title: Postoperative Ambulatory Performance Status Significantly Affects Implant Failure Rate Among Surgical Treatment Strategies in Patients With Proximal Femur Metastasis.
abstract: Surgical treatment strategies for proximal femur metastasis have been reported with mixed results. Little is known about risk factor for implant failure except for longer patient survival. Therefore, we determined whether implant survivorship differed among treatment strategies, as well as risk factors for implant failure. We retrospectively reviewed a consecutive 106 patients with proximal femur metastasis treated with prosthesis replacement (n = 38), intramedullary nail (n = 32), and dynamic hip screw (DHS) (n = 36). Eastern Cooperative Oncology Group (ECOG) scale and Karnofsky index were used to evaluate functional outcome. Patient characteristics and postoperative ambulatory performance status were assessed for their values in determining implant failure. Overall implant failure rate was 11.3% (12 of 106). Prosthesis replacement was related to better implant survivorship (P = 0.041), without mechanical failures. On the contrary, 7 of the 10 implant failures in the fixation group were considered mechanical failures. Better postoperative ambulatory status (ECOG ≤ 2) was a risk factor for implant failure (P = 0.03). Notably, for patients with poor ambulatory status (ECOG ≥ 3), implant survivorship was not different among choice of implants. In conclusion, prosthesis replacement would be a more durable option in the treatment of proximal femur metastasis. Postoperative ambulatory status could be an additional consideration. For patients with poor expected ambulatory performance status, fixation with intramedullary nail or DHS might be considered for a less technical demanding procedure.
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital.|Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei.|Division of Orthopaedic Oncology, Orthopaedic Department, Ditmanson Medical Foundation Chia-Yi Christian Hospital Chia-Yi City, Taiwan.
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Tsai
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital.|Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei.
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Wu
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital.|Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei.
authors.forename: Cheng-Fong
authors.initials: CF
authors.lastname: Chen
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital.|Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei.
authors.forename: Ming-Chau
authors.initials: MC
authors.lastname: Chang
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital.|Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D001859:Bone Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: -Implant failure; -Metastasis; -Peritrochanter; -Proximal femur; -Risk factor; Ambulation