Risk factors of ambulatory status in metastatic bone disease of the femur treated with intramedullary device fixation

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019 Background: New cancer managements have improved patient survival. However, these patients can develop metastatic bone disease and present with impending or pathologic fracture. Femur is a common metastatic site of the lower extremities. Bone stabilization is a commonly performed procedure in patients with metastatic bone at the shaft and subtrochanter of the femur. Intramedullary fixation is commonly performed due to mechanical benefit and less complications. Enhanced awareness of the factors that influence early postoperative ambulation may reduce complications and improve patient outcomes. Objective: To identify risk factors of ambulatory status in patients with metastatic bone disease of the femur that were treated with intramedullary device fixation. Materials and Methods: This retrospective study included patients with metastasis lesion at the shaft and subtrochanter of the femur that were treated with intramedullary nail fixation during 2007 to 2014 at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Patients were categorized into either the early (ambulation within 3 days of surgery) or late (ambulation later than 3 days postoperatively) ambulation groups. Results: Thirty-one patients (19 females, 12 males; mean age: 54.1 years) were included. The mean postoperative pain score was significantly lower in the early ambulation group (0.8+1.1 vs. 2.1+1.1; p = 0.015). There was no significant difference between groups for MSTS functional scoring, intra-operative bleeding, intraoperative blood transfusion, or operative time. Regarding postoperative care, the early ambulation group had a significantly shorter mean length of hospital stay (p = 0.016). Conclusion: Intramedullary nailing fixation is a treatment of choice in patients with metastatic bone tumor of the femur. Lower postoperative pain score was found to be an important factor that may predict early ambulation. Early ambulation in these particular patients can provide better outcome with less complications.