CORRInsights®: What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

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The proximal femur is the most common site for extremity pathologic fracture. Most of these are caused by metastatic disease, and these fractures cause pain, morbidity, and in some patients, premature death. In a survey of members of the Musculoskeletal Tumor Society (MSTS) presenting multiple clinical scenarios, a wide range was noted in the preferred treatments, including intramedullary nail fixation, proximal femur resection and reconstruction, cemented hemiarthroplasty, and open reduction internal fixation [2]. Furthermore, there was a nearly equal split regarding the use of polymethyl methacrylate around intramedullary nails.
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 [5], 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 [3].
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.
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