CORRInsights®: What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?
Classic musculoskeletal oncology dogma supports the “one bone, one operation” approach. However, recent data suggest that intermediate-length or long-stem arthroplasty prostheses may not always be necessary , as evidenced by low revision rates of short-cemented stems in properly selected patients with osseous metastases. Higher risks of complications associated with long-cemented stems may not always justify their routine use. Even the necessity of cement fixation of the prosthesis in metastatic disease has been questioned, despite the potential delay in bony ongrowth to a press-fit stem caused by the use of radiation therapy for these patients .
When there are multiple opinions regarding the best treatment for a condition, one may conclude that all procedures have similar limitations. However, in the treatment of proximal femur lesions, the general consensus is that all surgical options provide durable palliation, functional benefit, increased ambulation, and improvement in ease of care during the patient's remaining lifetime. In an effort to help identify the best surgical approach, we must first evaluate the results of each intervention, as the data continue to lag behind enthusiasm.