Application of Endoprosthetic Replacement in Old Patients with Isolated Proximal Femoral Bone Metastases.

Abstract

Due to radical resection, endoprosthetic reconstruction (EPR) is more invasive and increases the risk of dislocation. Therefore, the suitability of EPR for elderly patients with metastatic tumor needs further investigation. Seventy-one adult patients with isolated proximal femoral bone metastases who underwent EPR were retrospectively analyzed and stratified into two groups: elderly age group (≥60years, n=31) and younger age group (<60 years, n=40). The effect of age on prognosis was analyzed to determine whether EPR is beneficial in elderly patients with proximal femoral metastatic tumor. Cox regression modeling was used to evaluate the effect of different factors on postoperative survival outcomes. Ten (32.26%) and 9 (22.50%) cases of perioperative complications were recorded in the elderly and younger age groups, respectively, with median survival times of 22.00±4.61 months and 23.00±2.85 months, respectively; a log-rank test showed that the difference was not statistically significant (p=0.657). A Cox regression model was established with patient age as the covariable to evaluate whether it affected postoperative survival. The risk of death due to age was not significant (p=0.649), but malignancy and femoral metastasis type were significantly associated with postoperative survival (p=0.001 and p=0.019). Although older patients have a slightly higher incidence of postoperative complications than younger patients, they do not experience severe adverse consequences. With rigorous selection and careful preparation, EPR is appropriate for the treatment of proximal femoral metastases in older patients, including those with Harrington type I-II acetabular invasion.