Development and Evaluation of a Percutaneous Technique for Repairing Proximal Femora With Metastatic Lesions

摘要

Metastatic lesions in the proximal femur are a common and serious manifestation of breast cancer. These lesions can be painful and can lead to pathological fracture. Prophylactic surgical fixation is advised in patients thought to be at high risk of fracture and typically involves placement of a prosthetic implant or compression hip screw. This study demonstrated feasibility of an alternative approach in which proximal femora with metastatic lesions can be repaired by simply filling the defect with bone cement (polymethylmethacrylate) an innovative procedure that could be performed percutaneously and could eliminate the need for implanting hardware in many cases. If defects could be repaired using this technique patients would benefit from a shorter and less invasive surgical procedure less pain and discomfort greatly reduced recovery time and shorter hospital stays-all at much lower cost. To this end a mathematical model was developed to evaluate the need for prophylactic surgical fixation for specific patients. This model forms the basis of preliminary guidelines for the proposed surgery. Although viability of the proposed technique was demonstrated for low cyclic loading situations additional investigation is required to enable further implementation and to ensure fatigue resistance for long-term use.