Estimating Survival and Reconstruction Method
In the absence of reliable evidence, it is the opinion of the workgroup that surgeons utilize a validated method of estimating survival of the patient in choosing the method of reconstruction. Longer survival estimates may justify more durable reconstruction methods such as arthroplasty, if clinically appropriate.

Rationale

Metastatic bone disease presents unique surgical challenges within a very diverse patient population. Rather than base treatment decisions on radiographs alone, surgeons may consider the use a validated means to estimate survival such as the Tokuhashi method (Tokuhashi 2005), the PATHFx tool, available at www.pathfx.org (Ogura, 2017) or the Global Spine Tumour Study Group at www.spinemet.com. Doing so helps ensure other characteristics such as oncologic diagnosis, extent of metastases, hemoglobin, and performance status are considered when deciding on a treatment course. In general, short survival estimates (1-6 months) justify less invasive and less durable approaches, such as intramedullary nails, or less commonly, other internal fixation devices. Similarly, patients with longer estimates (>6 months) require more durable solutions such as endoprostheses, whenever possible. Patients with very short survival estimates of approximately one month may not be candidates for prophylactic fixation but may benefit from minimally or non-invasive nterventions such as radiotherapy, cryotherapy, orradio-frequency ablation for adequate pain relief (Meares, 2019; Korian, 2018). However, arthroplasty may still be indicated in patients with short survival time for palliation in certainclinical scenarios, for example fractured femoral neck.


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