently fails; therefore, prosthetic reconstruction may be the optimal choice for treatment. This article retrospectively reviews our experience with femoral bone metastases between 1999 and 2008. A series of 22 patients (14 men and 8 women; mean age, 61.8 years) with femoral bone metastases were treated with resection and modular megaprosthetic reconstruction. Bipolar hip prostheses were used in 19 patients, intercalary prostheses were used in 2 patients, and total knee replacement was used in 1 patient. Oncologic outcome was evaluated, and functional outcomes were obtained by the Musculoskeletal Tumor Society (MSTS) score, which assigns numerical values (0-5) for each of 5 parameters, excluding emotional status. A numerical score (maximum 25 points) and percent rating was calculated. Six-month survival was 86.4%, 1-year survival was 54.2%, and 2-year survival was 37.1%. Three patients were unable to ambulate due to acute paraplegia with spinal metastases at the perioperative period. Excluding these 3 patients, average MSTS score was 62.3%. The MSTS score in patients surviving >12 months was 70.8% compared with a score of 46.4% in those living <12 months (P<.05). Complications included 2 dislocations. Megaprosthetic reconstruction provides for optimal treatment of femoral metastatic disease in patients with a prognosis of >12 months with satisfactory functional outcomes based on lower complications.
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Tokyo 160-0023, Japan. hiroyuki.hattori@jcom.home.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hattori
authors.forename: Junya
authors.initials: J
authors.lastname: Mibe
authors.forename: Kengo
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001186:Artificial Limbs; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate; D016138:Walking