Prophylactic Stabilization for Bone Metastases, Myeloma, or Lymphoma: Do We Need to Protect the Entire Bone?

• DOI: 10.1007/s11999-012-2656-1
• Publication Date: 2012-10-26T14:14:42Z
• Authors: Hasham M. Alvi; Timothy A. Damron
• Keywords: Adult; Aged, 80 and over; Male; Humeral Fractures; Lymphoma; Arthroplasty, Replacement, Hip; Femoral Neoplasms; Embolism; Bone Neoplasms; Internal Fixators; 3. Good health; Arthroplasty; Fracture Fixation, Internal; 03 medical and health sciences; Fractures, Spontaneous; 0302 clinical medicine; Disease Progression; Humans; Female; Hemiarthroplasty; Arthroplasty, Replacement, Knee; Femoral Fractures; Aged

The current operative standard of care for disseminated malignant bone disease suggests stabilizing the entire to avoid need subsequent intervention but risks doing so include complications related embolic phenomena.We questioned whether progression and reoperation occur with enough frequency justify additional longer intramedullary devices.A retrospective chart review was done 96 patients metastases, myeloma, or lymphoma who had undergone stabilization arthroplasty impending actual femoral humeral pathologic fractures using an approach favoring fixation devices long-stem arthroplasty. Incidence progressive disease, reoperation, associated in instrumented femurs humeri determined.At minimum 0 months followup (mean, 11 months; range, 0-72 months), 80% died. Eleven (12%) experienced local bony progression; eight at original site, two originally recognized discretely separate lesions, one a new lesion develop that surgically treated. Six subjects (6.3%) required repeat symptomatic failure. Twelve (12.5%) physiologic nonfatal potentially attributable phenomena from long implants.Because most this series were treated intent protect implants when possible, rate may be lower than if not been protected. However, low incidence apart identified lesions (one 96) considerably complication (12 implants.Level IV, therapeutic study. See Guidelines Authors complete description levels evidence.