The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications

E. R. Henderson, B. J. Keeney, E. Pala, P. T. Funovics, W. C. Eward, J. S. Groundland, L. K. Ehrlichman, S. S.E. Puchner, B. E. Brigman, J. E. Ready, H. Thomas Temple, P. Ruggieri, R. Windhager, G. D. Letson, F. J. Hornicek

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims: Instability of the hip is the most common mode of failure after reconstruction with a proximal femoral arthroplasty (PFA) using an endoprosthesis after excision of a tumour. Small studies report improved stability with capsular repair of the hip and other techniques, but these have not been investigated in a large series of patients. The aim of this study was to evaluate variables associated with the patient and the operation that affect postoperative stability. We hypothesised an association between capsular repair and stability. Patients and Methods: In a retrospective cohort study, we identified 527 adult patients who were treated with a PFA for tumours. Our data included demographics, the pathological diagnosis, the amount of resection of the abductor muscles, the techniques of reconstruction and the characteristics of the implant. We used regression analysis to compare patients with and without post-operative instability. Results: A total of 20 patients out of 527 (4%) had instability which presented at a mean of 35 days (3 to 131) post-operatively. Capsular repair was not associated with a reduced rate of instability. Bivariate analysis showed that a posterolateral surgical approach (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02 to 0.86) and the type of implant (p = 0.046) had a significant association with reduced instability; age > 60 years predicted instability (OR 3.17, 95% CI 1.00 to 9.98). Multivariate analysis showed age > 60 years (OR 5.09, 95% CI 1.23 to 21.07), female gender (OR 1.73, 95% CI 1.04 to 2.89), a malignant primary bone tumour (OR 2.04, 95% CI 1.06 to 3.95), and benign condition (OR 5.56, 95% CI 1.35 to 22.90), but not metastatic disease or soft-tissue tumours, predicted instability, while a posterolateral approach (OR 0.09, 95% CI 0.01 to 0.53) was protective against instability. No instability occurred when a synthetic graft was used in 70 patients. Conclusion: Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. We did not find an association between capsular repair and improved stability. Extension of the tumour often dictates surgical technique; however, our results indicate that PFA using a posterolateral approach with a hemiarthroplasty and synthetic augment for soft-tissue repair confers the lowest risk of instability. Patients who are elderly, female, or with a primary benign or malignant bone tumour should be counselled about an increased risk of instability.

Original languageEnglish (US)
Pages (from-to)531-537
Number of pages7
JournalBone and Joint Journal
Volume99B
Issue number4
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Thigh
Hip
Odds Ratio
Confidence Intervals
Arthroplasty
Neoplasms
Hemiarthroplasty
Bone and Bones
Surgical Pathology
Cohort Studies
Multivariate Analysis
Retrospective Studies
Regression Analysis
Demography
Transplants
Muscles

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Henderson, E. R., Keeney, B. J., Pala, E., Funovics, P. T., Eward, W. C., Groundland, J. S., ... Hornicek, F. J. (2017). The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications. Bone and Joint Journal, 99B(4), 531-537. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0960.R1

The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications. / Henderson, E. R.; Keeney, B. J.; Pala, E.; Funovics, P. T.; Eward, W. C.; Groundland, J. S.; Ehrlichman, L. K.; Puchner, S. S.E.; Brigman, B. E.; Ready, J. E.; Thomas Temple, H.; Ruggieri, P.; Windhager, R.; Letson, G. D.; Hornicek, F. J.

In: Bone and Joint Journal, Vol. 99B, No. 4, 01.04.2017, p. 531-537.

Research output: Contribution to journalArticle

Henderson, ER, Keeney, BJ, Pala, E, Funovics, PT, Eward, WC, Groundland, JS, Ehrlichman, LK, Puchner, SSE, Brigman, BE, Ready, JE, Thomas Temple, H, Ruggieri, P, Windhager, R, Letson, GD & Hornicek, FJ 2017, 'The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications', Bone and Joint Journal, vol. 99B, no. 4, pp. 531-537. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0960.R1
Henderson, E. R. ; Keeney, B. J. ; Pala, E. ; Funovics, P. T. ; Eward, W. C. ; Groundland, J. S. ; Ehrlichman, L. K. ; Puchner, S. S.E. ; Brigman, B. E. ; Ready, J. E. ; Thomas Temple, H. ; Ruggieri, P. ; Windhager, R. ; Letson, G. D. ; Hornicek, F. J. / The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications. In: Bone and Joint Journal. 2017 ; Vol. 99B, No. 4. pp. 531-537.
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abstract = "Aims: Instability of the hip is the most common mode of failure after reconstruction with a proximal femoral arthroplasty (PFA) using an endoprosthesis after excision of a tumour. Small studies report improved stability with capsular repair of the hip and other techniques, but these have not been investigated in a large series of patients. The aim of this study was to evaluate variables associated with the patient and the operation that affect postoperative stability. We hypothesised an association between capsular repair and stability. Patients and Methods: In a retrospective cohort study, we identified 527 adult patients who were treated with a PFA for tumours. Our data included demographics, the pathological diagnosis, the amount of resection of the abductor muscles, the techniques of reconstruction and the characteristics of the implant. We used regression analysis to compare patients with and without post-operative instability. Results: A total of 20 patients out of 527 (4{\%}) had instability which presented at a mean of 35 days (3 to 131) post-operatively. Capsular repair was not associated with a reduced rate of instability. Bivariate analysis showed that a posterolateral surgical approach (odds ratio (OR) 0.11, 95{\%} confidence interval (CI) 0.02 to 0.86) and the type of implant (p = 0.046) had a significant association with reduced instability; age > 60 years predicted instability (OR 3.17, 95{\%} CI 1.00 to 9.98). Multivariate analysis showed age > 60 years (OR 5.09, 95{\%} CI 1.23 to 21.07), female gender (OR 1.73, 95{\%} CI 1.04 to 2.89), a malignant primary bone tumour (OR 2.04, 95{\%} CI 1.06 to 3.95), and benign condition (OR 5.56, 95{\%} CI 1.35 to 22.90), but not metastatic disease or soft-tissue tumours, predicted instability, while a posterolateral approach (OR 0.09, 95{\%} CI 0.01 to 0.53) was protective against instability. No instability occurred when a synthetic graft was used in 70 patients. Conclusion: Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. We did not find an association between capsular repair and improved stability. Extension of the tumour often dictates surgical technique; however, our results indicate that PFA using a posterolateral approach with a hemiarthroplasty and synthetic augment for soft-tissue repair confers the lowest risk of instability. Patients who are elderly, female, or with a primary benign or malignant bone tumour should be counselled about an increased risk of instability.",
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T1 - The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications

AU - Henderson, E. R.

AU - Keeney, B. J.

AU - Pala, E.

AU - Funovics, P. T.

AU - Eward, W. C.

AU - Groundland, J. S.

AU - Ehrlichman, L. K.

AU - Puchner, S. S.E.

AU - Brigman, B. E.

AU - Ready, J. E.

AU - Thomas Temple, H.

AU - Ruggieri, P.

AU - Windhager, R.

AU - Letson, G. D.

AU - Hornicek, F. J.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Aims: Instability of the hip is the most common mode of failure after reconstruction with a proximal femoral arthroplasty (PFA) using an endoprosthesis after excision of a tumour. Small studies report improved stability with capsular repair of the hip and other techniques, but these have not been investigated in a large series of patients. The aim of this study was to evaluate variables associated with the patient and the operation that affect postoperative stability. We hypothesised an association between capsular repair and stability. Patients and Methods: In a retrospective cohort study, we identified 527 adult patients who were treated with a PFA for tumours. Our data included demographics, the pathological diagnosis, the amount of resection of the abductor muscles, the techniques of reconstruction and the characteristics of the implant. We used regression analysis to compare patients with and without post-operative instability. Results: A total of 20 patients out of 527 (4%) had instability which presented at a mean of 35 days (3 to 131) post-operatively. Capsular repair was not associated with a reduced rate of instability. Bivariate analysis showed that a posterolateral surgical approach (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02 to 0.86) and the type of implant (p = 0.046) had a significant association with reduced instability; age > 60 years predicted instability (OR 3.17, 95% CI 1.00 to 9.98). Multivariate analysis showed age > 60 years (OR 5.09, 95% CI 1.23 to 21.07), female gender (OR 1.73, 95% CI 1.04 to 2.89), a malignant primary bone tumour (OR 2.04, 95% CI 1.06 to 3.95), and benign condition (OR 5.56, 95% CI 1.35 to 22.90), but not metastatic disease or soft-tissue tumours, predicted instability, while a posterolateral approach (OR 0.09, 95% CI 0.01 to 0.53) was protective against instability. No instability occurred when a synthetic graft was used in 70 patients. Conclusion: Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. We did not find an association between capsular repair and improved stability. Extension of the tumour often dictates surgical technique; however, our results indicate that PFA using a posterolateral approach with a hemiarthroplasty and synthetic augment for soft-tissue repair confers the lowest risk of instability. Patients who are elderly, female, or with a primary benign or malignant bone tumour should be counselled about an increased risk of instability.

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