Management of Lower-Extremity Bone Metastasis
Kristy L. Weber, MD; R. Lor Randall, MD; Seth Grossman, MS; Javad Parvizi, MD

Introduction

The incidence of metastatic bone disease is increasing as patients with cancer are living longer1. Although malignant skeletal tumors are usually initially managed by orthopaedic surgeons with expertise in oncology, patients with metastatic disease of the bone may seek medical care at community hospitals. Hence, general orthopaedic surgeons may often be required to care for patients with metastatic bone disease. The overall care of such patients often requires a multidisciplinary team of health-care providers, including a medical oncologist, radiation oncologist, orthopaedic surgeon, pathologist, radiologist, physical therapist, and chaplain1. There are multiple factors to consider in the treatment of patients with bone metastasis, including comorbidities, the histological characteristics of the primary tumor, the expected life span of the patient, the patient's activity level, and pain.

Surgical considerations involve the same issues in addition to the location of the tumor and the presence of neurologic symptoms. Occasionally, nonoperative treatment is indicated. In general, stabilization of impending or actual pathologic fractures involves techniques and concepts that differ from those used for patients with nonpathologic, traumatic fractures. Bone infiltrated with metastatic cancer is weakened and requires more durable implants or prosthetic devices to last the remainder of the patient's life. For instance, patients with a pathologic femoral neck fracture are treated with prosthetic replacement rather than in situ pinning or plate-and-screw fixation1. Methylmethacrylate is often used in combination with prostheses or intramedullary devices to supplement the fixation.

Fig. 1

Distribution of the operatively and nonoperatively treated lesions according to the type of primary cancer. GI = gastrointestinal.

The objective of this multi-institutional study was to assess the types of surgical and nonsurgical treatments used for patients with metastases in the long bones of the lower extremities and to evaluate postoperative complications and oncologic outcomes. In addition, an algorithm was developed …


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