Abstract
Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (P-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; P-value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; P-value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.
Highlights
Corticosteroids have been commonly used in patients with brain tumors to control peritumoral edema and neurological symptoms [1,2,3]
After removal of the tumor, additional radiotherapy was performed in nine patients (34%), gamma knife surgery was done in four (15%), and chemotherapy was conducted in three patients (12%)
It should be noted that more postoperative delirium, longer hospital stay, and lower functional outcomes were identified in the patients with brain tumors
Summary
Corticosteroids have been commonly used in patients with brain tumors to control peritumoral edema and neurological symptoms [1,2,3]. The optimal dose of dexamethasone in the perioperative period of neurosurgery is 10–32 mg/day, which is considerably higher than the usual therapeutic dose [5]. Surgical resection of sellar lesions (e.g., pituitary adenoma and craniopharyngioma) frequently results in dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis, which necessitates long-term steroid replacement [6,7,8]. A serious corticosteroid-induced complication in the musculoskeletal system is osteonecrosis of the femoral head (ONFH). A large necrotic lesion frequently causes severe hip pain, which significantly impairs the quality of life. Total hip arthroplasty (THA) has become the most successful surgical option for treating painful ONFH, a proportion of early failure in THA is inevitable [9,10]. The three leading causes of reoperation in contemporary THA are recurrent dislocation, periprosthetic joint infection (PJI), and periprosthetic femoral fracture (PFF), all of which are still challenging situations
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