Clinical effects of bipolar hemiarthroplasty in the treatment of proximal femoral osteosarcoma

SHEN Jia-kang; SUN Wei; HUA Ying-qi; MA Xiao-jun; SUN Meng-xiong; FU Ze-ze; CAI Zheng-dong

doi:10.3969/j.issn.2095-252X.2018.05.004

Abstract：Objective Osteosarcoma, commonly located at the proximal femur, is one of the most common malignant bone tumors. Reconstruction of the hip joint with total hip arthroplasty after wide resection of tumors is the most popular way of limb-salvage surgery. We noticed that tumors were inclined to transfer to regions near the acetabulum. We presumed that localized metastasis was caused by acetabulum reaming which would break the biological parclose of the cartilage during total hip arthroplasty ( THA ). Methods We retrospectively studied 25 patients ( Male 15, Female 10 ) of proximal femoral osteosarcoma from Jan, 2012 to Jan, 2016. All were randomly divided into 2 groups: Group A, reconstruction with bipolar hemiarthroplasty ( BHA ); Group B, reconstruction with THA. MSTS score, Harris scale, ROM of the hip, metastasis rate and survival rate were evaluated after surgery. Results All patients were followed up for 34.4 months. Group A: survival rate 84.6%; 3 patients had lung metastasis and 2 of them died; no pelvic metastasis or local recurrence was observed; the average Harris score was ( 76.0 ± 3.6 ); the average VAS was 1.77; ROM of the hip was ( 96.5 ± 9.5 ) °; the average MSTS score was 27.5 / 30 with satisfaction rate 90%. Group B: survival rate 83.3%; 2 patients had lung metastasis and both of them died; 5 patients had metastatic lesions on the pelvic; the average Harris score was ( 72.40 ± 6.34 ) ( P > 0.05 ), the average VAS was 2.8; ROM of the hip was ( 94.1 ± 15.1 ) °, the average MSTS score was 27.25 / 30 with satisfaction rate 80%. Conclusions Incidence of pelvic metastasis of Group A is obviously lower than that of the Group B, while the joint function and survival rate are similar in both groups. It is suggested that acetabulum reaming may lead to local metastasis. We suggest to reconstruct the hip joint with BHA, and revise with THA as late as possible if necessary.