Treatment Outcomes and Quality of Life after the Implantation of Modular Prostheses of the Proximal Femur in Patients with Cancer Metastases

Abstract

BACKGROUND: Surgical treatment of pathological fractures of the proximal femur with intramedullary rods produces good short-term outcomes, but after some time the fixation often becomes unstable in patients with a good prognosis and a repeat surgery is required. Modular prostheses allow for better long-term outcomes. MATERIAL AND METHODS: A total of 64 surgical resection procedures for metastatic tumours of the proximal femur combined with the implantation of modular prostheses were performed at the Oncological Orthopaedics Department in Brzozow in 2010-2014. Modular prostheses were used in cases of extensive bone loss involving the proximal femoral epiphysis and metaphysis in patients in a good general condition. All patients were assessed with respect to their condition, pain intensity (VAS scale) and physical function according to the Karnofsky scale. After surgery, the patients underwent additional assessment of gait efficiency and performance with the MSTS and HHS scores. A total of 38 women and 26 men were operated on. The mean age was 66 years among the women and 69 years among the men. The follow-up period ranged from 3.6 to 1.2 years (1.8 years on average). RESULTS: A total of 28 GMRS (Stryker) and 36 MUTARS (Implantcast) endoprostheses were implanted. The implants were fixed with cement in 19 cases and cementless in 45 cases. All patients reported an improved quality of life after surgery. Mean pain intensity measured in a VAS scale was 3.8 and the Karnofsky physical function score was 65. Mean gait efficiency and performance assessed in the HHS and MSTS scores at 6 weeks post surgery was 75 and 20 points, respectively. All patients were able to walk and the majority could do so without crutches or using one crutch. Complications were rare. One patient experienced a massive relapse with implant loosening. There were no deep infections requiring implant removal and no implant loosening or dislocation. CONCLUSIONS: 1. Surgical treatment of bony metastases with modular prostheses leads to good outcomes. 2. As a surgical solution, modular prostheses considerably improve the quality of life and show slight positive progress in post-operative follow-up. 3. Complications in the form of infections, implant loosening or tumour relapse found in the patients were consistent with other literature reports.