scholarly journals CORR® Tumor Board: Is Prophylactic Intervention More Cost-Effective than the Treatment of Pathologic Fractures in Metastatic Bone Disease?

2016 ◽  
Vol 474 (7) ◽  
pp. 1560-1562
Author(s):  
Megan E. Anderson ◽  
Jim S. Wu ◽  
Sara O. Vargas
Keyword(s):  
Bone Disease ◽  
Cost Effective ◽  
Metastatic Bone Disease ◽  
Tumor Board ◽  
Pathologic Fractures

scholarly journals Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease

2021 ◽  
Vol 28 (4) ◽  
pp. 2731-2740
Author(s):  
Aaron Gazendam ◽  
Daniel Axelrod ◽  
David Wilson ◽  
Michelle Ghert
Keyword(s):  
Surgical Management ◽  
Bone Disease ◽  
Surgical Techniques ◽  
Metastatic Bone Disease ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Porous Tantalum ◽  
Pain Disability ◽  
Pathologic Fractures ◽  
Surgical Options

The pelvis is a common site of metastatic bone disease. Peri-acetabular lesions are particularly challenging and can cause severe pain, disability and pathologic fractures. Surgical management of these lesions has historically consisted of cementoplasty for contained lesions and Harrington reconstructions for larger, more destructive lesions. Due to the limitations of these procedures, a number of novel procedures have been developed to manage this challenging problem. Percutaneous techniques—including acetabular screw fixation and cementoplasty augmented with screws—have been developed to minimize surgical morbidity. Recent literature has demonstrated a reliable reduction in pain and improvement in function in appropriately selected patients. Several adjuncts to the Harrington procedure have been utilized in recent years to reduce complication rates. The use of constrained liners and dual mobility bearings have reduced the historically high dislocation rates. Cage constructs and porous tantalum implants are becoming increasingly common in the management of large bony defects and destructive lesions. With novel and evolving surgical techniques, surgeons are presented with a variety of surgical options to manage this challenging condition. Physicians must take into account the patients’ overall health status, oncologic prognosis and anatomic location and extent of disease when developing an appropriate surgical plan.

scholarly journals Low Infection Rate after Tumor Hip Arthroplasty for Metastatic Bone Disease in a Cohort Treated with Extended Antibiotic Prophylaxis

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Werner H. Hettwer ◽  
Peter Frederik Horstmann ◽  
Thea Bechmann Hovgaard ◽  
Tomas Andreas Grum-Scwensen ◽  
Michael M. Petersen
Keyword(s):  
Antibiotic Prophylaxis ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Bone Disease ◽  
Tumor Resection ◽  
Metastatic Bone Disease ◽  
Endoprosthetic Reconstruction ◽  
Pathologic Fractures ◽  
Increased Risk

Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic prophylaxis for this patient population remains unknown.Material and Methods. To establish the infection rate associated with prolonged antibiotic prophylaxis in our department, we performed a retrospective review of all adult patients who underwent endoprosthetic reconstruction of the proximal femur after tumor resection for metastatic bone disease during a 4-year period from 2010 to 2013(n=105patients).Results. Intravenous antibiotic prophylaxis was administrated for an extended duration of a mean of 7.4 days. The overall infection rate was 3.6% (4/111 implants), infection free survival was 96% at 2 years, and the risk of amputation associated with infection was 25% (1/4 patients).Discussion. Preemptive eradication of bacterial contamination may be of value in certain clinical situations, where the risk level and consequences of implant-associated infection are unacceptable. Our findings suggest that extended postoperative antibiotic prophylaxis may reduce the risk of PJI in patients undergoing tumor resection and endoprosthetic replacement for metastatic bone disease associated impending or de facto pathologic fractures of the proximal femur.

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