Surgical management of metastatic lesions in the proximal femur: a systematic review
Purpose: The proximal femur is a frequent site of cancer dissemination in the extremities. Patients treated surgically for skeletal metastases have poorer overall health compared to other orthopedic patients, with only one-third expected to survive two years post-surgery. Choosing a treatment that m...
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Bioscientifica
2025-02-01
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| Series: | EFORT Open Reviews |
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| author | Afrim Iljazi Mads Sten Andersen Stig Brorson Michael Mørk Petersen Michala Skovlund Sørensen |
| author_facet | Afrim Iljazi Mads Sten Andersen Stig Brorson Michael Mørk Petersen Michala Skovlund Sørensen |
| author_sort | Afrim Iljazi |
| collection | DOAJ |
| description | Purpose: The proximal femur is a frequent site of cancer dissemination in the extremities. Patients treated surgically for skeletal metastases have poorer overall health compared to other orthopedic patients, with only one-third expected to survive two years post-surgery. Choosing a treatment that minimizes revision risk and ensures the implant outlives the patient is therefore crucial. We conducted a systematic review to assess the revision rate following internal fixation (IF) or endoprosthetic reconstruction (EPR) of the proximal femur for metastatic bone disease (MBD). Methods: This study adhered to the PRISMA guidelines. MEDLINE and Embase were searched, identifying 10,299 records. After removing duplicates, 7731 unique records were screened, 334 of which were retrieved for full-text screening. We included 34 studies in the qualitative synthesis. The MINORS instrument was used for quality assessment. Results: The quality of the included studies was low to moderate, with median scores of 6/16 for non-comparative studies and 10/24 for comparative studies. We therefore refrained from a comparative analysis. Revision rates varied between 0 and 12.4% following EPR (25 studies) and between 0 and 26.7% following IF, while implant removal rates ranged between 0 and 8.3% and 0 and 26.7%, respectively. Conclusions: Revision and implant removal rates for various methods of EPR and IF are satisfactory. However, a meta-analysis or comparison between IF and EPR is not feasible due to a lack of prospective studies, randomized trials and high-quality studies. |
| format | Article |
| id | doaj-art-da470bb1b1294458b9366e65b39f444e |
| institution | Kabale University |
| issn | 2058-5241 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | EFORT Open Reviews |
| spelling | doaj-art-da470bb1b1294458b9366e65b39f444e2025-02-09T12:02:52ZengBioscientificaEFORT Open Reviews2058-52412025-02-0110210411410.1530/EOR-24-01381Surgical management of metastatic lesions in the proximal femur: a systematic reviewAfrim Iljazi0Mads Sten Andersen1Stig Brorson2Michael Mørk Petersen3Michala Skovlund Sørensen4Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Medicine – Copenhagen University Hospital Amager and Hvidovre, Copenhagen, DenmarkDepartment of Orthopedic Surgery, Zealand University Hospital Køge, Køge, DenmarkDepartment of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkPurpose: The proximal femur is a frequent site of cancer dissemination in the extremities. Patients treated surgically for skeletal metastases have poorer overall health compared to other orthopedic patients, with only one-third expected to survive two years post-surgery. Choosing a treatment that minimizes revision risk and ensures the implant outlives the patient is therefore crucial. We conducted a systematic review to assess the revision rate following internal fixation (IF) or endoprosthetic reconstruction (EPR) of the proximal femur for metastatic bone disease (MBD). Methods: This study adhered to the PRISMA guidelines. MEDLINE and Embase were searched, identifying 10,299 records. After removing duplicates, 7731 unique records were screened, 334 of which were retrieved for full-text screening. We included 34 studies in the qualitative synthesis. The MINORS instrument was used for quality assessment. Results: The quality of the included studies was low to moderate, with median scores of 6/16 for non-comparative studies and 10/24 for comparative studies. We therefore refrained from a comparative analysis. Revision rates varied between 0 and 12.4% following EPR (25 studies) and between 0 and 26.7% following IF, while implant removal rates ranged between 0 and 8.3% and 0 and 26.7%, respectively. Conclusions: Revision and implant removal rates for various methods of EPR and IF are satisfactory. However, a meta-analysis or comparison between IF and EPR is not feasible due to a lack of prospective studies, randomized trials and high-quality studies.https://eor.bioscientifica.com/view/journals/eor/10/2/EOR-2024-0138.xmlsystematic reviewmetastatic bonediseaseproximal femurinternal |
| spellingShingle | Afrim Iljazi Mads Sten Andersen Stig Brorson Michael Mørk Petersen Michala Skovlund Sørensen Surgical management of metastatic lesions in the proximal femur: a systematic review EFORT Open Reviews systematic review metastatic bone disease proximal femur internal |
| title | Surgical management of metastatic lesions in the proximal femur: a systematic review |
| title_full | Surgical management of metastatic lesions in the proximal femur: a systematic review |
| title_fullStr | Surgical management of metastatic lesions in the proximal femur: a systematic review |
| title_full_unstemmed | Surgical management of metastatic lesions in the proximal femur: a systematic review |
| title_short | Surgical management of metastatic lesions in the proximal femur: a systematic review |
| title_sort | surgical management of metastatic lesions in the proximal femur a systematic review |
| topic | systematic review metastatic bone disease proximal femur internal |
| url | https://eor.bioscientifica.com/view/journals/eor/10/2/EOR-2024-0138.xml |
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