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Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis

  • Authors:
    • Deng‑Xing Lun
    • Yong‑Cheng Hu
    • Xiong‑Gang Yang
    • Feng Wang
    • Zhao‑Wan Xu

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  • Published online on: January 16, 2018     https://doi.org/10.3892/ol.2018.7804
  • Pages: 3508-3517

  • Copyright: © Lun et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Reconstruction of bone defects following femoral diaphyseal tumor resection is challenging. Segmental allograft (SA) and intercalary prosthesis (IP) are the most common reconstruction methods for femoral diaphyseal metastatic tumors with pathological fracture. However, whether the complications and functional outcomes differ between SA and IP remains unclear. To compare the clinical outcomes and complications for patients treated with SA reconstruction or IP replacement for femoral shaft tumors, 34 patients who had undergone intercalary resection for metastatic tumor with pathological fracture in the femoral diaphysis were evaluated. Of these, 18 had received SA and 16 IP. There were 11 males, and 24 females, with a mean age of 64.5±11.3 years. The most common sites of primary metastases were lung (26.5%), breast (17.6%) and liver (14.7%). The visual analog scale (VAS), implant‑related complications and the Musculoskeletal Tumor Society (MSTS) scores for each patient were collected. The follow‑up period for patients ranged from 2 to 27 months. At the most recent follow‑up, 28 patients had succumbed to mortality, with a mean survival time of 6.9±3.7 months for the IP group and 7.4±3.0 months for the SA group. Patients with IP had a significantly shorter time to full weight bearing and hospitalization time than those who received SA (P=0.003 and P=0.002, respectively). The rates of overall complications and implant‑related complications were significantly lower for IP as compared with SA (18.8 vs. 66.7%, P=0.007; 12.5 vs. 55.6%, P=0.013). The reoperation rate of the SA group was higher than that of the IP group (38.9 vs. 12.5%), however the difference between the two groups was statistically insignificant (P=0.125). MSTS scores were significantly higher for the IP group as compared with the SA group at one month after surgery (IP, 26.7±1.6 vs. SA, 20.3±1.5; P<0.05), without a significant difference at the final follow‑up. There were no statistically significant differences in age, sex, length of resection, follow‑up time, operative time or blood loss between the two groups. In summary, IP reconstruction may provide improved early functional outcomes and fewer early complications, particularly for patients with a shorter life expectancy due to femoral metastatic tumors with pathological fracture.
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March-2018
Volume 15 Issue 3

Print ISSN: 1792-1074
Online ISSN:1792-1082

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Spandidos Publications style
Lun DX, Hu YC, Yang XG, Wang F and Xu ZW: Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis. Oncol Lett 15: 3508-3517, 2018.
APA
Lun, D., Hu, Y., Yang, X., Wang, F., & Xu, Z. (2018). Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis. Oncology Letters, 15, 3508-3517. https://doi.org/10.3892/ol.2018.7804
MLA
Lun, D., Hu, Y., Yang, X., Wang, F., Xu, Z."Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis". Oncology Letters 15.3 (2018): 3508-3517.
Chicago
Lun, D., Hu, Y., Yang, X., Wang, F., Xu, Z."Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis". Oncology Letters 15, no. 3 (2018): 3508-3517. https://doi.org/10.3892/ol.2018.7804