Abstract:
BACKGROUND:The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. QUESTIONS/PURPOSES:In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? METHODS:Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. RESULTS:Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The latter two complications resulted in amputation in two patients. The median MSTS score was 32 (range, 13-57). CONCLUSIONS:Despite attempts to select patients who might have anticipated greater life expectancy, eight of 11 patients died by 6 months after surgery, and an additional two patients had undergone an amputation at 8 and at 17 months postoperatively. Most patients undergoing total femur replacement in this series did not recover from the procedure by the time they died, despite our best attempts to perform the procedure in patients whom we thought would live at least 6 months. Based on this, we believe that most patients with extensive metastatic disease to the femur should be offered palliative care, rather than major reconstruction. LEVEL OF EVIDENCE:Level IV, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Sevelda F,Waldstein W,Panotopoulos J,Kaider A,Funovics PT,Windhager Rdoi
10.1007/s11999.0000000000000125subject
Has Abstractpub_date
2018-05-01 00:00:00pages
977-983issue
5eissn
0009-921Xissn
1528-1132journal_volume
476pub_type
杂志文章abstract:BACKGROUND:The use of traction during hip arthroscopy is commonly used to provide safe joint access and to improve visualization. However, traction during hip arthroscopy has been associated with complications ranging from transient neuropraxias to devastating soft-tissue necrosis. Trendelenburg positioning may be help...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
doi:10.1097/CORR.0000000000000804
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arth...
journal_title:Clinical orthopaedics and related research
pub_type: 历史文章,杂志文章
doi:10.1007/s11999-010-1733-6
更新日期:2011-09-01 00:00:00
abstract::A study of the injury fatality rate in an adult population was done in the Moscow region. Investigators determined that side by side with the severity of injury, the direct causes of death were erroneous diagnosis, ungrounded delay of surgical interventions, and lack of and insufficient use of necessary medical care. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::Degenerative arthritis of the wrist follows very specific patterns from onset to terminal severe bone and joint destruction. About 95% of them occur as periscaphoid area problems: SLAC (scapholunate advanced collapse pattern) wrist (55%), triscaphe arthritis (26%), and a combination of the two (14%). In SLAC wrist, th...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::The formation of heterotopic bone within soft connective tissue is a common feature of at least three distinct genetic disorders of osteogenesis in humans: fibrodysplasia ossificans progressiva; progressive osseous heteroplasia; and Albright hereditary osteodystrophy. The pathobiologic characteristics of osteogenic in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200005000-00028
更新日期:2000-05-01 00:00:00
abstract::The clinical and metallurgical performance of 12 retrieved Noiles total knee prostheses was investigated. Clinical histories and serial roentgenograms were used in conjunction with the American Society for Testing and Materials (ASTM) standard implant retrieval and analysis techniques to assess device performance. All...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
abstract::The authors reviewed 10 patients with subcapital fractures associated with extensive osteonecrosis of the femoral head and distinguished these fractures from traumatic femoral neck fractures The mean age of the patients was 52 years (range, 36-68 years). Nine patients were younger than 60 years. Eight patients had ris...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200109000-00026
更新日期:2001-09-01 00:00:00
abstract::Long thought to be expendable or insignificant for function, the menisci may well be very important structures in the knee joint. Menisci are of critical importance from the standpoint of stability, shock absorption, load transmission, and lubrication, and also play a role in preventing synovial impingement, and in de...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1980-09-01 00:00:00
abstract::Lead markers were placed on various osseous structures of the talus and calcaneus in fresh amputation specimens to analyze the radiographic anatomy of the hindfoot. Analysis of the talocalcaneal articulations revealed that only the central one-third of the posterior subtalar joint can be visualized on the lateral proj...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-07-01 00:00:00
abstract::If the underlying pathology of the syndrome of fat embolism is the presence of circulating emboli of neutral fat with adherent platelets and red blood cells, then one could expect certain changes in normal vascular cellular elements and fat metabolism, with resultant alterations in pulmonary function. In our series of...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-03-01 00:00:00
abstract:UNLABELLED:We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized con...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000198721.75976.d9
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND:Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity. QUESTIONS/PURPOSES:We therefore determined whether (1) biologic and treatment factors greater in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2524-z
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:For patients with failed surgical treatment of an infected TKA, salvage operations such as arthrodesis or above-knee amputation (AKA) may be considered. Clinical and institutional factors associated with AKA and arthrodesis after a failed TKA have not been investigated in a large-scale population, and the ut...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-017-5285-x
更新日期:2017-12-01 00:00:00
abstract::Loading of the lunate in patients with Kienböck's disease and a negative ulnar variance provide the rationale for a radial shortening osteotomy. This osteotomy decreases forces transmitted from the radius to the lunate. We retrospectively reviewed 12 patients with Kienböck's disease who had 13 radial shortening osteot...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/BLO.0b013e318041d309
更新日期:2007-07-01 00:00:00
abstract::Dual energy xray absorptiometry was investigated as a method for evaluation of the strength of closed tibial fractures. In 40 goats, a closed midshaft fracture was created in the left tibia. The fractures were stabilized with an external fixator. After 2 weeks (n = 21) and after 4 weeks (n = 19), both tibias were expl...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200011000-00035
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Kidney dysfunction (KD) after hip fracture surgery is a major complication. However, the incidence and risk factors of KD in this population are unclear. QUESTIONS/PURPOSES:We therefore (1) determined the incidence of KD in a large cohort of fracture patients, (2) identified preoperative risk factors predis...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3098-0
更新日期:2013-12-01 00:00:00
abstract::The objective of this study was to determine which criteria in the residency application had the highest correlation with subsequent performance of orthopaedic residents. Data collected from the application files of 58 residents included scores on standardized tests, number of honors grades in the basic and clinical y...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200206000-00034
更新日期:2002-06-01 00:00:00
abstract::The structure of the extracellular matrix of articular cartilage varies considerably with age. These changes are attributable to variations in molecular abundance and structure, and they can affect all the matrix components, but none more so than the proteoglycans. Some of these changes are attributable to variations ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200110001-00015
更新日期:2001-10-01 00:00:00
abstract::Radial polydactyly, a common congenital problem, most often occurs as thumb duplication. It appears in pentadactylous, polydactylous, and hypoplastic hands and is simulated by complex syndactyly. Classically, there are three categories for radial polydactyly: severe hypoplasia, partial duplication, and total duplicati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1985-05-01 00:00:00
abstract::An osteoid osteoma occurred in the distal femoral epiphysis of an 11-year-old boy. Only eight other cases of this tumor in an open epiphysis have been reported. An image intensifier was used to place the tip of a wire in the center lesion. Removal through a small incision with a bone trephine placed over a guiding Kir...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract::Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively follo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-0808-8
更新日期:2009-09-01 00:00:00
abstract::Moiré topography, a simple technique for three-dimensional quantitation, was used to provide interference fringe photographs of the human back with sufficient accuracy to be used for detecting children with asymmetry due to scoliosis. Experimental equipment, built and tested at the National Research Council of Canada,...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197711000-00019
更新日期:1977-11-01 00:00:00
abstract::Indwelling prosthetic joints may become colonized by microbial biofilms, although the biofilm structure, composition of the microbial community, and physiologic activity of the organisms in these devices are not well understood. New approaches that rely on the use of fluorescent stain technology can be used to charact...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000175120.66051.29
更新日期:2005-08-01 00:00:00
abstract::The authors reviewed the medical records of 53 patients with a lower cervical spine injury who were treated by anterior decompression, bone grafting, and instrumentation using an anterior cervical spine plate and screws. The average age of the patients was 36 years and the mean followup was 58 months. Twenty-six patie...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000068185.83581.cf
更新日期:2003-06-01 00:00:00
abstract::Twenty-two patients (23 shoulders) with arthrographically verified adhesive capsulitis of the glenohumeral joint were treated by a combination of distention-arthrography, local anesthetics and steroids intraarticularly, and manipulation. The mean duration of the disease at the time of treatment was 14 months, and all ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-09-01 00:00:00
abstract::Exogenous steroids are known to induce aseptic necrosis in the femoral head of adults. This case report of a 9-year-old girl with corticosteroid induced femoral head necrosis demonstrates effective treatment with an abduction device in a manner similar to that prescribed for the treatment of Legg-Calve-Perthes disease...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-06-01 00:00:00
abstract::Roentgen stereophotogrammetry allows one to localize the position of an object in space using roentgen rays. For orthopaedic purposes it was developed 35 years ago by Göran Selvik, and since that time many investigators have refined the radiostereometric calculations and evaluative software. Many uses and mathematical...
journal_title:Clinical orthopaedics and related research
pub_type: 历史文章,杂志文章
doi:10.1097/01.blo.0000224001.95141.fe
更新日期:2006-07-01 00:00:00
abstract::Osteopetrosis is an inherited skeletal condition characterized by increased bone radiodensity. There are three clinical groups: infantile-malignant autosomal recessive, fatal within the first few years of life (in the absence of effective therapy); intermediate autosomal recessive, appears during the first decade of l...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract::Twenty patients underwent operative arthroscopic procedures of the hip joint. All procedures were performed with the patient in the supine position on a standard fracture table using fluoroscopy through three arthroscopic portals (anterolateral, anterior paratrochanteric, and posterior paratrochanteric). The initial i...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199808000-00018
更新日期:1998-08-01 00:00:00
abstract::This biographical sketch of Marshall R. Urist corresponds to the historic texts, The Classic: Bone Morphogenetic Protein, available at DOI 10.1007/s11999-009-1068-3; The Classic: A Morphogenetic Matrix for Differentiation of Cartilage in Tissue Culture, available at DOI 10.1007/s11999-009-1069-2; and The Classic: A Mo...
journal_title:Clinical orthopaedics and related research
pub_type: 传,历史文章,杂志文章
doi:10.1007/s11999-009-1067-4
更新日期:2009-12-01 00:00:00