Journal article
No consensus on implant choice for oligometastatic disease of the femoral head and neck
Journal of bone oncology, Vol.12, pp.14-18
09/2018
DOI: 10.1016/j.jbo.2018.02.006
PMCID: PMC5966516
PMID: 29850399
Abstract
Metastatic disease involving the femoral head and neck is often treated with a hemiarthroplasty or total hip arthroplasty (THA) to prevent pathologic fracture but there are no outcome studies demonstrating superiority of one option over the other.
This investigation was designed as a survey of the current members of the Musculoskeletal Tumor Society (MSTS). The survey contained seven clinical vignettes with identical imaging of a pathologic lesion of the femoral head and neck. The primary outcome measured was decision to treat the lesion with hemiarthroplasty or THA. Secondary outcomes included method of fixation of the femoral/acetabular components and head type utilized.
A total of 93 members (30.0%) of the MSTS completed the survey. Across all clinical vignettes, 73.3% (p < 0.001) of the responses were in favor of hemiarthroplasty; however, there was no significant difference between hemiarthroplasty and THA in Cases 1 & 2 (p = 0.08, p = 0.6, respectively); the cases representing younger patients with a more favorable histologic diagnosis. When THA was selected the majority of respondents preferred hybrid or cementless fixation construct (56.1% and 27.0%, respectively, p < 0.001). When hemiarthroplasty was selected respondents selected a cemented, bipolar construct (86.4% and 64.2%, respectively, p < 0.001).
When treating metastatic lesions of the femoral head and neck orthopaedic oncologists do not agree on reconstructing with THA versus hemiarthroplasty for patients with younger age and favorable histology. This investigation highlights the controversy of this clinical decision and indicates the need for a collaborative prospective trial among this specific patient population in order to determine the optimal treatment method.
•Hemiarthroplasty used in older patients with widely metastatic disease and poor histology.•No consensus between hemiarthroplasty and THA in younger patients with limited disease.•Cemented stems and bipolar heads are most commonly employed.•Arthroplasty fellowship/elective practice does not impact implant choice.•A multicenter RCT should address which implant has better outcomes.
Details
- Title: Subtitle
- No consensus on implant choice for oligometastatic disease of the femoral head and neck
- Creators
- Taylor J Reif - Loyola University Chicago, Department of Orthopaedic Surgery and Rehabilitation, 2160 South First Ave, Maywood, IL 60153-3328, USAPatrick K Strotman - Loyola University Chicago, Department of Orthopaedic Surgery and Rehabilitation, 2160 South First Ave, Maywood, IL 60153-3328, USAStephanie A Kliethermes - Loyola University Chicago, Department of Public Health Sciences, 2160 South First Ave, Maywood, IL 60153-3328, USABenjamin J Miller - University of Iowa Hospitals & Clinics, Department of Orthopedics and Rehabilitation, 200 Hawkins Drive, Iowa City, IA 52242, USALukas M Nystrom - Loyola University Chicago, Department of Orthopaedic Surgery and Rehabilitation, 2160 South First Ave, Maywood, IL 60153-3328, USA
- Resource Type
- Journal article
- Publication Details
- Journal of bone oncology, Vol.12, pp.14-18
- DOI
- 10.1016/j.jbo.2018.02.006
- PMID
- 29850399
- PMCID
- PMC5966516
- NLM abbreviation
- J Bone Oncol
- ISSN
- 2212-1374
- eISSN
- 2212-1374
- Publisher
- Elsevier GmbH
- Language
- English
- Date published
- 09/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984040438902771
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