title: Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region.
abstract: OBJECTIVE
  In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur.
  
  
  METHODS
  Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22-85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1-27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS).
  
  
  RESULTS
  No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0-10) to 2.3 ± 2.4 (range 0-7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded.
  
  
  CONCLUSIONS
  RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery.
  
  
  CONCLUSIONS
  • Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty. • RC provides effective bone stability and pain relief. • RC is a suitable minimally invasive option for patients in poor general condition.
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Kévin
authors.initials: K
authors.lastname: Premat
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.|Paris VI University Pierre et Marie Curie, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
authors.affiliation: Department of Orthopaedic Surgery, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Bonaccorsi
authors.affiliation: Paris VI University Pierre et Marie Curie, Paris, France.|Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Degos
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Évelyne
authors.initials: É
authors.lastname: Cormier
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. jacques.chiras@aphp.fr.|Paris VI University Pierre et Marie Curie, Paris, France. jacques.chiras@aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D060826:Cementoplasty / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000628:therapy; D005266:Femoral Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Femoral neck; Metastasis; Osteosynthesis; Percutaneous; Reinforced cementoplasty