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Inchaustegui ML, Ruiz K, Gonzalez MR, Pretell-Mazzini J. Surgical Management of Metastatic Pathologic Subtrochanteric Fractures: Treatment Modalities and Associated Outcomes. JBJS Rev 2023; 11:01874474-202305000-00002. [PMID: 37141383 DOI: 10.2106/jbjs.rvw.22.00232] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Subtrochanteric pathological fractures (PFs) occur in approximately one-third of femur bone metastases. We seek to analyze surgical treatment strategies for subtrochanteric metastatic PFs and their revision rates. METHODS A systematic review was performed using the PubMed and Ovid databases. Reoperations as a result of complications were analyzed according to initial treatment modality, primary tumor site, and type of revision procedure. RESULTS We identified a total of 544 patients, 405 with PFs and 139 with impending fractures. The study population's mean age was 65.85 years with a male/female ratio of 0.9. Patients with subtrochanteric PFs who underwent an intramedullary nail (IMN) procedure (75%) presented a noninfectious revision rate of 7.2%. Patients treated with prosthesis reconstruction (21%) presented a noninfectious revision rate of 8.9% for standard endoprostheses and 2.5% for tumoral endoprostheses (p < 0.001). Revision rates because of infection were 2.2% for standard and 7.5% for tumoral endoprostheses. There were no infections within the IMN and plate/screws group (p = 0.407). Breast was the most common primary tumor site (41%) and had the highest revision rate (14.81%). Prosthetic reconstructions were the most common type of revision procedure. CONCLUSION No consensus exists regarding the optimal surgical approach in patients with subtrochanteric PFs. IMN is a simpler, less invasive procedure, ideal for patients with a shorter survival. Tumoral prostheses may be better suited for patients with longer life expectancies. Treatment should be tailored considering revision rates, patient's life expectancy, and surgeon's expertise. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Kim Ruiz
- Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcos R Gonzalez
- Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida
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Liu P, Wang Z, Zhang S, Ding G, Tan K, Zhou J. Application of Endoprosthetic Replacement in Old Patients with Isolated Proximal Femoral Bone Metastases. Ann Surg Oncol 2022; 29:8623-8630. [PMID: 35606471 DOI: 10.1245/s10434-022-11912-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Due to radical resection, endoprosthetic reconstruction (EPR) is more invasive and increases the risk of dislocation. Therefore, the suitability of EPR for elderly patients with metastatic tumor needs further investigation. METHODS Seventy-one adult patients with isolated proximal femoral bone metastases who underwent EPR were retrospectively analyzed and stratified into two groups: elderly age group (≥60 years, n = 31) and younger age group (<60 years, n = 40). The effect of age on prognosis was analyzed to determine whether EPR is beneficial in elderly patients with proximal femoral metastatic tumor. Cox regression modeling was used to evaluate the effect of different factors on postoperative survival outcomes. RESULTS Ten (32.26%) and 9 (22.50%) cases of perioperative complications were recorded in the elderly and younger age groups, respectively, with median survival times of 22.00 ± 4.61 months and 23.00 ± 2.85 months, respectively; a log-rank test showed that the difference was not statistically significant (p = 0.657). A Cox regression model was established with patient age as the covariable to evaluate whether it affected postoperative survival. The risk of death due to age was not significant (p = 0.649), but malignancy and femoral metastasis type were significantly associated with postoperative survival (p = 0.001 and p = 0.019). CONCLUSION Although older patients have a slightly higher incidence of postoperative complications than younger patients, they do not experience severe adverse consequences. With rigorous selection and careful preparation, EPR is appropriate for the treatment of proximal femoral metastases in older patients, including those with Harrington type I-II acetabular invasion.
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Affiliation(s)
- Peng Liu
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Zhuan Wang
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Shiyuan Zhang
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Guoqiang Ding
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Ke Tan
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Ji Zhou
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China.
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Yang TH, Yang RS, Lin CP, Tseng TH. Bone Cement Implantation Syndrome in Bone Tumor Surgeries: Incidence, Risk Factors, and Clinical Experience. Orthop Surg 2020; 13:109-115. [PMID: 33274603 PMCID: PMC7862161 DOI: 10.1111/os.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. Methods This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1–2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO2 <94%) or hypotension (fall in systolic blood pressure >20%); grade II, severe hypoxia (SpO2 <88%) or hypotension (fall in systolic blood pressure >40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis. Results A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self‐limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events. Conclusion Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Xu YM, Peng HM, Feng B, Weng XS. Progress of antibiotic-loaded bone cement in joint arthroplasty. Chin Med J (Engl) 2020; 133:2486-2494. [PMID: 32960839 PMCID: PMC7575178 DOI: 10.1097/cm9.0000000000001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
Bone cement, consisting of polymethyl methacrylate, is a bioinert material used for prothesis fixation in joint arthroplasty. To treat orthopedic infections, such as periprosthetic joint infection, antibiotic-loaded bone cement (ALBC) was introduced into clinical practice. Recent studies have revealed the limitations of the antibacterial effect of ALBC. Moreover, with the increase in high infection risk patients and highly resistant microbes, more researches and modification of ALBC are required. This paper reviewed latest findings about ALBC for most popular and destructive pathogens, summarized the influence of antibiotic kind, drug dosage, application method, and environment towards characteristic of ALBC. Subsequently, new cement additives and clinical applications of ALBC in joint arthroplasty were also discussed.
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Affiliation(s)
- Yi-Ming Xu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:1567-1572. [PMID: 30729272 DOI: 10.1007/s00264-019-04305-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The neutrophil to lymphocyte ratio (NLR) is a simple predictor used in oncology and cardiology. We aimed to analyze the NLR profile of patients with diaphyseal fractures of the humerus, femur, and tibia. METHODS We performed a cross-sectional, consecutive-case population-based study including 148 patients (41.9% men respectively 58.1% women) with humeral (23.0%), femoral (30.4%), and tibial (46.6%) diaphyseal fractures, admitted for surgical treatment in our level 1 trauma centre over two years. RESULTS The differences in NLR between the studied subgroups were not significant (p = 0.067), the highest value being observed in patients with femoral fracture (5.6) in contrast to patients with humeral fracture (4). In the global cohort, there was a significantly positive correlation between NLR and PLR (platelet to lymphocyte ratio; Spearman's r = 0.595; p < 0.001). The stratified subgroup analysis found significant association between NLR and duration of admission only for patients with femoral fracture (Spearman's r = - 0.308; p < 0.001). When compared with controls, all three fracture types had significantly higher neutrophil numbers and NLR and lower thrombocyte numbers. CONCLUSIONS NLR are elevated in femur diaphyseal fractures compared with tibia and humerus, up to cut-off values with negative prediction of outcome in malignancy and cardiovascular patients. Increased NLR are predictive of longer hospital admissions for femur fractures.
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Vicenti G, Bizzoca D, Carrozzo M, Nappi V, Rifino F, Solarino G, Moretti B. The ideal timing for nail dynamization in femoral shaft delayed union and non-union. INTERNATIONAL ORTHOPAEDICS 2019; 43:217-222. [PMID: 30167836 DOI: 10.1007/s00264-018-4129-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/21/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Nail dynamization is one of the proposed surgical options to manage femoral shaft non-union. This study aims to assess the efficacy and the ideal timing for dynamization in patients with femoral shaft delayed union or non-union. MATERIAL AND METHODS Sixty-eight patients (38 male and 30 female, mean age 36.85 years old, range 22-58) were recruited. The patients were divided into three groups according to the fracture healing time: groupa A, fracture healing occurred within nine months; group B, fracture healing occurred between nine and 12 months; and group C, fracture healing after 12 months or secondary procedure needed for union. Callus-to-diaphysis ratio was calculated on femur X-rays at the time of dynamization. RESULTS In 30 patients out of 68, the fracture healing was observed at nine month follow-up; in 26 patients, the fracture healed within 12 months; eight fractures healed in more than 12 months and only four fractures required a secondary procedure for union. Dynamization was successful in 64 patients out of 68 (94.12%). The mean callus-diaphysis ratio was significantly different in group A (p = 0.001) and in group B (p = 0.03), compared with group C. The timing of dynamization resulted significantly different between the three groups. Linear regression analysis revealed that nail dynamization should be performed between three and six months after trauma. The optimal callus-to-diaphysis ratio should be comprised between 1.47 and 1.19, at the time of dynamization. DISCUSSION Nail dynamization revealed safe and effective in the treatment of femoral delayed union and non-union. It should be considered as a first-line treatment for femoral non-union or delayed union.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Vittorio Nappi
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Francesco Rifino
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Biagio Moretti
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Cross-cultural adaptation and validation of a patient-reported hip outcome score. INTERNATIONAL ORTHOPAEDICS 2018; 42:1001-1006. [PMID: 29307032 DOI: 10.1007/s00264-017-3742-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to perform psychometric testing for the translated Oxford Hip Score (OHS) for use as a recommended tool to measure treatment outcomes. METHODS The original English questionnaire was translated and culturally validated using the instrument developer's guidelines and the ISPOR principles of good practice. One hundred patients completed the form together with the Harris Hip Score (HHS) and EQ-5D-5 L. Fifty patients repeated the form after two days. They were suffering from hip osteoarthritis, had had hip replacement or underwent osteosynthesis for a fracture of the trochanteric region. RESULTS The questionnaire had a high degree of reliability with a Cronbach α of 0.917 at the initial completion and 0.917 at the second testing, respectively. The two results were strongly positive and significantly correlated (Pearson's r = 0.947; p < 0.001). The OHS was strongly and significantly correlated with the HHS (Pearson's r = 0.880 initial and r = 0.840 s; p < 0.001) and strongly, positive and significantly correlated with the EQ-5D-5 L VAS (Pearson's r = 0.614 initial and r = 0.704 s; p < 0.001). CONCLUSIONS Our study showed that the translation of the OHS is a reliable, reproducible and valid measure of function in patients who undergo treatment for hip pathology.
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