Recovery of ambulation in older adults undergoing fracture surgery for femoral metastasis: a multicenter retrospective cohort study.

Fracture surgery for metastatic femur is frequently performed in older adults. In contrast to impending fracture (IF), complete pathological fracture (CF) renders patients bedridden during the preoperative period, which might affect the postoperative recovery of ambulation. Thus, we aimed to investigate the clinical significance of the recovery in older adults after fracture surgery for femoral metastasis, and predictors for recovery after CF. This multicenter retrospective study enrolled 146 adults aged ≥55 years undergoing surgery. A total of 78.1% (114/146) patients showed recovery; no association was observed between the presence of postoperative weight-bearing restriction and recovery (p = 0.50). The rate of chemotherapeutic intervention was higher in patients who had recovered compared to the others (52/114 vs. 8/32, p = 0.03). Non-recovery of ambulation was an independent poor prognostic factor for one-year suvival (hazard ratio, 1.85; 95% confidence interval, 1.06-3.22; p < 0.01). Subgroup analyses showed shorter preoperative waiting periods in the recovered patients than in the others (5.6 ± 0.6 vs. 7.9 ± 1.1; p = 0.03) among CF cases. Recovery of ambulation was a prognostic factor and was associated with postoperative chemotherapy. Shorter preoperative waiting time was associated with the recovery in patients with CF. Prompt surgical intervention should be considered when older adults develop CF due to femoral metastasis.