DOS 2020

DOS Kongressen 2020 · 83 Surgical Treatment of Proximal Femoral Metastases: A Systematic Review and Meta-Analysis of Reoperations and Implant Failures Mads Sten Andersen, Michala Skovlund Sørensen, Michael Mørk Petersen Orthopedic surgery, Rigshospitalet Background: The continuous improvements in survival of cancer patients increases the prevalence of metastatic bone disease, while also altering the demands for the durability of the surgical implants used. In the appendicular skeleton the metastatic lesions requiring surgery are most often located in the proximal femur, and are currently treated with either open reduction and inter- nal fixation (ORIF), intramedullary nailing (IMN) or endoprosthetic reconstruc- tion (EPR). Purpose / Aim of Study: To investigate whether there is a difference in reop- eration or implant failure rates between the currently used methods of surgical treatment of metastatic bone disease of the proximal femur.  Materials and Methods: The literature was systematically reviewed through a PubMed search in order to identify studies concerning surgical treatment of proximal femur metastases in the period 01.01.2009-04.01.2020. The pri- mary outcome measure was reoperation rate, while implant failure rate was registered as the secondary outcome measure. Eighteen studies, with a total of 2489 patients, were included for analysis, all retrospective and non-random- ized. In a meta-analysis pooled estimates for the odds-ratios (OR) between treatments regarding both reoperation and implant failure were calculated with 95 % confidence intervals (CI).  Findings / Results: Meta-analysis showed more patients treated with ORIF needed further surgery, with the pooled OR estimate being 3.07 (95% CI: 1.98- 4.76, p<0.001) for reoperation and 8.47 (95% CI: 5.05-14.21, p<0.001) for implant failure compared to EPR. No difference was found when comparing re- operation after IMN to EPR (OR = 1.04 (95% CI: 0.77-1.42, p=0.79)), but the analysis showed a higher risk of implant failure after IMN with an OR of 2.65 (95% CI: 1.74-4.02, p<0.001). Conclusions: The higher reoperation rate found in patients treated with ORIF, suggests that this method of treating proximal femur metastases should be considered obsolete. Analysis of implant failure further indicates, that EPR provides a more mechanically stable solution compared to IMN. The mediocre evidence that the included studies provide calls for further research report- ing time-adjusted reoperation rates, allowing for more optimal comparison of methods between studies. 70.