Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey.
Tuzla State Hospital, Istanbul, Turkey.
Hip Int. 2022 Mar;32(2):174-184. doi: 10.1177/11207000211014813. Epub 2021 May 2.
This study aimed to evaluate the patient and implant survival, clinical and functional outcomes, and the rate of complications resulting in reconstruction failure following endoprosthetic reconstruction (EPR) of extensive proximal femoral metastases associated with actual or impending pathological fractures.
A total of 111 patients with actual or impending pathological fractures due to metastatic disease of the proximal femur were treated with EPR between 2003 and 2018. Staged surgery, bilateral EPR, was performed in 3 cases. The patients comprised 51 females and 60 males with a mean age of 52.1 ± 12.3 years. The patient and implant survival were recorded. Clinical and functional outcomes were assessed by using the visual analogue scale (VAS), Musculoskeletal Tumour Society (MSTS) functional scoring, and Karnofsky Performance Scale (KPS). The different types of abductor mechanism repair were evaluated by functional tests and existence of Trendelenburg gait at postoperative follow-ups. The complications resulting in reconstruction failure were investigated.
The mean follow-up was 23.1 ± 17.9 months. The overall survival of patients after EPR was 89% at 6 months, 72% at 1 year and 10% at 5 years. The estimated 1- and 5-year overall implant survival was 100% and 97.3% (95% CI, 0.95-0.98), respectively, as the endpoint was defined as complete removal of the prosthesis. Median VAS score before endoprosthetic replacement was 8 and after 3 months 4. Before surgery, the median MSTS score was 40 (30-56.6%) and the median KPS score was 40 (30-50). Postoperative third month, the median MSTS score was 56.6 (53.3-86.6%) and the median KPS score was 60 (40-70). Functional scores were superior in trochanter major split osteotomized group compared to trochanter major removed group. Trendelenburg gait was seen in 20 (17.5%) patients postoperatively. There were 10 (8.7%) complications resulting in reconstruction failure.
Endoprosthetic replacement can provide a durable fixation with high implant survival rate and good clinical and functional results in extensive proximal femoral metastases associated with a pathological fracture.
本研究旨在评估广泛累及股骨近端转移瘤伴实际或即将发生病理性骨折患者行人工假体重建（EPR）后的患者和假体生存率、临床和功能结果以及导致重建失败的并发症发生率。
2003 年至 2018 年间，111 例股骨近端转移瘤伴实际或即将发生病理性骨折的患者接受了 EPR 治疗。3 例患者接受了分期手术和双侧 EPR。患者包括 51 名女性和 60 名男性，平均年龄为 52.1±12.3 岁。记录患者和假体的生存率。采用视觉模拟评分（VAS）、肌肉骨骼肿瘤学会（MSTS）功能评分和卡诺夫斯基功能状态评分（KPS）评估临床和功能结果。通过术后随访时的功能试验和存在的 Trendelenburg 步态来评估不同类型的外展肌机制修复情况。研究了导致重建失败的并发症。
平均随访时间为 23.1±17.9 个月。EPR 后患者的总体生存率为术后 6 个月 89%、1 年 72%和 5 年 10%。预计 1 年和 5 年的总体假体生存率分别为 100%和 97.3%（95%CI：0.95-0.98），此时终点定义为假体完全取出。人工假体置换前的 VAS 评分中位数为 8，3 个月后为 4。术前 MSTS 评分中位数为 40（30-56.6%），KPS 评分中位数为 40（30-50）。术后 3 个月，MSTS 评分中位数为 56.6（53.3-86.6%），KPS 评分中位数为 60（40-70）。转子间大劈开组的功能评分优于转子间切除组。术后有 20 例（17.5%）患者出现 Trendelenburg 步态。有 10 例（8.7%）患者发生导致重建失败的并发症。
在广泛累及股骨近端伴病理性骨折的转移瘤患者中，人工假体置换可提供牢固的固定，具有较高的假体生存率和良好的临床及功能效果。
