Radical excision of solitary femoral metastasis and reconstruction with Adler Pantheon proximal femoral endoprosthesis with trochanteric reattachment using Kinamed SuperCables
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Metastatic bone disease is becoming increasingly prevalent and more cases are presenting to orthopaedic surgeons. These patients may be referred by GPs or from emergency departments or oncologists with skeletal related events, such as severe pain, impending fracture or pathological fracture, metastatic spinal cord compression or hypercalcaemia.
Metastatic prostate cancer is the second most common presentation of metastatic bone disease to orthopaedic oncologists, after breast cancer. Prostate cancer frequently metastasises to bone and surgical options may include stabilisation of pathological fractures, arthroplasty, spinal decompression, resection and endoprosthetic reconstruction. Almost half the patients with prostate cancer who develop bone metastases develop skeletal related events within nine months of the development of skeletal disease.
In this case, a patient with carcinoma of the prostate was referred by their oncologist, having undergone whole-body staging for an increasing PSA using a Choline PET-CT, which identified an asymptomatic proximal femoral metastasis. After discussions between the patient, oncologist and surgeon, it was decided that there was an advantage to the patient of excision of this solitary prostate bone metastasis (oligometastasis = <3 metastatic lesions) for local control and improved oncological outcomes. The underlying principle regarding the term ‘oligometastatic’, coined in the 1990s, is that treatment still has curative intent, which sadly is rarely the case in patients with multiple metastases.
The patient underwent excision and reconstruction with a modular Adler Pantheon proximal femoral endoprosthesis with reattachment of the greater trochanter, to permit early weight-bearing and rapid return to function. The Adler Pantheon system was selected for this case because of the 3D printed bridging collar designed to achieve bone in- and on-growth to minimise the risk of aseptic loosening and trochanteric reattachment failure, the Agluna silver coating to minimise the risk of early prosthetic joint infection, and modularity to permit any possible segmental reconstruction of the proximal femur.
Author:Jonathan Stevenson FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK