ESULTS OF MINIMALLY INVASIVE SURGICAL TREATMENT OF PATIENTS SUSCEPTIBLE TO PATHOLOGICAL FRACTURES DUE TO PROXIMAL FEMUR METASTASIS

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Abstract

Purpose. To study the effectiveness of minimally invasive surgical treatment of patients susceptible to pathological fractures due to proximal femur metastasis.

Materials and methods. A retrospective study was done for a group of 46 women of mean age 44.5 years (range 38 to 60 years). The histologic diagnosis of each patient was breast cancer. The overall survival of included patients was more than 18 months after intramedullary nailing and cement injection of the proximal femur. In first subgroup, 22 patients underwent intramedullary nailing and cement injection immediately after RF (radiofrequency) ablation. Second subgroup included 24 patients who underwent internal fixation of impending pathologic fractures without RF ablation. Pain relief was evaluated by visual analogue scale (VAS). Functional outcomes and life quality were assessed with MSTS and SF-36 scores.

Results. The authors obtained statistically significant differences in the scores dynamics on SF-36 scale.

Most of the patients continued comprehensive treatment as well as were receiving bisphosphonates after 18 months postoperatively. Hip function, assessed on MSTS scale, did not demonstrate statistically significant differences (83.2 for the first subgroup and 88.1 for the second). Pain syndrome in the early postoperative period was statistically lower in the first subgroup.

X-ray and CT examination of patients in the first subgroup revealed 2 cases of continued metastatic growth accompanied by cut-out syndrome, implant instability or severe pain. In the second subgroup, where prophylactic fixation was performed without radiofrequency ablation such complication was observed in 6 cases.

Conclusions. RF ablation and internal fixation of impending femoral pathologic fractures can be combined in one stage procedure. Such method proved feasibility and efficiency for treatment of osteolytic and mixed metastatic lesions of proximal femur with low incidence of implant-related complications and lower risk of revisions.

About the authors

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg; Mechnikov North Western State Medical University, St. Petersburg

Email: fake@neicon.ru

Tikhilov Rashid M. - professor, director of Vreden Russian Research Institute of Traumatology and Orthopedics; professor of department of traumatology and orthopedics of Mechnikov NSMU

Russian Federation

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg; Mechnikov North Western State Medical University, St. Petersburg

Email: fake@neicon.ru

Ptashnikov Dmitry A. - professor, head of department N 18; the head of department of traumatology and orthopedics of Mechnikov NSMU 

Russian Federation

P. V. Grigoriev

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Author for correspondence.
Email: maddoc_pvg@mail.ru

Grigoriev Petr V. - research assistant of the department of bone tumors.

Ul. Akad. Baykova, 8, St. Petersburg, Russia, 195427; e-mail: maddoc_pvg@mail.ru Russian Federation

I. M. Mikailov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Email: fake@neicon.ru

Mikailov Ilkin M. - research assistant of the department of bone tumors

Russian Federation

P. J. Zasulsky

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Email: fake@neicon.ru

Zasulsky PhilippJu. - leading researcher of the department of bone tumors

Russian Federation

References

  1. Бухаров A.B., Тепляков В.В., Карпенко В.Ю., франк Г.А., Степанов С.О., Седых С.А. Радиочастотная термо-аблация в лечении пациентов с опухолевым поражением костей. Российский онкологический журнал. 2008; (5):15-21.
  2. Дианов С.В. Воздействие сверхнизких температур наопухолеподобные поражения костей при хирургическом лечении. Травматология и ортопедия России. 2008;2:57-60.
  3. Дианов С.В., Тарасов А.Н., Мочалов А.п. Отдаленные результаты криохирургического лечения опухолепо-добных поражений костей. Травматология и ортопедия России. 2012;(3):21-26.
  4. Жуков Н.В. Метастатическое поражение костей. Практическая онкология. 2009;10(3):125-130.
  5. Эоря В.И., Элобина Ю.С. патологические переломы костей конечностей метастатического происхождения (диагностика и лечение). Травматология и ортопедия России. 2008;1(47):27-33.
  6. Машков В.М., Несенюк Е.Л., Безродная Н.В., Шахматенко И.Е. Трансфеморальный доступ при ревизионных операциях эндопротезирования на тазобедренном суставе. Травматология и ортопедия России. 2006;(40):201.
  7. Петров В.Г., Гафтон Г.И., Семиглазов В.В., Тришкин В.А., Гудзь Ю.В., Иванова Т., Гафтон И.Г. Эффективность эндопротезирования при злокачественных опухолях конечностей. Вопросы онкологии. 2012;58(6): 727-735.
  8. Тихилов Р.М., Пташников Д.А., Эасульский ф.Ю., Микайлов И.М., Григорьев П.В., Плиев Д.Г. Ближайшие и среднесрочные результаты эндопротезирования тазобедренного сустава при опухолях проксимального отдела бедренной кости. Травматология и ортопедия России. 2014;(72):14-21.
  9. Bernthal N., Schwartz A., Oakes D., Kabo J.M., Eckardt J. How Long Do Endoprosthetic Reconstructions for Proximal Femoral Tumors Last? Clin Orthop Relat Res. 2010;468(11):2867-2874.
  10. Giacomo G.D., Ziranu A., Perisano C., Piccioli A., Maccauro G. Local Adjuvants in Surgical Management of Bone Lesions. J Cancer Ther. 2015;6:473-481.
  11. Chandrasekar C.R., Grimer R.J., Carter S.R., Tillman R.M., Abudu A. Modular endoprosthetic replacement for metastatic tumours of the proximal femur. J Bone Joint Surg Br. 2009;91:108-112.
  12. Cho H.S., Lee YK., Ha YCh., Koo KH. Trochanter/ calcar preserving reconstruction in tumors involving the femoral head and neck. WorldJ Orthop. 2016;7(7):442-447.
  13. Damron T.A., Morgan H., Prakash D., Grant W., Aronowitz J., Heiner J. Critical evaluation of Mirels' rating system for impending pathologic fractures. Clin Orthop Relat Res. 2003;415:201-207.
  14. Dijkstra S., Stapert J., Boxma H., Wiggers T. Treatment of pathological fractures of the humeral shaft due to bone metastases: a comparison of intramedullary locking nail and plate osteosynthesis with adjunctive bone cement. Eur J Surg Oncol. 1996;22:621-626.
  15. Gibbons C.E., Pope S.J., Murphy J.P., Hall A.J. Femoral metastatic fractures treated with intramedullary nailing. Int Orthop. 2000;24:101-103.
  16. Harrington K.D., Sim F.H., Enis J.E. et al. Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases. J Bone Joint Surg Am. 1976;58:1047-1055.
  17. Hattori H., Mibe J., Matsuoka H., Nagai S., Yamamoto K. Surgical management of metastatic disease of the proximal femur. J Orthop Surg (HongKong). 2007;15(3):295-298.
  18. Healey J.H., Brown H.K. Complications of bone metastases: surgical management. Cancer. 2000; 88(12 suppl):2940-2951.
  19. Hoffmann R.T., Jakobs T.F., Trumm C.J. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. Vasc Interv Radiol. 2008;19(3):419-425.
  20. Krol R., Radomski S. Fixation of pathological fractures and impending long bone fractures in the course of neoplastic disease with the use of polymethylmethacrylate with added methotrexate. Ortop Traumatol Rehabil. 2003;5:319-326.
  21. Kurup A.N., Callstrom M.R. Ablation of skeletal metastases: Current status. J Vasc Interv Radiol. 2010; 21:5242-5250.
  22. Maccauro G., Muratori F., Liuzza F., Rossi B., Ambrogio C. Anterograde femoral nail for the treatment of femoral metastases. Eur J Orthop Surg Traum. 2008;18(7):509-513.
  23. Masala S., Manenti G., Roselli M. et al. Percutaneous combined therapy for painful sternal metastases: a radiofrequencythermalablation(RFTA)andcementoplasty protocol. Anticancer Res. 2007;27:4259-4262.
  24. Moon B., Lin P., Satcher R., Bird J., Lewis V. Intramedullary nailing of femoral diaphyseal metastases: is it necessary to protect the femoral neck? Clin Orthop Relat Res. 2015;473(4):1499-1502.
  25. Obert L., Jarry A., Lepage D., Jeunet L., Tropet Y., Vichard P., Garbuio P. Centromedullary nailing of the femur for bone metastasis: clinical and radiological evaluation using the Tokuhashi score in 24 patients. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(8): 737-745.
  26. Ogura K., Miyake R., Shiina S. et al. Bone radiofrequency ablation combined with prophylactic internal fixation for metastatic bone tumor of the femur from hepatocellular carcinoma. Int J Clin Oncol. 2012;17(4):417-421.
  27. Ptashnikov D.A., Usikov V.D., Smecalenkov O.A., Mikhailov D.A. Percutaneous transpedicular fixation with cement vertebroplasty in patients with osteoporosis and widespread metastasis. Acta Neurochir. 2011;153(9):1889-1890.
  28. Ruairi F., QuinlanJ.F., Stapleton R.D., Hurson B., DudenyS., O'Toole G.C. Inter and intra-observer variability травматология и ортопедия россии 2016 22(3) 6 associated with the use of the Mirels' scoring system for metastatic bone lesions. Int Orthop. 2011;35(1):83-86.
  29. Shemesh S., Kosashvili Y., Sidon E., Yaari L., Cohen N., Velkes S. Intramedullary nailing without curettage and cement augmentation for the treatment of impending and complete pathological fractures of the proximal or midshaft femur. Acta Orthop Belg. 2014;(80):144-150.
  30. Sokolovski V.A., Voloshin V.P., Aliev M.D., Zubikov V.S., Saravanan S.A., Martynenko D.V. et al. Total hip replacement for proxial femoral tumours. Our midterm results. Int Orthop. 2006;30(5): 399-402.
  31. Tillman R.M. et al. British Association of Surgical Oncology. Guidelines for the Management of Metastatic Bone Disease in the United Kingdom. Eur J Surg Oncol. 1999:25:3-23.
  32. Wedin R., Bauer H.C.F. Surgical treatment of skeletal metastatic lesions of the proximal femur, endoprothesis or reconstruction nail? J Bone Joint Surg Br. 2005;85: 1653-1657.
  33. Weikert D.R., Schwartz H. Intramedullary nailing for impending pathological subtrochanteric fractures. J Bone Joint Surg Br. 1991;73:668-670.

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