Efficiency and Advantages of Percutaneous Femoroplasty versus Proximal Femoral Replacement for Proximal Femur Metastases

摘要

Background: The proximal femur is the most common site of bone metastasis, and metastasis at this site can cause chronic, intolerable pain and even result in pathologic fractures, thereby negatively affecting patients’ quality of life. Selecting an appropriate method for resecting metastasis within the proximal femur requires thorough consideration of various factors, including the biological behavior of the primary tumor, the extent of the femur lesion, the current general systemic condition of the patient, and perioperative risks. Objective: To compare the perioperative safety of and early functional recovery following percutaneous femoroplasty (PFP) and proximal femoral replacement (PFR) in treating patients with metastasis of the proximal femur. Methods: We retrospectively analyzed the cases of 53 patients with proximal femur metastases who received surgical treatment by either PFP (n = 28) or PFR (n = 25). Perioperative blood loss, surgical time, and perioperative complications were compared between groups. Pain intensity according to the visual analogue scale (VAS) and early postoperative function according to the Karnofsky Performance Scale (KPS) were evaluated at 3, 7, and 30 days as well as 6 months after surgical treatment. Results: In the PFP group, the VAS scores were lower soon after operation than preoperation (P 0.05). PFP significantly and immediately improved patients’ quality of life as measured by the KPS in the early period after surgery (preoperative vs 3 days postoperative, P < 0.01), but the patients who underwent PFR suffered a short-term decrease in quality of life (preoperative vs 3 days postoperative, P < 0.01). Blood loss (P < 0.01) and operating time (P < 0.01) were significantly less than PFP. The complication rate was higher in the PFR group (28%) than in the PFP group (3.6%). The results also showed no difference in survival time between the two groups. Conclusion: PFP is an attractive minimally invasive therapeutic option for proximal femur metastasis that can significantly improve the patient’s quality of life in the short term.