Patients with skeletal metastases may be considered for prophylactic surgical intervention to prevent impending fracture. Few studies have examined the long term outcomes from these procedures. To assess these, we have examined the orthopedic and oncological outcomes in patients with acetabular or femoral metastasis who underwent prophylactic surgical intervention.
Patients with femoral or acetabular metastases who had undergone prophylactic orthopaedic interventions were identified via surgical records from May 2015 to March 2017. Data was extracted on baseline characteristics, including age at procedure, primary tumour, type of operation, performance status, Mirels score and pre-procedure symptoms. Outcomes included time to independent ambulation, orthopaedic events, post-operative complications and post-operative survival.
Fourteen prophylactic femoral procedures were performed in 12 patients for peritrochanteric or acetabular metastases. This included 7 intramedullary nails, 5 total hip arthroplasties and 2 hemiarthroplasties. The most common primary tumour was breast, followed by lung. Median age at time of procedure was 60.5 (range 53-88). Performance status ranged from 1 – 2 (8 and 3 patients, respectively). Median Mirels score was 9 (range 9-12).
Eight patients were deceased at the time of data extraction. Median overall survival was 9.2 months (range 1.1-14.7). Four patients died within 3 months of procedure. Median time to independent ambulation was 4 days (range 1-24). No patients experienced subsequent periprosthetic fracture. Three patients (25%) developed post-operative complications, including severe hypotension, haemorrhage and post-operative wound infection . In patients with available data, 5 of 6 experienced a reduction in pain.
This series supports the concept that prophylactic orthopedic procedures can be performed safely in selected patients with metastatic cancers. These procedures can lead to a rapid return to independent ambulation, avoid risk of pathological fracture and improve symptoms. A multi-disciplinary approach in selecting patients who will benefit is recommended.