Clinical outcomes of proximal femur metastases after surgical fixation : a two centres study

Abstract

Surgical fixation in skeletal metastases especially over the femur area is found to reduce morbidity, improve the quality of life in advanced diseases and improve the patients' survival rate. This study aims to evaluate the functional result and survival rate of patients who underwent skeletal reconstructive surgery for metastatic bone tumour of the proximal femur. Thirty patients had undergone surgeries for skeletal metastasis over the proximal femur at two centres which were Hospital Sultan Ismail and Hospital Tengku Ampuan Afzan between 2013 till 2017. The choice of implants, complications, survival rate and functional outcome were evaluated. Functional outcomes after 6 months postoperatively were measured using Musculoskeletal Tumour Society (MSTS) score. Endoprosthesis ( 17 patients) was the most common procedure performed followed by osteosyntheses (13 patients). For endoprosthesis, 9 patients underwent total hip replacement and 8 patients had hemiarthroplasty performed respectively. For osteosynthesis, dynamic hip screw (6 patients) was the most common surgical procedure performed followed by interlocking nail ( 4 patients) and proximal femoral nail (3 patients). There were a total of 10 complications consisted of implant loosening (3 patients), implant failures (2 patients), hip dislocation (1 patient), surgical site infection (1 patient), and 3 systemic complications as 2 patients developed pneumonia and 1 patient developed pulmonary embolism. Survival rate one-year post surgery was 83.3% and survival rate after 3 years was 61.9%. For the functional outcome, the mean MSTS score was 71 %. Seventy-seven percent of the patients had good functional outcome with MSTS score more than 70%. In conclusion, patients with skeletal metastasis have prolonged survival rate and should undergo skeletal reconstruction to reduce morbidity and improve quality of life with expected good functional outcome. The surgical construct should be stable and outlast the patient as to avoid further surgery.