Surgical treatment of tibial metastases: Retrospective, multicenter, observational study of 25 patients - 15/10/19

Doi : 10.1016/j.otsr.2019.07.017

Paul Bonnevialle ^a,⁎ , Jules Descamps ^b, Lucas Niglis ^c, Marie Lebaron ^d, Julie Falguieres ^d, Olivier Mericq ^a, Thierry Fabre ^e, Nicolas Reina ^a, Frédéric Sailhan ^b
members of the SoFCOT^f
^a Département d’Orthopédie Traumatologie, Hôpital Pierre-Paul Riquet, Place Baylac-Toulouse, 31052 Toulouse cedex, France
^b Service d’Orthopédie Traumatologie, Hôpital Cochin, 27, rue du Faubourg St Jacques, 75014 Paris, France
^c Service hospitalo-universitaire d’Orthopédie Traumatologie, Hôpital Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
^d Service hospitalo-universitaire d’Orthopédie Traumatologie, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France
^e Service hospitalo-universitaire d’Orthopédie Traumatologie, Hôpital Pellegrin, place Amelie-Raba, 33000 Bordeaux, France
^f 56, rue Boissonade, 75014 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

Long bone metastasis to the tibia is somewhat rare and has only been studied in a few publications with a limited number of cases. This led us to carry out a large multicenter, observational, retrospective study to 1) evaluate the clinical and radiological outcomes of surgical treatment at this location and 2) highlight the specific risks associated with this condition.

Hypothesis

We hypothesized that the clinical outcomes and survivorship were comparable to those reported in the literature.

Material and methods

The case series included 15 men and 10 women with a mean age of 66±11.7 years. The most common primary cancers were kidney (10 patients) and lung (4 patients). Thirteen patients had a concurrent visceral metastasis and sixteen had metastasis in another bone. The tibial metastasis was the initial sign of cancer in seven patients. The surgical procedure was done to prevent an impending fracture in 19 patients and to treat a pathological fracture in 6 patients (initial sign of cancer in 4 patients). Osteolysis occurred in the proximal epiphysis/metaphysis in 12 patients, diaphysis in 9 patients and distal epiphysis/metaphysis in 4 patients. We performed fixation with a lateral cortex plate and cementoplasty in 14 patients, locked intramedullary nailing in 8 patients, cementoplasty only in 2 patients and knee arthroplasty in 1 patient.

Results

Three surgical site infections, one pulmonary embolism and one cardiac rhythm disturbance occurred. Four patients died before the 3^rd month postoperative. At their best clinical status, 2 patients had not resumed walking, 10 could walk short distances with two canes or a walker, 3 had altered gait but could walk without aids and 6 could walk normally. The mean survival was 14±11.7 months (95% CI: 8.1–19.8) for all patients, 4±4 months (95% CI: 3–14) for those with a lung primary and 32±14 months (95% CI: 20–47) for those with a kidney primary. The survival was 15 months (95% CI: 4–29) after preventative treatment and 5 months (95% CI: 4–26) after fracture treatment.

Conclusion

Our clinical outcomes are comparable overall to the three main published articles on this topic. The risk of infection and benefits of preventative fixation were apparent in our cohort.