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When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?
Author(s) -
Lin James S.,
SantiagoTorres Juan E.,
Everhart Joshua S.,
Zayan Nicole E.,
Mayerson Joel L.,
Scharschmidt Thomas J.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24792
Subject(s) - medicine , intramedullary rod , surgery , fixation (population genetics) , hazard ratio , femur , odds ratio , retrospective cohort study , confidence interval , population , environmental health
Background Malignant hip lesions can be managed operatively by intramedullary (IM) nail fixation and hemiarthroplasty. Methods A retrospective review was performed on 86 patients who underwent hemiarthroplasty ( n = 22) or IM nail fixation ( n = 64) for prophylactic treatment of impending pathologic fracture due to malignant lesions of the hip. Cox proportional hazards and logistic regression modeling were performed to determine risk of death, fixation failure, pain relief, and return to ambulation without gait aids. Results Median survival time after surgery was 8.8 months (with no difference in survival between hemiarthroplasty and IM nail [adjusted Hazard Ratio 1.40, CI 0.72, 2.53; P = 0.31]). Hemiarthroplasty was associated with lower risk of pathologic fracture, fixation failure, or reoperation (adjusted HR 0.02, CI < 0.001, 0.48; P = 0.01). Hemiarthroplasty did not increase odds of unassisted ambulation compared to IM nail fixation (adjusted Odds Ratio [OR] 2.23, CI 0.56, 9.71; P = 0.26). The strongest predictor of postoperative ambulation was preoperative ambulation without aids (adjusted OR 28.9, CI 7.37, 161; P < 0.001). Conclusions There is no difference in survival or likelihood of unassisted ambulation after prophylactic femoral fixation with IM nails versus hemiarthroplasty in patients with metastatic disease of proximal femur.