Proximal femoral tumor resection followed by joint prosthesis replacement: a systematic review and meta-analysis

Surgical treatments of metastatic bone disease of the hip joint: a scoping review protocol

INTRODUCTION

Metastatic disease of the hip causes severe pain and is a serious threat to the patient's motor function. Surgery is required, but the actual efficacy is unclear, and there are many concerns for both patients and doctors. The purpose of this protocol is to conduct a scoping review for helping decisions of the intended audience.

METHODS AND ANALYSIS

This scoping review will be conducted according to the framework proposed by Arksey and O'Malley and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews criteria. To answer our research questions, we will search Chinese and English databases using appropriate search terms, comb through clinical studies on surgical procedures for metastatic bone disease of the hip and incorporate visual charts and graphs to provide a comprehensive analysis and evaluation of the literature according to the criteria for basic characteristics, interventions and outcome indicators.

ETHICS AND DISSEMINATION

Since the data are publicly available, no ethical approval or participant consent is required. The results of the review will be published in an open-access peer-reviewed journal and presented at national and international conferences.

What Abductor Repair Technique Provides the Best Functional Outcomes After Proximal Femur Endoprosthetic Reconstruction for Oncologic Indications? A Systematic Review

BACKGROUND

There is conflicting data regarding the optimal abductor mechanism (AM) repair technique after resection of proximal femur tumors. We sought to compare functional outcomes following tumor resection and reconstruction with proximal femoral replacement based on the AM repair technique utilized.

METHODS

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We established two study groups based on AM repair technique as follows: soft-tissue reattachment (STr) and greater trochanter preservation (GTp). In the STr group, the gluteus medius and minimus muscles were reattached to the endoprosthesis, whereas in the GTp group, the greater trochanter and gluteal tendons were preserved. The STr group was further subdivided into direct and indirect reattachments. Weighted means adjusting for sample size were calculated.

RESULTS

A total of 658 patients from 12 articles were included. Patients who had STr displayed higher Musculoskeletal Tumor Society scores (75 versus 67.3%, P < 0.001), lower rates of Trendelenburg gait (33.9 versus 52.4%, P < 0.01), and ambulation with assistive devices (30.4 versus 54.9%, P < 0.001) compared to the GTp group. Within the STr group, indirect reattachment was associated with higher Musculoskeletal Tumor Society scores (87.2 versus 70.1%, P < 0.001) and lower rates of Trendelenburg gait (3.8 versus 36.3%, P < 0.001) and ambulation with assistive devices (0 versus 42.4%, P < 0.001) compared to direct reattachment. The reattachment hardware failure rate in GTp was 15%.

CONCLUSION

A STr provided superior functional outcomes compared to GTp in tumor-related proximal femoral replacement. From a functional outcome perspective, the use of indirect STr was better compared to direct STr.

LEVEL OF EVIDENCE

III.

Does liquid nitrogen recycled autograft for treatment of bone sarcoma impact local recurrence rate? A systematic review

The gold standard treatment for primary bone sarcomas has been surgical resection with wide margins. However, there is no consensus regarding an optimal method for limb salvage reconstruction. In 2005, a technique for recycling resected bone after intraoperative treatment with liquid nitrogen was described. This technique has been reported to have a spectrum of advantages; nonetheless, acceptance for routine use has been limited, primarily for fear of local recurrence. A systematic search of the literature using PubMed and Google Scholar was performed. Full-text articles published between 2008 and 2023 were included if the study presented sufficient information regarding patients with a diagnosis of a primary bone sarcoma of the limbs or pelvis who had undergone reconstruction with liquid nitrogen recycled autografts. Sixteen studies that included 286 patients met criteria for analyses. Local recurrence occurred in 25 patients (8.7 %) during the first 4 years following limb salvage reconstruction using recycled autografts for treatment of primary bone sarcomas, which compares favorably to the 15-30 % local recurrence rates reported for patients undergoing limb salvage reconstruction using artificial implants. Systematic synthesis of the current evidence regarding local recurrence rates following use of the liquid nitrogen recycled autograft technique for limb salvage reconstruction after bone sarcoma resection suggests a favorable comparison to other limb salvage reconstruction options. As such, this technique warrants further consideration as a viable option for indicated patients based on relative advantages regarding costs, availability, and biologic and surgical reconstruction benefits.

Surgical Management and Reconstruction of Dedifferentiated Chondrosarcoma in the Proximal Femur: A Case Report

A primary malignant bone tumor, or more commonly, metastasis, can occur in the proximal femur. Surgical treatment can have palliative or curative purposes. In the case of the latter, it involves two stages: resection of the tumor, which aims to address the cancer, and reconstruction of the bone and soft tissue, which aims to restore function. It is important for the excision to be wide with adequate resection margins in the soft tissue, particularly when the goal is curative treatment. Typically, surgery involves excision and reconstruction to ensure good mechanical stability. Reconstruction can be done using different methods, such as a composite prosthesis or a massive prosthesis, which may be modular or custom-made. Joint reconstruction options include hemiarthroplasty, intermediate prosthesis, or, in some cases, total hip replacement.

Similar complications, implant survival, and function following modular prosthesis and allograft-prosthesis composite reconstructions of the proximal femur for primary bone tumors: a systematic review and meta-analysis

PURPOSE

There is a lack of consensus regarding the best type of reconstruction of the proximal femur following bone tumor resection. The objective of this study was to analyze the complication risks, implant survival, and functional outcomes following modular prosthesis (MP) and allograft-prosthesis composite (APC) reconstruction of the proximal femur after primary bone tumor resections.

METHODS

We performed a search in the PubMed and Scopus libraries, obtaining 1 843 studies. We included studies reporting functional outcomes, complications, and implant survival of proximal femur reconstruction with MP or APC following primary bone tumor resection with a 2-year minimum follow-up. We excluded studies analyzing metastatic patients or studies with pooled data in which it was impossible to separate the data of patients with primary bone tumors from those with bone metastases.

RESULTS

We analyzed 18 studies (483 patients) reporting on 234 (48%) patients with MP reconstruction and 249 (52%) patients with APC reconstruction. The risk of complications was similar in patients with MP reconstruction (29%; 95% CI [0.11; 0.47]) and APC reconstruction (36%; 95% CI [0.24; 0.47]) (p = 0.48). Implant survival following MP reconstruction ranged from 81 to 86% at 5 years, 75 to 86% at 10 years, and 82% at 15 years. Implant survival following APC reconstruction ranged from 86 to 100% at 5 years and 86% at 10 years, and 86% at 15 years. Functional outcomes following MP reconstruction and APC reconstruction ranged from 24.0 to 28.3 and from 21.9 to 27.8, respectively.

CONCLUSION

Patients with primary bone tumor of the proximal femur who underwent MP or APC reconstruction seem to have similar complication risks, implant survival, and functional outcomes.