Abstract:
BACKGROUND:Prophylactic surgical treatment of the femur is commonly offered to patients with metastatic disease who have a high risk of impending pathologic fracture. Prophylactic fixation is associated with improved functional outcomes in appropriate patients selected based on established criteria, but the perioperative complication profile has received little attention. Given the substantial comorbidity in this population, it is important to characterize surgical risks for surgeons and patients to improve treatment decisions. QUESTIONS/PURPOSES:(1) What is the incidence of postoperative adverse events after prophylactic surgical stabilization of metastatic lesions of the femoral shaft or distal femur? (2) How does this complication profile compare with stabilization of pathologic fractures adjusted for differences in patient demographics and comorbidity? METHODS:We performed a retrospective study using the National Surgical Quality Improvement Program (NSQIP) database. We identified patients undergoing prophylactic treatment of the femoral shaft or distal femur by Current Procedural Terminology (CPT) codes. Patients undergoing treatment of a pathologic fracture were identified by CPT code for femur fracture fixation as well as an International Classification of Diseases code indicating neoplasm or pathologic fracture. We tracked adverse events, operative time, blood transfusion, hospital length of stay, and discharge to a facility within 30 days postoperatively. There were 332 patients included in the prophylactic treatment group and 288 patients in the pathologic fracture group. Patients in the prophylactic treatment group presented with greater body mass index (BMI), whereas the pathologic fracture group presented with a greater incidence of disseminated cancer. The odds of experiencing adverse events were initially compared between the two groups using bivariate logistic regression and then using multivariate regression controlling for age, sex, BMI, and American Society of Anesthesiologists (ASA) class and disseminated cancer causing marked physiological compromise per NSQIP guidelines. RESULTS:With multivariate analysis controlling for age, sex, BMI, and ASA class, patients with pathologic fracture were more likely to experience any adverse event (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.03-2.29; p = 0.036), major adverse events (OR, 1.61; 95% CI, 1.01-2.55; p = 0.043), death (OR, 1.90; 95% CI, 1.07-3.38; p = 0.030), blood transfusion (OR, 1.57; 95% CI, 1.08-2.27; p = 0.017), and hospital stay ≥ 9 days (OR, 1.51; 95% CI, 1.05-2.19; p = 0.028) compared with patients undergoing prophylactic treatment. However, when additionally controlling for disseminated cancer, the only difference was that patients with pathologic fractures were more likely to receive a blood transfusion than were patients undergoing prophylactic fixation (OR, 1.61; 95% CI, 1.12-2.36; p = 0.011). CONCLUSIONS:After controlling for differences in patient characteristics, prophylactic treatment of femoral metastases was associated with a decreased likelihood of blood transfusion and no differences in terms of the frequency of other adverse events. In the context of prior studies supporting the mechanical and functional outcomes of prophylactic treatment, the findings of this cohort suggest that the current guidelines have achieved a reasonable balance of morbidity in patients with femoral lesions and further support the current role of prophylactic treatment of impending femur fractures in appropriately selected patients. LEVEL OF EVIDENCE:Level III, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
McLynn RP,Ondeck NT,Grauer JN,Lindskog DMdoi
10.1097/CORR.0000000000000489subject
Has Abstractpub_date
2018-12-01 00:00:00pages
2381-2388issue
12eissn
0009-921Xissn
1528-1132journal_volume
476pub_type
杂志文章abstract:UNLABELLED:Ten patients who had reconstruction of the acromion and deltoid in a painful dysfunctional shoulder after an acromionectomy were reviewed with respect to pain, range of motion, strength, patients' satisfaction, and complications. There were four total acromionectomies, five subtotal acromionectomies, and one...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章
doi:10.1097/01.blo.0000146535.77776.5f
更新日期:2005-01-01 00:00:00
abstract::A prospective study of 236 patients with neglected femoral neck fractures was done to determine the usefulness of a preoperative classification based on the radiologic changes that occur at the site of the fracture. Thirty-four patients were observed in Group I, 125 patients were observed in Group II, and nine patient...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:2005-02-01 00:00:00
abstract:UNLABELLED:Acetabular component orientation during total hip arthroplasty affects dislocation, range of motion, polyethylene wear, pelvic osteolysis, and component migration. New total hip arthroplasty navigation systems have been introduced to avoid the errors reported after acetabular component orientation using a ma...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000201165.82690.f8
更新日期:2006-04-01 00:00:00
abstract::The ability to forecast the course and outcome of severe mechanical trauma would aid clinicians in making decisions concerning the treatment of patients. Multifactorial regression models, developed from data obtained from 933 patients with polytrauma and shock, have a high predictive value. A two-part data sheet was d...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-05-01 00:00:00
abstract::A diskoid medial meniscus is a rare finding occurring in approximately 0.3% of the general population. Bilateral medial diskoid menisci are even less common, with only three other cases appearing in the literature. This may be the first reported case of bilateral medial diskoid menisci diagnosed by magnetic resonance ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract::Spinal cord injury (SCI) results in multiple degenerative changes that may in part be related to physical inactivity. There are indications that some of these changes may be reversed by exercise and fitness training. Computerized functional electrical stimulation (FES) allows active exercise of limbs paralyzed by uppe...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract::Endoprosthetic proximal femur replacement is a well-accepted method for treatment of primary bone tumors; however the functional results of treatment are not well documented. To evaluate functional outcomes, we recorded the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society 1987 and 1993 scores in 29 pa...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000136840.67864.78
更新日期:2004-09-01 00:00:00
abstract::The effects of chondroitinase ABC on surgically induced degenerative rabbit intervertebral discs were determined during a 12-week period by magnetic resonance imaging, radiography, and histologic examination. Rabbit intervertebral discs were surgically extruded, inducing disc degeneration 12 weeks before injection of ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract:BACKGROUND:Virtual fracture clinics are an alternative to the traditional model of fracture care. Since their introduction in 2011, they have become increasingly used in the United Kingdom and Ireland. The coronavirus disease 2019 (COVID-19) health crisis has driven institutions to examine such innovative solutions to ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001388
更新日期:2020-11-01 00:00:00
abstract::Osteonecrosis of the talus secondary to adrenal corticosteroids is rare. The pathophysiology of the disorder is controversial. This is a report of bilateral talar necrosis secondary to steroid medications in a 23-year-old male. Conservative methods of management of the condition are not altogether satisfactory. Bilate...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
abstract::Contemporary management of Grade IIIB open tibial fractures has evolved to include intravenous antibiotics, thorough interval surgical debridement, rigid skeletal fixation, early local or free tissue myoplasty, and liberal use of autogenous bone graft beneath a clean, stable wound. External fixation has been the skele...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,meta分析
doi:10.1097/00003086-199611000-00003
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:MRI is the gold standard for evaluating the relationship of disc material to soft tissue and neural structures. However, terminologies used to describe lumbar disc herniation and nerve root compression have always been a source of confusion. A clear understanding of lumbar disc terminology among clinicians, ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-014-3674-y
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Patient expectations may affect their satisfaction and functional outcomes after treatment of musculoskeletal injuries. Although there is evidence that patient expectations of ACL reconstruction (ACLR) are inflated, there is limited knowledge about the relationship between physician and patient expectations ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001082
更新日期:2020-03-01 00:00:00
abstract::Highly cross-linked polyethylene (PE) has been introduced as an alternative bearing material in total hip arthroplasty (THA) because of high wear resistance in laboratory tests but the clinical experience of this material is limited. We evaluated a highly cross-linked PE (warm irradiated adiabatic melting, absorbed do...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.blo.0000096802.78689.45
更新日期:2003-12-01 00:00:00
abstract::Local antibiotic delivery is an emerging area of study designed to provide alternative methods of treatment to clinicians for compromised wound sites where avascular zones can prevent the delivery of antibiotics to the infected tissue. Antibiotic-loaded bone cement is the gold standard for drug-eluting local delivery ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0228-1
更新日期:2008-06-01 00:00:00
abstract::Cross-linked polyethylene currently is being introduced in knee prostheses. The wear rates, wear debris, and biologic reactivity of non cross-linked, moderately cross-linked, and highly cross-linked polyethylene have been compared in multidirectional wear tests and knee simulators. Multidirectional pin-on-plate wear s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000148783.20469.4c
更新日期:2004-11-01 00:00:00
abstract::Myositis ossificans of the thigh produced severe limitation of knee motion in a 22-year-old man after passive manipulation of a knee on three separate occasions. Motion improved after excision of the bony mass and postoperative radiation to prevent recurrence. Caution is advised in passive manipulation of the knee, be...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-09-01 00:00:00
abstract::Decisions made regarding resumption of driving after total hip arthroplasty may be determined by a combination of factors including driving reaction time and when postsurgical precautions need no longer be adhered to. Ninety patients, ranging in age from 34 to 85 years old were recruited after total hip arthroplasty t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000072468.32680.ff
更新日期:2003-08-01 00:00:00
abstract::The aseptically loosened prosthesis provided a means for investigating the in vivo and in vitro activity of the cells associated with the loosening process in seven dogs. The cells were isolated and maintained in culture for sufficient periods of time so that their biologic activity could be studied as well as the eff...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-12-01 00:00:00
abstract::Fifty years ago Albright contributed the following to understanding osteoporosis: (1) He recognized it as a deficiency of formation, not of mineralization of bone matrix; (2) he observed that 40 of 42 patients with osteoporosis before age 65 were women past menopause or young women postoophorectomy; (3) he concluded t...
journal_title:Clinical orthopaedics and related research
pub_type: 传,历史文章,杂志文章
doi:
更新日期:1991-08-01 00:00:00
abstract::Fifteen patients with fracture of the axis arch ("Hangman's Fracture" of the cervical spine) reviewed with regard to the clinical features, mechanism of injury and management, present a relatively high rate of cord involvement (11 patients) and injuries around the jaw (5 patients). All of the injuries occurred in civi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197501000-00024
更新日期:1975-01-01 00:00:00
abstract::Musculoskeletal injuries are a major public health problem globally, contributing a large burden of disability and suffering. This burden could be considerably lowered by implementation of affordable and sustainable strategies to strengthen orthopaedic trauma care, especially in low- and middle-income countries. This ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-008-0416-z
更新日期:2008-10-01 00:00:00
abstract::A quantitative three-dimensional measurement method, radiographic stereophotogrammetry (SPG), was employed to assess the relation between early subsidence of the femoral prosthesis after total hip arthroplasty (THA) and subsequent clinical course. The SPG technique and the authors' error control mechanisms are describ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-12-01 00:00:00
abstract::It is now well established that the meniscus performs a number of roles that are important to the efficient performance of the knee joint. Of particular importance is the recognition of its load-bearing function and its stabilization of the joint during flexion-extension. The compression of the wedge-shaped meniscus d...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1987-11-01 00:00:00
abstract:BACKGROUND:Despite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4350-6
更新日期:2016-02-01 00:00:00
abstract::In the process of prosthetic loosening, the initial motion of the implant relative to the bone is a key element. In order to provide quantitative information, three straight and one curved cementless hip stems were submitted to in vitro tests in autopsy specimens of the femur under dynamic axial and torsional loads wi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-11-01 00:00:00
abstract::Titanium implants are an alternative to stainless steel implants for internal fixation after fracture. The advantages of titanium include decreased implant stiffness, increased bio-compatibility, and diminished stress shielding. However, titanium has been implicated in tendon irritation and adhesions when used in the ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000205894.98361.29
更新日期:2006-04-01 00:00:00
abstract::The impact of preoperative gait analysis on the orthopaedic care of 97 patients (101 gait analyses) at the authors' institution was evaluated. For the 70 patients for whom a specific treatment plan had been outlined before the preoperative gait study, the treatment plan was altered in 62 (89%) after the gait analysis ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200003000-00023
更新日期:2000-03-01 00:00:00
abstract::Histomorphologic analyses of artificial joint components implanted into bone need special technology for processing and for documentation; published histological work systematically done therefore is rare. The histopathology, three-dimensionally analyzed in a complete sequence of sections is, however, the only precise...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000150424.59854.7b
更新日期:2005-01-01 00:00:00
abstract::Degenerative changes in the spine, specifically disc degeneration and facet arthrosis, and osteoporosis are conditions that primarily affect the elderly and may significantly impact the quality of life. The relationship between osteoporosis and degenerative changes in the hip joint has been studied, but their correlat...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199603000-00017
更新日期:1996-03-01 00:00:00