Arthroplasty procedures carry greater potential morbidity and higher healthcare costs than internal fixation. However, these procedures may be indicated in select patients with longer expected survival and higher performance status. Four low-quality studies (Gao, H., 2016, Sarahrudi, K., 2009, Tsuda, Y., 2016, and Zacherl, M., 2011) reported comparative outcomes between arthroplasty and internal fixation for pathologic fractures of the proximal femur. Results from these studies indicate that the benefits of arthroplasty include improved function as determined by Harris Hip Scores, and a decreased need for adjuvant radiotherapy for disease control. Surgical management with both arthroplasty and internal fixation provides immediate stability to the femur and the opportunity for early post-operative mobility. The differences in outcomes are small and therefore both treatment options are reasonable.
Benefits/Harms of Implementation
Despite the benefits of arthroplasty, these procedures carry a higher risk of post-operative complications such as dislocation.
Given the increased cost of arthroplasty and the small increased risk for dislocation, the benefits of improved function and less need for radiation may not offset the cost and risks for all patients. Future studies can determine which patient characteristics are most likely to result in benefit from arthroplasty procedures in this population.
- Gao, H., Liu, Z., Wang, B., Guo, A. Clinical and functional comparison of endoprosthetic replacement with intramedullary nailing for treating proximal femur metastasis. Chinese Journal of Cancer Research 2016; 2: 209-214
- Sarahrudi, K., Greitbauer, M., Platzer, P., Hausmann, J. T., Heinz, T., Vecsei, V. Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients. Journal of Trauma-Injury Infection & Critical Care 2009; 4: 1158-63
- Tsuda, Y., Yasunaga, H., Horiguchi, H., Fushimi, K., Kawano, H., Tanaka, S. Complications and Postoperative Mortality Rate After Surgery for Pathological Femur Fracture Related to Bone Metastasis: Analysis of a Nationwide Database. Annals of Surgical Oncology 2016; 3: 801-10
- Zacherl, M., Gruber, G., Glehr, M., Ofner-Kopeinig, P., Radl, R., Greitbauer, M., Vecsei, V., Windhager, R. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures : Resection vs. stabilisation. International Orthopaedics 2011; 10: 1537- 1543