Skip to main content
SpringerLink
Log in

Metastatic instability at the proximal end of the femur

Comparison of endoprosthetic replacement and plate osteosynthesis

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

A retrospective study was performed of the surgical treatment of metastatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis was performed in another 25 consecutive patients. Indications for surgical treatment were pathological fractures or, for prophylactic treatment, lesions of the femoral cortex exceeding 2.5 cm in diameter or affecting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-bearing stability was obtained in all patients. Group analysis showed that the functional rating of the hip joint was unchanged, i.e., good or excellent, in all patients with compound osteosynthesis, compared to only 68% in the endoprosthesis group. Pain relief was excellent or good in 84% and 88% respectively. Dislocation of the tumor prosthesis occurred in 3 patients. Closed reduction was possible in 2 cases. Local recurrence was higher in the patients undergoing plate osteosynthesis, as was the frequency of tumor-related implant failure. Postoperative survival averaged 14.7 months and 12.1 months respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Broos PLO, Rommens PM, Vanlangenaker MJU (1992) Pathological fractures of the femur: improvement of quality of life after surgical treatment. Arch Orthop Trauma Surg 111:73–77

    Google Scholar 

  2. Enneking WF (1987) Limb salvage in musculoskeletal oncology. Churchill Livingstone, New York, pp 5–16

    Google Scholar 

  3. Friedl W (1992) Chirurgische Therapie von Skelettmetastasen und pathologischen Frakturen der unteren Extremität. In: Ewerbeck V, Friedl W (eds) Chirurgische Therapie von Skelettmetastasen. Springer, Berlin Heidelberg New York, pp 171–189

    Google Scholar 

  4. Galasko CSB (1974) Pathological fractures secondary to metastatic cancer. J R Coll Surg Edinb 19:351–362

    Google Scholar 

  5. Ganz R, Isler B, Mast J (1984) Internal fixation technique in pathological fractures of the extremities. Arch Orthop Trauma Surg 103:73–80

    Google Scholar 

  6. Habermann ET, Sachs R, Stern RE, Hirsch DM, Anderson WJ (1982) The pathology and treatment of metastatic disease of the femur. Clin Orthop 169:70–82

    Google Scholar 

  7. Harrington KD (1982) New trends in the management of lower extremity metastases. Clin Orthop 169:54–61

    Google Scholar 

  8. Isler B (1990) Chirurgische Maßnahmen bei metastatischen Läsionen des Extremitäten- und des Beckenskelettes. Unfallchirurg 93:449–456

    Google Scholar 

  9. Joyce MJ, Makley JT, Sauer J (1991) Pitfalls in the management of metastatic disease of the femur. In: Langlais F, Tomeno B (eds) Limb salvage. Springer, Berlin Heidelberg New York, pp 701–709

    Google Scholar 

  10. Karachalios T, Atkins RM, Sarangi PP, Crichlow TPKR, Solomon L (1993) Reconstruction nailing for pathological subtrochanteric fractures with coexisting femoral shaft metastases. J Bone Joint Surg [Br] 75-B:119–122

    Google Scholar 

  11. Knahr K, Kotz R, Plattner E, Salzer M (1979) Endoprothesen-implantation nach Resektion maligner Extremitätengeschwülste. Z Orthop 117:967–973

    Google Scholar 

  12. Krebs H (1978) Management of pathologic fractures of long bones in malignant disease. Arch Orthop Trauma Surg 92:133–137

    Google Scholar 

  13. Lane JM, Sculco TP, Zolan S (1980) Treatment of pathological fractures of the hip by endoprosthetic replacement. J Bone Joint Surg [Am] 62-A:954–959

    Google Scholar 

  14. Levine AM, Russell TA, Taylor JC, LaVelle DG, Bosse MJ (1989) Treatment of metastatic lesions of the femur with locked intramedullary rod fixation. Proceedings of 56th Meeting of the American Academy of Orthopaedic Surgeons, Las Vegas, p 124

  15. Levy RN, Sherry HS, Siffert RS (1982) Surgical management of metastatic disease of bone at the hip. Clin Orthop 169:62–69

    Google Scholar 

  16. Lewis MM, Chekofsky KM (1982) Proximal femur replacement for neoplastic disease. Clin Orthop 171:72–79

    Google Scholar 

  17. Marsden FW, Hale DG, Sullivan JA, Findlay MPM (1991) Treatment of metastatic disease involving the proximal femur and hip joint. In: Langlais F, Tomeno B (eds) Limb salvage. Springer, Berlin Heidelberg New York, pp 689–696

    Google Scholar 

  18. Mirels H (1989) Metastatic disease in long bones. Clin Orthop 249:256–264

    Google Scholar 

  19. Poigenfürst J, Marcove RC, Miller TC (1968) Surgical treatment of fractures through metastases in the proximal femur. J Bone Joint Surg [Br] 60-B:743–756

    Google Scholar 

  20. Rompe JD, Eysel P, Hopf C, Heine J (1993) Decompression/stabilization of the metastatic spine. Cotrel-Dubousset instrumentation in 50 patients. Acta Orthop Scand 64:3–8

    Google Scholar 

  21. Rompe JD, Eysel P, Hopf C, Heine J, Schaub T (1993) Der Einsatz der Tumorprothese bei sekundär-neoplastischer Destruktion des proximalen Femurendes. Z Orthop 131:446–451

    Google Scholar 

  22. Santori FS, Ghera S, Manili M, Vitullo A, Erriquez A (1991) Surgical treatment of bone metastases. In: Langlais F, Tomeno B (eds) Limb salvage. Springer, Berlin Heidelberg New York, pp 757–762

    Google Scholar 

  23. Schreiber A, Exner GU, Hochstetter AR (1991) Muscle reattachment — especially the gluteal muscles — after proximal femoral resection and replacement by tumor prosthesis. In: Langlais F, Tomeno B (eds) Limb salvage. Springer, Berlin Heidelberg New York, pp 395–398

    Google Scholar 

  24. Sim E (1990) Hüfttumorprothese — Indikation in einem unfallchirurgischen Schwerpunktkrankenhaus und Ergebnisse. Unfallchirurgie 16:291–298

    Google Scholar 

  25. Sim FH (1988) Operative treatment: general considerations. In: Sim FH (ed) Diagnosis and management of metastatic bone disease. Raven Press, New York, pp 161–170

    Google Scholar 

  26. Sugimoto M, Takahashi S, Toguchida J, Kotoura Y, Shibamoto Y, Yamamuro T (1991) Changes in bone after high-dose radiation. J Bone Joint Surg [Br] 73-B:492–497

    Google Scholar 

  27. Tomiczek H, Wruhs O (1987) Indikation und Anwendung der Verriegelungsnagelung bei pathologischen Oberschenkelschaftfrakturen. Unfallchirurg 90:67–72

    Google Scholar 

  28. Veth RP, Nielsen HK, Oldhoff J, Schraffordt Koops H, Mahta D, Oosterhuis JW, Kamps WA, Goeeken LN (1989) Megaprostheses in the treatment of primary malignant and metastatic tumors in the hip region. J Surg Oncol 40:214–218

    Google Scholar 

  29. Veth RP, Nielsen HK, Oldhoff J, Schraffordt Koops H, Oldhoff J, Hoekstra HJ, Mahta D, Willemse PHB, Goeeken LN, Oosterhuis JW, Verkerke GJ (1991) Use of megaprosthesis in the treatment of metastatic bone disease. In: Langlais F, Tomeno B (eds) Limb salvage. Springer, Berlin Heidelberg New York, pp 697–699

    Google Scholar 

  30. Windhager R, Ritschl P, Rokus U, Kickinger W, Braun O, Kotz R (1989) Die Rezidivhäufigkeit von infra- und extraläsional operierten Metastasen langer Röhrenknochen. Z Orthop 127:402–405

    Google Scholar 

  31. Yazawa Y, Frassica FJ, Chao EYS, Pritchard DJ, Sim FH, Shives TC (1990) Metastatic bone disease. Clin Orthop 251:213–219

    Google Scholar 

  32. Zichner L, Heipertz W (1981) Der Ersatz des proximalen Femurendes. Z Orthop 119:102–110

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Johannes Gutenberg-University Hospital, Langenbeckstrasse 1, D-55131, Mainz, Germany

    J. D. Rompe, P. Eysel, C. Hopf & J. Heine

Authors
  1. J. D. Rompe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Eysel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Hopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Heine
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rompe, J.D., Eysel, P., Hopf, C. et al. Metastatic instability at the proximal end of the femur. Arch Orthop Trauma Surg 113, 260–264 (1994). https://doi.org/10.1007/BF00443814

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00443814

Keywords

Search

Navigation