Arthroplasty
Clinicians may consider arthroplasty to improve patient function and decrease the need for post-operative radiation therapy in patients with pathologic fractures from metastatic carcinoma in the femur.

Rationale

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.

Future Research

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.


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