UNCEMENTED ARTHROPLASTY AFTER HIP METASTATIC DISEASE AND MULTIPLE MYELOMA.

André Mathias Baptista,Daniel César Seguel Rebolledo,Luiz Filipe Marques Correia,Sergio Pinheiro De Souza Meirelles,Olavo Pires De Camargo

doi:10.1590/1413-785220162404158362

André Mathias Baptista, Daniel César Seguel Rebolledo + Show 3 more

Open Access

https://doi.org/10.1590/1413-785220162404158362

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Abstract

ABSTRACTObjective: To describe a case series using a combination of narrative, graphical exploratory analysis and Bayesian Network modeling. Methods: Case series with 34 patients undergoing uncemented and hybrid arthroplasty procedures secondary to hip pain or fracture secondary to metastatic disease or multiple myeloma. Results:The most common tumors included gastrointestinal, multiple myeloma and breast cancer. Most devices were total arthroplasty (n = 16, 84.2%) rather than partial and uncemented arthroplasty (n = 12, 63.2%) rather than hybrid. The average time between surgery and deambulation was 20 days, the average length of hospital stay was 13 days, and the average patient survival was 589 days. Only one infection was reported. Uncemented and hybrid arthroplasty devices did not differ regarding time to walk, as well as the length of hospital stay in this sample. Conclusion: Our model may be used as a prior for the addition of subsequent patient samples, personalizing, thus, its recommendations to other patient populations. Level of Evidence IV, Case series.

Highlights

The increased survival of patients with bone metastatic disease or multiple myeloma has led to a subsequent increase in the incidence of imminent and pathologic fractures of the proximal femur in this population.[1]
To report the development of a Bayesian Network model to compare uncemented vs hybrid hip arthroplasty devices regarding time until the first walk and length of hospital stay
Uncemented 0.2094290 0.1827573 0.2340346 0.3737791. This is the first comprehensive case report, graphical exploratory analysis and causal modeling related to the use of uncemented arthroplasty for metastatic disease and multiple myeloma of the hip

Summary

Introduction

The increased survival of patients with bone metastatic disease or multiple myeloma has led to a subsequent increase in the incidence of imminent and pathologic fractures of the proximal femur in this population.[1] As a consequence, prophylactic and therapeutic orthopedic procedures are performed more frequently.[2] Currently, cemented hip arthroplasty is considered the treatment of choice for such fractures.[3] such procedures are associated with an increased rate of adverse events,[4,5] specially given the common occurrence of comorbid conditions.[6] In face of this high rate of complications, it would be plausible to consider the use of uncemented arthroplasty but, to our knowledge, there is no adequate evaluation of whether it would be a viable alternative. To report a case series of uncemented arthroplasty cases for hip pain and fracture after metastatic disease and multiple myeloma, performed at Instituto do Cancer do Estado de São Paulo (ICESP) between 2010 and 2014. To report the development of a Bayesian Network model to compare uncemented vs hybrid hip arthroplasty devices regarding time until the first walk and length of hospital stay.

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Conclusion