Abstract
Purpose. We report a series of 58 patients with metastatic bone disease treated with resection and endoprosthetic reconstruction over a five-year period at our institution. Introduction. The recent advances in adjuvant and neoadjuvant therapy in cancer treatment have resulted in improved prognosis of patients with bone metastases. Most patients who have either an actual or impending pathological fracture should have operative stabilisation or reconstruction. Endoprosthetic reconstructions are indicated in patients with extensive bone loss, failed conventional reconstructions, and selected isolated metastases. Methods and Results. We identified all patients who were diagnosed with metastatic disease to bone between 1999 and 2003. One hundred and seventy-one patients were diagnosed with bone metastases. Metastatic breast and renal cancer accounted for 84 lesions (49%). Fifty-eight patients with isolated bone metastasis to the appendicular skeleton had an endoprosthetic reconstruction. There were 28 males and 30 females. Twelve patients had an endoprosthesis in the upper extremity and 46 patients had an endoprosthesis in the lower extremity. The mean age at presentation was 62 years (24 to 88). At the time of writing, 19 patients are still alive, 34 patients have died, and 5 have been lost to follow up. Patients were followed up and evaluated using the musculoskeletal society tumour score (MSTS) and the Toronto extremity salvage score (TESS). The mean MSTS was 73% (57% to 90%) and TESS was 71% (46% to 95%). Mean follow-up was 48.2 months (range 27 to 82 months) and patients died of disease at a mean of 22 months (2 to 51 months) from surgery. Complications included 5 superficial wound infections, 1 aseptic loosening, 4 dislocations, 1 subluxation, and 1 case, where the tibial component of a prosthesis rotated requiring open repositioning. Conclusions. We conclude that endoprosthetic replacement for the treatment of isolated bone metastases is a reliable method of limb reconstruction in selected cases. It is associated with low complication and failure rates in our series, and achieves the aims of restoring function, allowing early weight bearing and alleviating pain.
Highlights
Bony metastases are the most common neoplasms of bone and the skeleton is the third most common site for metastatic diseases, after the lung and liver [1]
Endoprosthetic reconstruction has a role in the management of metastatic lesions with extensive bone loss, failure of conventional reconstruction, and large isolated lesions with the aim being curative
The majority of the endoprosthetic reconstructions in our series were proximal femoral replacements, a finding reflected in other series of endoprosthetic replacements for bone metastases [5, 12], with the proximal femur being the most common site of long-bone involvement by metastatic disease [8, 17, 18]
Summary
Bony metastases are the most common neoplasms of bone and the skeleton is the third most common site for metastatic diseases, after the lung and liver [1]. Advances in adjuvant and neoadjuvant therapies, especially in the fields of hormonal therapy and chemotherapy, have improved the prognosis of patients with cancer. This has subsequently led to an increase in the incidence of bony metastases and resultant pathological fractures of the long bones. The management of the patient with a pathological fracture presents a challenge to the orthopaedic surgeon and necessitates a multidisciplinary approach. Stabilising impending of actual pathological fractures allows early resumption of ambulation, which significantly improves patients’ quality of life [7].
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