1
|
Zhu C, Ji Z, Zhu J, Xu H, Li S, Liu C, Wei B. Perioperative Administration of Tranexamic Acid and Low Molecular Weight Heparin for Enhanced Blood Management in Intertrochanteric Fractures: A Randomized Controlled Study. Med Sci Monit 2024; 30:e944063. [PMID: 38875178 PMCID: PMC11184985 DOI: 10.12659/msm.944063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/24/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND This prospective study from a single center aimed to compare the perioperative blood loss (PBL) in 79 patients with intertrochanteric fractures (IF) treated with intramedullary nailing (IMN) using 3 regimens of combined tranexamic acid (TXA) and low molecular weight heparin (LMWH), proposing a novel therapy of 4-dose TXA. MATERIAL AND METHODS We recruited 79 patients and randomly divided them into 3 groups. The 4-dose TXA group (22 patients) received 1.0 g intravenous TXA 30 min before surgery and 1.0 g at intervals of 3, 6, and 9 h before surgery. The 1-dose TXA group (25 patients) received 1.0 g intravenous TXA 30 min before surgery, while the control group (32 patients) did not receive TXA. LMWH was applied 12 h after surgery in each group. The primary metrics evaluated included hidden blood loss (HBL), total blood loss (TBL), and the number and incidence rate of deep vein thrombosis (DVT). RESULTS Analysis of the HBL revealed that the 4-dose TXA group had the lowest average (583.13±318.08 ml), followed by the 1-dose TXA group (902.94±509.99 ml), and the control group showed the highest (1154.39±452.06 ml) (P<0.05). A similar result was observed for TBL (4-dose group: 640.86±337.22 ml, 1-dose group: 971.74±511.14 ml, control group: 1226.27±458.22 ml, P<0.05). Regarding DVT, the 4-dose TXA group had 5 cases (incidence rate 22.73%), the 1-dose TXA group had 6 cases (incidence rate 24.00%), and the control group had 8 cases (incidence rate 25.00%), with no significant difference among groups (P>0.05). CONCLUSIONS Treatment using 4-dose TXA and LMWH can effectively reduce PBL without increasing the DVT risk in IF patients with IMN.
Collapse
|
2
|
Yüce A, Yerli M, Erkurt N, Akdere KB, Bayraktar MK, Çakar M, Adaş M. Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis. Indian J Orthop 2024; 58:542-549. [PMID: 38694690 PMCID: PMC11058733 DOI: 10.1007/s43465-024-01121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Background Proximal femur resection and prosthetic reconstruction are preferred in patients with extensive bone destruction, pathological fractures, tumours resistant to radiation therapy, and patients with more proximal metastatic lesions. There is increasing evidence that the CRP/albumin ratio (CAR) is an independent marker of inflammation in various primary organ cancers and maybe a more accurate prognostic factor. We aimed to evaluate whether preoperative and postoperative CAR values could be a factor in predicting mortality in these patients. We hypothesized that CAR could predict these patients' postoperative 90-day and 1-year mortality. Methods The patient's age and gender, primary tumour, number of bone metastases, and presence of visceral metastases were recorded using imaging techniques such as computed tomography and bone scan or positron emission tomography. The following laboratory data were analyzed before and after surgery. Results The mean age of the patients was 62.67 ± 14.8; 56.9% were female (n:29), and 43.1% were male (n:22). When the results of the ROC analysis of the parameters in predicting 1-year mortality were examined, and the cut-off value for preoperative albumin was taken as ≤ 3.75, the AUC value was found to be statistically significant as 0.745 (p:0.003). When the cut-off value for postoperative CAR was taken as ≥ 87.32, the AUC value was found to be 0.7 statistically significant (p:0.015). Conclusion Length of stay, preoperative albumin and postoperative CAR values can be used as independent predictive values in predicting 1-year mortality in patients undergoing endoprosthesis due to proximal femur metastasis.
Collapse
Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Nazım Erkurt
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Kamil Berkay Akdere
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mehmet Kürşad Bayraktar
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Murat Çakar
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Müjdat Adaş
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Tepper SC, Lee L, Kasson LB, Herbst LR, Vijayakumar G, Colman MW, Gitelis S, Blank AT. Hip Arthroplasty Outcomes in Patients with Metastatic Bone Disease. Orthop Rev (Pavia) 2024; 16:94568. [PMID: 38505134 PMCID: PMC10950198 DOI: 10.52965/001c.94568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background/Objective The hip is a common location for metastatic bone disease (MBD) and surgical intervention is often indicated to relieve pain and improve function. MBD of the hip is usually treated with hemiarthroplasty or with total hip arthroplasty if there are acetabular lesions. As treatment for metastatic disease evolves and patients may expect to live longer after diagnosis, further evaluation of the complications and functional outcomes associated with hip arthroplasty for MBD are necessary. Methods This was a retrospective review of patients who underwent hip arthroplasty for MBD at a single institution between 2007 and 2021. Outcomes included rates of reoperation, complications, and overall survival. Results Ninety-three cases in 91 patients were included. Total hip arthroplasty (THA) was performed in 52 cases (55.9%), hemiarthroplasty in 15 (16.1%), and complex arthroplasty, including proximal femur replacement or THA with complex acetabular reconstruction, was performed in 26 (28%). There were 11 reoperations in five patients and six dislocations. Median survival was 10.4 months and one-year overall survival was 53.3%. There was a significant increase in the proportion of patients who were able to ambulate independently (35.2% vs 17.6%; p=0.02) and a significant decrease in patients confined to a wheelchair (18.7% vs 3.3%; p=0.045) after surgery. Conclusions Hip arthroplasty for MBD leads to relatively low rates of complications and reoperations in this population known to have high postoperative morbidity and mortality. Hip arthroplasty provides the majority of MBD patients with a durable reconstruction that exceeds their lifespan and enables them to return to an acceptable level of function.
Collapse
|
4
|
Ataei A, Eggermont F, Verdonschot N, Lessmann N, Tanck E. The effect of deep learning-based lesion segmentation on failure load calculations of metastatic femurs using finite element analysis. Bone 2024; 179:116987. [PMID: 38061504 DOI: 10.1016/j.bone.2023.116987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Bone ranks as the third most frequent tissue affected by cancer metastases, following the lung and liver. Bone metastases are often painful and may result in pathological fracture, which is a major cause of morbidity and mortality in cancer patients. To quantify fracture risk, finite element (FE) analysis has shown to be a promising tool, but metastatic lesions are typically not specifically segmented and therefore their mechanical properties may not be represented adequately. Deep learning methods potentially provide the opportunity to automatically segment these lesions and change the mechanical properties more adequately. In this study, our primary focus was to gain insight into the performance of an automatic segmentation algorithm for femoral metastatic lesions using deep learning methods and the subsequent effects on FE outcomes. The aims were to determine the similarity between manual segmentation and automatic segmentation; the differences in predicted failure load between FE models with automatically segmented osteolytic and mixed lesions and the models with CT-based lesion values (the gold standard); and the effect on the BOne Strength (BOS) score (failure load adjusted for body weight) and subsequent fracture risk assessments. From two patient cohorts, a total number of 50 femurs with osteolytic and mixed metastatic lesions were included in this study. The femurs were segmented from CT images and transferred into FE meshes. The material behavior was implemented as non-linear isotropic. These FE models were considered as gold standard (Finite Element no Segmented Lesion: FE-no-SL), whereby the local calcium equivalent density of both femur and metastatic lesion was extracted from CT-values. Lesions in the femur were manually segmented by two biomechanical experts after which final lesion segmentation for each femur was obtained based on consensus of opinions between two observers. Subsequently, a self-configuring variant of the popular deep learning model U-Net known as nnU-Net was used to automatically segment metastatic lesions within the femur. For these models with segmented lesions (Finite Element with Segmented Lesion: FE-with-SL), the calcium equivalent density within the metastatic lesions was set to zero after being segmented by the neural network, simulating absence of load-bearing capacity of these lesions. The models (either with or without automatically segmented lesions) were loaded incrementally in axial direction until failure was simulated. Dice coefficient was used to evaluate the similarity of the manual and automatic segmentation. Mean calcium equivalent density values within the automatically segmented lesions were calculated. Failure loads and patterns were determined. Furthermore, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both groups by comparing the predictions to the occurrence or absence of actual fracture within the patient cohorts. The automatic segmentation algorithm performed in a none-robust manner. Dice coefficients describing the similarity between consented manual and automatic segmentations were relatively low (mean 0.45 ± standard deviation 0.33, median 0.54). Failure load difference between the FE-no-SL and FE-with-SL groups varied from 0 % to 48 % (mean 6.6 %). Correlation analysis of failure loads between the two groups showed a strong relationship (R2 > 0.9). From the 50 cases, four cases showed clear deviations for which models with automatic lesion segmentation (FE-with-SL) showed considerably lower failure loads. In the whole database including osteolytic and mixed lesions, sensitivity and NPV remained the same, but specificity and PPV decreased from 94 % to 83 %, and from 78 % to 54 % respectively from FE-no-SL to FE-with-SL. This study indicates that the nnU-Net yielded none-robust outcomes in femoral lesion segmentation and that other segmentation algorithms should be considered. However, the difference in failure pattern and failure load between FE models with automatically segmented osteolytic and mixed lesions were relatively small in most cases with a few exceptions. On the other hand, the accuracy of fracture risk assessment using the BOS score was lower compared to the FE-no-SL. In conclusion, this study showed that automatic lesion segmentation is a none-solved issue and therefore, quantifying lesion characteristics and the subsequent effect on the fracture risk using deep learning will remain challenging.
Collapse
Affiliation(s)
- Ali Ataei
- Orthopaedic Research Lab, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Florieke Eggermont
- Orthopaedic Research Lab, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Lab, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands; Laboratory for Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboud university medical center, Nijmegen, the Netherlands
| | - Esther Tanck
- Orthopaedic Research Lab, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Zhang C, He H, Tong X, Zeng H, Qiu X, Liu Q. Synthetic Ligament-Assisted Functional Soft-Tissue Reconstruction in Tumor-Related Proximal Femoral Replacements. J Arthroplasty 2024; 39:472-479. [PMID: 37598780 DOI: 10.1016/j.arth.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Soft-tissue functional reconstruction is important for restoring hip function in proximal femoral replacement for tumor resection. This study evaluated the functional outcome and postoperative complications of a specific synthetic ligament for soft-tissue functional reconstruction in proximal femoral replacement for tumor resection. METHODS This cohort included 80 patients (40 men and 40 women, mean age, 40 years (range, 10 to 79)) who had benign invasive tumors (n = 13), primary malignant bone tumors (n = 40), or bone metastases (n = 27). Patients' medical records, imaging files, surgical details, and postoperative pathological diagnoses were collected. Tumor staging was performed with the Enneking staging criteria. Lower limb and hip functions were assessed using the Musculoskeletal Tumor Society scoring system and Harris Hip score, respectively. RESULTS Mean postoperative Musculoskeletal Tumor Society and Harris Hip scores were 27 (range, 24 to 30) and 90 (range, 76 to 97), respectively, indicating satisfactory range of motion and stability. Trendelenburg gait was observed in 3 osteosarcoma patients (3.8%), and 6 patients showed unequal lower-limb lengths. Reoperations occurred in 5 cases, including 3 cases of deep vein thromboses and 1 case each of giant cell granuloma and periprosthetic infection. There were 27 patients who had bone metastases who did not require reoperation. CONCLUSIONS The synthetic ligament reconstruction of the hip with proximal femoral replacement for tumor resection was associated with improved outcomes. Its implementation exhibits the potential to reduce postoperative incidences of hip dislocation and periprostheses infection, thereby warranting its prospective clinical application.
Collapse
Affiliation(s)
- Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Xiaopeng Tong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinzhu Qiu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| |
Collapse
|
6
|
Farho MA, Sawas MN, Alnajjar M, Al-Kurdi MAM, Nawlo A, Alloush H. Subtrochanteric fracture in previously treated breast cancer patient handled by proximal femoral nail: A case report. Int J Surg Case Rep 2023; 108:108411. [PMID: 37354822 PMCID: PMC10382742 DOI: 10.1016/j.ijscr.2023.108411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION Breast cancer (BC) is the most common and high mortality rate cancer in females. The main complication of BC is metastases, where bone metastases (BM) are present in 90 % of women with distant metastases and commonly recurrence after BC therapy. However, treatment options are numerous, and improving patients' quality of life (QoL) is a priority. PRESENTATION OF CASE A 58-year-old female patient presented to the emergency department with pain and movement restriction in the right lower extremity after minor trauma. Clinical history included a surgically resected BC eight years ago, besides chemotherapy and radiotherapy. After clinical and radiographic examination, we encountered a subtrochanteric femoral fracture although the patient is in the end stage, the multidisciplinary team discussed the surgery option with the patient and eventually internally fixed the fracture. DISCUSSION Subtrochanteric femur fractures represent a challenging orthopedic issue, ranging from 10 % to 34 % of all hip fractures. Hence, after a detailed discussion, the proximal femoral nail (PFN) was the procedure of choice acording to the patient's preferences and tumor prognosis. Proximal femoral metastasis treatment aims to improve the quality of life (QoL), alleviate bone pain, and rehabilitate skeletal function. CONCLUSION In this case report, we highlight the surgical decision consequences for a patient with end-stage cancer, as it may put their life at risk or improve their QoL, likewise the patient in this report.
Collapse
Affiliation(s)
- Mohamad Ali Farho
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Mohamad Nabhan Sawas
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Maen Alnajjar
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Mohammed Al-Mahdi Al-Kurdi
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ahmad Nawlo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Hani Alloush
- Department of Orthopaedic Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| |
Collapse
|
7
|
Jiang W, Friedlaender G, Lindskog D, Latich I, Lee FY. Comparison of Percutaneous Interventional Ablation-Osteoplasty-Reinforcement-Internal Fixation (AORIF), Long Intramedullary Nailing, and Hemiarthroplasty for the Treatment of Focal Metastatic Osteolytic Lesions in the Femoral Head and Neck. Cardiovasc Intervent Radiol 2023; 46:649-657. [PMID: 37052716 DOI: 10.1007/s00270-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Osteolytic metastatic lesions in the femoral head and neck are traditionally treated with intramedullary long nailing (IM) or hemiarthroplasty (HA). Recovery, surgical complications, and medical co-morbidities delay oncologic care. This study sought to elucidate the comparative efficacy of percutaneous ablation-osteoplasty-reinforcement-internal fixation (AORIF), IM, and HA in stabilizing osteolytic lesions in the femoral head and neck. METHODS A retrospective study of 67 patients who underwent IM, AORIF, or HA for osteolytic femoral head and neck lesions was performed. Primary outcome was assessed using a combined pain and ambulatory score (Range 1-10: 1 = bedbound, 10 = normal ambulation) at first follow-up (~ 2 weeks). Surgical complications associated with each treatment were compared. RESULTS Sixty-seven patients (mean age, 65 ± 13, 36 men and 31 women) underwent IM (40), AORIF (19), and HA (8) with a mean follow-up of 9 ± 11 months. Two patients in the IM group (5%), three in the AORIF group (16%), and none in the HA (0%) group required revision procedures. AORIF demonstrated superior early improvement in combined pain and ambulatory function scores by 3.0 points [IQR = 2.0] (IM p = 0.0008, HA p = 0.0190). Odds of post-operative complications was 10.3 times higher in HA than IM (95% confidence interval 1.8 to 60.3). Future revision procedures were not found to be statistically significant between AORIF and IM (p = 0.234). CONCLUSIONS A minimally invasive interventional skeletal procedure for focal femoral head and neck osteolytic lesions may serve as an effective alternative treatment to traditional surgical approaches, conferring a shorter recovery time and fewer medical complications.
Collapse
Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Gary Friedlaender
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Dieter Lindskog
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale Interventional Radiology, 47 College Pl., New Haven, CT, 06510, USA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA.
| |
Collapse
|
8
|
Banskota N, Fang X, Yuan D, Lei S, Zhang W, Duan H. Comparative Study of Proximal Femur Bone Tumor Patients Undergoing Hemiarthroplasty versus Total Hip Arthroplasty: A Meta-Analysis. J Clin Med 2023; 12:jcm12031209. [PMID: 36769857 PMCID: PMC9918064 DOI: 10.3390/jcm12031209] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Hemiarthroplasty and total hip arthroplasty are routinely performed procedures. A comparison of these procedures in tumor patients can be performed based on complications and functional outcomes. To weigh the advantages and disadvantages of both procedures, a comparative study is indeed required to decide which procedure is more beneficial for primary bone tumor patients. The outcomes of proximal femur tumor-resected patients were collected from research reports from PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar until 30 December 2022. Differences between these two operative procedures in primary bone tumors patients were analyzed based on dislocation, infection, local recurrence, MSTS, and HHS. Six articles were included according to the selection criteria with a total of 360 patients. Our results showed that there was a significant difference in our primary outcome as hemiarthroplasty participants encountered less dislocation than those with total hip arthroplasty. Moreover, the secondary outcomes of our study were similar. Proximal femur bone tumors, when resected, tend to produce more complications and decrease functional ability due to extensive tumor extension and soft tissue involvement. The lower dislocation rate in hemiarthroplasty participants emphasizes the importance of preserving the acetabular head in hemiarthroplasty as a key to preventing dislocation.
Collapse
Affiliation(s)
| | | | | | | | - Wenli Zhang
- Correspondence: (W.Z.); (H.D.); Tel.: +86-18980601402 (H.D.)
| | - Hong Duan
- Correspondence: (W.Z.); (H.D.); Tel.: +86-18980601402 (H.D.)
| |
Collapse
|
9
|
Jouma Alhejazi T, Bdeiwi H, Sukkari MW, Ibrahim M, Sukari A, Alloush H. Femoral metastasis in previously treated bladder cancer patient: A case report. Clin Case Rep 2022; 10:e6357. [PMID: 36177084 PMCID: PMC9474905 DOI: 10.1002/ccr3.6357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Although treated appropriately, bladder cancer can recur and metastasize. We are reporting the case of a patient with a well‐cured bladder cancer who presented after 14 months with femoral pain which turned out to be a bony metastasis. The patient underwent surgical excision followed by chemotherapy. Secondary bone metastases from a primary transitional carcinoma in the bladder are very rare. In this case, we present a femoral metastasis from a primary urothelial carcinoma in the bladder that had been successfully treated 14 months earlier.
Collapse
Affiliation(s)
| | - Hassan Bdeiwi
- Faculty of Medicine University of Aleppo Aleppo Syria
| | | | | | - Ammar Sukari
- Department of Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Hani Alloush
- Department of Orthopedic Surgery Faculty of Medicine, Aleppo University Hospital, University of Aleppo Aleppo Syria
| |
Collapse
|
10
|
Errani C. Treatment of Bone Metastasis. Curr Oncol 2022; 29:5195-5197. [PMID: 35892980 PMCID: PMC9331427 DOI: 10.3390/curroncol29080411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
The incidence of metastatic bone disease is increasing, as patients with cancer are living longer [...]
Collapse
Affiliation(s)
- Costantino Errani
- III Clinica di Ortopedia e Traumatologia, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
11
|
Megaprosthesis for Metastatic Bone Disease—A Comparative Analysis. Curr Oncol 2022; 29:3460-3471. [PMID: 35621669 PMCID: PMC9139992 DOI: 10.3390/curroncol29050279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 01/14/2023] Open
Abstract
Background: Megaprosthetic reconstruction is sometimes indicated in advanced metastatic bone disease (MBD) of the appendicular skeleton with large degrees of bone loss or need for oncological segmental resection. Outcome after megaprosthetic reconstruction was studied in the setting of primary bone sarcoma with high levels of complications, but it is not known if this applies to MBD. Method: We performed a comparative analysis of complications and revision surgery for MBD and bone sarcoma surgery in an institutional cohort from 2005–2019. Presented are the descriptive data of the cohort, with Kaplan–Meier (K–M) rates of revision at 1, 2 and 5 years together with a competing risk analysis by indication type. Results: Rates of revision surgery are significantly lower for MBD (8% at 1 year, 12% at 2 years), in the intermediate term, compared to that of sarcoma (18% at 1 year, 24% at 2 years) (p = 0.04). At 5 years this is not significant by K–M analysis (25% for MBD, and 33% for sarcoma), but remains significant in a competing risk model (8% for MBD, and 20% for sarcoma) (p = 0.03), accounting for death as a competing event. Conclusion: Rates of revision surgery after megaprosthetic reconstruction of MBD are significantly lower than that for primary bone sarcoma in this cohort.
Collapse
|