Surgical strategy for benign lesions in proximal femur: internal fixation or endoprosthetic replacement
- 134 Downloads
The purpose of this study was to explore the indications for the two most frequently applied surgical procedures for benign lesions in the proximal femur.
We retrospectively reviewed 142 patients with benign lesions in the proximal femur from January 2010 to January 2015. Internal fixation (IF) was adopted in 110 patients, while endoprosthetic replacement (EPR) was applied in 32 patients. Clinical data, including operation time, blood loss, hospitalization time, and hospitalization expenses, were compared between the groups. Limb mobilization was evaluated by the Musculoskeletal Tumor Society Score-93 (MSTS-93) and Harris Hip Score (HHS). Local recurrences and complications were statistically compared.
The average follow-up was 66 months (range 32–84 months). In the EPR group, operation time and hospitalization time were significantly shorter (p < 0.05 and p < 0.05, respectively), while blood loss and hospitalization expenses were significantly higher (p < 0.05 and p < 0.05, respectively). Functional outcomes of the MSTS-93 and HHS were higher at the three week follow-up in the EPR group (p < 0.001 and p < 0.001, respectively) but lower at 6 months (p = 0.031 and p = 0.042, respectively). No differences were observed in the two scores at three months (p = 0.261 and p = 0.134, respectively). Local recurrence and complication rates were similar in the two groups (p = 0.895 and p = 0.942, respectively).
The strategy for benign proximal femur lesions should depend on the site, size, initial diagnosis, and thinning degree of cortical bone. IF and EPR both result in satisfactory local control and functional and radiological results, while EPR is more suitable for aggressive and recurrent lesions and serves as an effective measure after IF failure.
KeywordsBenign lesions Curettage Internal fixation Endoprosthetic replacement Surgical strategy
Compliance with ethical standards
All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and national research community and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Jaffe KA, Dunham WK (1990) Treatment of benign lesions of the femoral head and neck. Clin Orthop Relat Res 257:134–137Google Scholar
- 6.Chen F, Xia J, Wang S, Wei Y, Wu J, Huang G, Chen J, Shi J (2013) Use of extended curettage with osteotomy and fenestration followed by reconstruction with conservation of muscle insertion in the treatment of Enneking stage II locally aggressive bone tumor of the proximal extremities: resection and treatment of bone tumors. World J Surg Oncol 11:54. https://doi.org/10.1186/1477-7819-11-54 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Erol B, Topkar MO, Aydemir AN, Okay E, Caliskan E, Sofulu O (2016) A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Traum Surg 136(8):1051–1061. https://doi.org/10.1007/s00402-016-2486-9 CrossRefGoogle Scholar
- 12.Mirels H (1989) Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 249:256–264Google Scholar
- 13.Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246Google Scholar
- 20.Han N, Sun G, Li Z, Li G, Lu Q, Han Q, Wei X (2011) Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system-distal femur systems in the treatment of proximal femoral fractures. Orthop Surg 3(1):7–13. https://doi.org/10.1111/j.1757-7861.2010.00118.x CrossRefPubMedGoogle Scholar