title: Complications After Surgical Management of Proximal Femoral Metastasis: A Retrospective Study of 417 Patients.
abstract: BACKGROUND
  Proximal femoral fractures resulting from metastatic disease often require surgical management. Few studies have compared surgical techniques, and physicians' preferred strategies vary. This study compared revision and complication rates among surgical strategies.
  
  
  METHODS
  The study consisted of a retrospective review of electronic medical records of 417 consecutive patients with proximal femoral metastasis or multiple myeloma who underwent intramedullary nailing (n = 302), endoprosthetic reconstruction (n = 70), and open reduction and internal fixation (n = 45) between 1999 and 2014 at two orthopaedic oncology centers. Primary outcome measures were revisions and 30-day systemic complications. Secondary outcome measures were total estimated blood loss, anesthesia time, duration of hospital admission, and 30-day survival.
  
  
  RESULTS
  Revision rates did not differ between strategies (5.3% after intramedullary nailing, 11% after endoprosthetic reconstruction, and 13% after open reduction and internal fixation; P = 0.134). When reasons for revision were assessed separately, fixation failure was most common after open reduction and internal fixation (13% versus 3.0% after intramedullary nailing and none after endoprosthetic reconstruction; P < 0.001), whereas deep infection was most common after endoprosthetic reconstruction (8.6% versus 2.0% after intramedullary nailing and none after open reduction and internal fixation; P = 0.010). Overall systemic complication rates did not differ between strategies (8.3% after intramedullary nailing, 14% after endoprosthetic reconstruction, and 11% after open reduction and internal fixation; P = 0.268).
  
  
  CONCLUSIONS
  Implant-specific complications and their timing should be considered in the choice of surgical strategy. Analysis of secondary outcomes and risk factors for systemic complications could aid in surgical decision making.
  
  
  METHODS
  Therapeutic Level III.
authors.affiliation: From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.forename: Joost T P
authors.initials: JT
authors.lastname: Kortlever
authors.forename: John E
authors.initials: JE
authors.lastname: Ready
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Raskin
authors.forename: Marco L
authors.initials: ML
authors.lastname: Ferrone
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Hornicek
authors.forename: Santiago A
authors.initials: SA
authors.lastname: Lozano-Calderon
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Schwab
mesh_terms: D000368:Aged; D001186:Artificial Limbs / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005266:Femoral Neoplasms / Q000556:secondary / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome