Modular megaprosthesis in metastatic bone disease of the femur

The treatment of bone metastases is frequently palliative, aiming to achieve satisfactory pain control and to prevent or treat pathological fractures. For lesions involving the femur, internal fixation frequently fails; therefore, prosthetic reconstruction may be the optimal choice for treatment. This article retrospectively reviews our experience with femoral bone metastases between 1999 and 2008. A series of 22 patients (14 men and 8 women; mean age, 61.8 years) with femoral bone metastases were treated with resection and modular megaprosthetic reconstruction. Bipolar hip prostheses were used in 19 patients, intercalary prostheses were used in 2 patients, and total knee replacement was used in 1 patient. Oncologic outcome was evaluated, and functional outcomes were obtained by the Musculoskeletal Tumor Society (MSTS) score, which assigns numerical values (0-5) for each of 5 parameters, excluding emotional status. A numerical score (maximum 25 points) and percent rating was calculated. Six-month survival was 86.4%, 1-year survival was 54.2%, and 2-year survival was 37.1%. Three patients were unable to ambulate due to acute paraplegia with spinal metastases at the perioperative period. Excluding these 3 patients, average MSTS score was 62.3%. The MSTS score in patients surviving >12 months was 70.8% compared with a score of 46.4% in those living <12 months (P<.05). Complications included 2 dislocations. Megaprosthetic reconstruction provides for optimal treatment of femoral metastatic disease in patients with a prognosis of >12 months with satisfactory functional outcomes based on lower complications.