Prosthetic joint replacement for long bone metastases: Analysis of 154 cases

F. Camnasio, C. Scotti, G. M. Peretti, F. Fontana, G. Fraschini

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Introduction: Metastatic bone disease is the most common cause of malignancies to the skeleton in adults. The treatment of bone metastases is frequently palliative aiming to achieve a satisfactory control of pain and to prevent or to treat pathological fractures. In selected cases the resection of a single bone metastasis may improve the survival of the patients. Our experience with bone metastases located in the appendicular skeleton, between 1992 and 2004, is retrospectively reviewed here. Materials and methods: We report a series of 154 patients (95 females and 59 males) treated with prosthesis for metastatic bone disease. Lower limb localization was more frequent with 117 cases, while upper limb was affected in 37 cases. Metastatic breast and renal carcinoma predominated and accounted for 66% of the lesions. Indications to surgery were reported, oncologic outcome was evaluated and functional results were obtained by the Musculoskeletal Tumor Society scoring system. Results: Follow up ranged from 6 months to 12 years (median 26 months). One-year survival was 69.5%, 2-years survival was 44.8%, 5-years survival was 19.5%; and 5 (3.2%) died in the early post surgical period. Functional results were good or higher in 73.8% of patients for the proximal femur, in 50% of patients for the knee and 30.6% of patients for the proximal humerus. Conclusion: In this series, satisfactory results were achieved with few complications. We emphasized the importance of giving the patient a definitive treatment and preventing pathological fractures as they determine disability and a spreading of the tumor in the soft tissues, leading to an increased probability of local recurrence. Prosthetic replacement contributes to an improved quality of life and limb functionality and, in selected cases; this radical surgical approach is indicated as it may improve patient's life expectancy.

Original languageEnglish
Pages (from-to)787-793
Number of pages7
JournalArchives of Orthopaedic and Trauma Surgery
Volume128
Issue number8
DOIs
Publication statusPublished - Aug 2008

Fingerprint

Replacement Arthroplasties
Neoplasm Metastasis
Bone and Bones
Spontaneous Fractures
Survival
Bone Diseases
Skeleton
Neoplasms
Humerus
Life Expectancy
Upper Extremity
Femur
Prostheses and Implants
Lower Extremity
Knee
Extremities
Quality of Life
Breast Neoplasms
Kidney
Recurrence

Keywords

  • Allograft-prosthesis reconstruction
  • Appendicular skeleton
  • Bone metastases
  • Pathological fracture
  • Prostheses

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Prosthetic joint replacement for long bone metastases : Analysis of 154 cases. / Camnasio, F.; Scotti, C.; Peretti, G. M.; Fontana, F.; Fraschini, G.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 128, No. 8, 08.2008, p. 787-793.

Research output: Contribution to journalArticle

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abstract = "Introduction: Metastatic bone disease is the most common cause of malignancies to the skeleton in adults. The treatment of bone metastases is frequently palliative aiming to achieve a satisfactory control of pain and to prevent or to treat pathological fractures. In selected cases the resection of a single bone metastasis may improve the survival of the patients. Our experience with bone metastases located in the appendicular skeleton, between 1992 and 2004, is retrospectively reviewed here. Materials and methods: We report a series of 154 patients (95 females and 59 males) treated with prosthesis for metastatic bone disease. Lower limb localization was more frequent with 117 cases, while upper limb was affected in 37 cases. Metastatic breast and renal carcinoma predominated and accounted for 66{\%} of the lesions. Indications to surgery were reported, oncologic outcome was evaluated and functional results were obtained by the Musculoskeletal Tumor Society scoring system. Results: Follow up ranged from 6 months to 12 years (median 26 months). One-year survival was 69.5{\%}, 2-years survival was 44.8{\%}, 5-years survival was 19.5{\%}; and 5 (3.2{\%}) died in the early post surgical period. Functional results were good or higher in 73.8{\%} of patients for the proximal femur, in 50{\%} of patients for the knee and 30.6{\%} of patients for the proximal humerus. Conclusion: In this series, satisfactory results were achieved with few complications. We emphasized the importance of giving the patient a definitive treatment and preventing pathological fractures as they determine disability and a spreading of the tumor in the soft tissues, leading to an increased probability of local recurrence. Prosthetic replacement contributes to an improved quality of life and limb functionality and, in selected cases; this radical surgical approach is indicated as it may improve patient's life expectancy.",
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AB - Introduction: Metastatic bone disease is the most common cause of malignancies to the skeleton in adults. The treatment of bone metastases is frequently palliative aiming to achieve a satisfactory control of pain and to prevent or to treat pathological fractures. In selected cases the resection of a single bone metastasis may improve the survival of the patients. Our experience with bone metastases located in the appendicular skeleton, between 1992 and 2004, is retrospectively reviewed here. Materials and methods: We report a series of 154 patients (95 females and 59 males) treated with prosthesis for metastatic bone disease. Lower limb localization was more frequent with 117 cases, while upper limb was affected in 37 cases. Metastatic breast and renal carcinoma predominated and accounted for 66% of the lesions. Indications to surgery were reported, oncologic outcome was evaluated and functional results were obtained by the Musculoskeletal Tumor Society scoring system. Results: Follow up ranged from 6 months to 12 years (median 26 months). One-year survival was 69.5%, 2-years survival was 44.8%, 5-years survival was 19.5%; and 5 (3.2%) died in the early post surgical period. Functional results were good or higher in 73.8% of patients for the proximal femur, in 50% of patients for the knee and 30.6% of patients for the proximal humerus. Conclusion: In this series, satisfactory results were achieved with few complications. We emphasized the importance of giving the patient a definitive treatment and preventing pathological fractures as they determine disability and a spreading of the tumor in the soft tissues, leading to an increased probability of local recurrence. Prosthetic replacement contributes to an improved quality of life and limb functionality and, in selected cases; this radical surgical approach is indicated as it may improve patient's life expectancy.

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