How Often Do Acetabular Erosions Occur After Bipolar Hip Endoprostheses in Patients With Malignant Tumors and Are Erosions Associated With Outcomes Scores?
Notice bibliographique
Résumé
BACKGROUND: Bipolar endoprosthetic replacement is an option for reconstruction of the proximal femur to restore a functional extremity and salvage the limb. However, because these patients are young, there is a theoretical risk for long-term degenerative changes of the acetabulum. Currently, there is a paucity of data concerning the proportion of patients who experience degenerative acetabulum changes after reconstruction and whether these changes are associated with Musculoskeletal Tumor Society (MSTS) scores. QUESTIONS/PURPOSES: (1) What proportion of patients develop acetabular cartilage degeneration after bipolar hemiarthroplasty for malignant tumor-related reconstructions? (2) What is the survivorship free from revision for acetabular wear, erosions, or progressive arthritis? (3) Is there an association between the presence of acetabular erosions and lower MSTS scores? METHODS: Between 2000 and 2015, 148 patients underwent endoprosthetic reconstruction of the proximal femur with a bipolar hemiarthroplasty for a malignant tumor and were potentially eligible for this retrospective study. Minimum followup was 1 year except for those who died or were revised earlier; of the 148, no patients were lost to followup before that time who were not known to have died; mean followup on the remainder was 79 months (range, 12-220 months), and the mean time to death after surgery for those who died was 28 months (range, 0-196 months). Over the course of the study, 93 (63%) patients died. The mean (± SD) patient age was 57 ± 17 years, and 55% (81 of 148) of the patients were men. We used magnification-corrected supine AP plain radiographs of the hip to evaluate degenerative acetabulum changes, and we used the 1993 MSTS score to assess function through chart review and a longitudinally maintained institutional database. We used a competing-risks survivorship estimator rather than Kaplan-Meier because of the high proportion of patients who had died during the surveillance period. RESULTS: Nineteen patients (13%) developed cartilage erosion > 2 mm in the acetabulum, with two also developing protrusio after proximal femoral replacement with a bipolar endoprosthesis. Three additional patients also developed signs of protrusio. The mean acetabular wear after bipolar replacement was 1.2 mm. Patients with longer followup (p = 0.001) were at higher risk for developing acetabular wear. Six patients underwent conversion to THA to treat hip pain. At 10 years the cumulative incidence for conversion to THA for acetabular wear is 5% (95% confidence interval [CI], 0%-11%), whereas the cumulative incidence of death was 70% (95% CI, 61%-79%). There was no difference in mean MSTS scores between patients who developed > 2 mm of acetabular erosion (65% ± 25%) and those who did not (67% ± 20%; p = 0.77). CONCLUSIONS: Wear was uncommon among patients with malignant hip tumors treated with bipolar endoprostheses, but the followup here was short, and some patients indeed developed wear and underwent wear-related revisions to THA. Patients expected to survive more than a few years should have periodic radiographic surveillance and should be followed for a longer period to get a better sense for whether the problem worsens with time, as we expect it may, among patients who survive for longer periods. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».