Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study
Abstract Background Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-05728-5 |
| _version_ | 1797653555627163648 |
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| author | Raffaele Vitiello Carlo Perisano Tommaso Greco Luigi Cianni Chiara Polichetti Rocco Maria Comodo Ivan De Martino Vincenzo La Vergata Giulio Maccauro |
| author_facet | Raffaele Vitiello Carlo Perisano Tommaso Greco Luigi Cianni Chiara Polichetti Rocco Maria Comodo Ivan De Martino Vincenzo La Vergata Giulio Maccauro |
| author_sort | Raffaele Vitiello |
| collection | DOAJ |
| description | Abstract Background Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. Methods We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1–6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. Result Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. Conclusion Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred. |
| first_indexed | 2024-03-11T16:46:17Z |
| format | Article |
| id | doaj.art-6dd74822b7e8470fa873e10c1bd7ab95 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-11T16:46:17Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-6dd74822b7e8470fa873e10c1bd7ab952023-10-22T11:03:46ZengBMCBMC Musculoskeletal Disorders1471-24742022-09-0122S21810.1186/s12891-022-05728-5Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective studyRaffaele Vitiello0Carlo Perisano1Tommaso Greco2Luigi Cianni3Chiara Polichetti4Rocco Maria Comodo5Ivan De Martino6Vincenzo La Vergata7Giulio Maccauro8Fondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSUniversità Cattolica Del Sacro CuoreFondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSFondazione Policlinico Universitario Agostino Gemelli - IRCCSAbstract Background Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. Methods We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1–6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. Result Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. Conclusion Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.https://doi.org/10.1186/s12891-022-05728-5MetastasisProximal femurTrochantericMegaprosthesisNailingNLR |
| spellingShingle | Raffaele Vitiello Carlo Perisano Tommaso Greco Luigi Cianni Chiara Polichetti Rocco Maria Comodo Ivan De Martino Vincenzo La Vergata Giulio Maccauro Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study BMC Musculoskeletal Disorders Metastasis Proximal femur Trochanteric Megaprosthesis Nailing NLR |
| title | Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study |
| title_full | Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study |
| title_fullStr | Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study |
| title_full_unstemmed | Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study |
| title_short | Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study |
| title_sort | intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur clinical outcomes and complication in a retrospective study |
| topic | Metastasis Proximal femur Trochanteric Megaprosthesis Nailing NLR |
| url | https://doi.org/10.1186/s12891-022-05728-5 |
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