Functional outcomes after open reconstruction or nonoperative management of 81 pathologic acetabular fractures from metastatic bone disease Conference Paper
| Authors: | Leland, C. R.; Morris, C. D.; Forsberg, J. A.; Levin, A. S. |
| Title: | Functional outcomes after open reconstruction or nonoperative management of 81 pathologic acetabular fractures from metastatic bone disease |
| Conference Title: | 2021 Musculoskeletal Tumor Society Annual Meeting |
| Abstract: | Background: Pathologic acetabular fracture secondary to skeletal metastasis may result in debilitating pain, inability to ambulate, and impaired quality of life, which may mark the first period of dependent care in cancer patients. Acetabular reconstruction may involve morbid procedures with increased complication rates. This study aimed to evaluate the evolution of pain, performance status, and ambulation following nonoperative management or open reconstruction of pathologic acetabular fractures. Methods: A retrospective cohort of 2630 adult patients with osseous metastatic disease treated at a high-volume cancer center between 2005 and 2021 was screened for pathologic fractures of the acetabulum. The study outcomes were pain, performance status, and the ability to ambulate. We identified 78 patients (median age, 60 years; 37 female patients [46%]) with 81 fractures. Of these, treatment consisted of open reconstruction (n = 34) or nonoperative management alone (n = 47). The mean follow-up in surviving patients was 3.4 years. Results: Open reconstruction was performed more frequently for displaced fractures (P < 0.01), Harrington class III or IV acetabula (P < 0.01), and patients with a performance status ≥3 at hospitalization (P = 0.00). Open reconstruction was associated with clinically meaningful improvements in pain (adjusted odds ratio [aOR], 8.3; 95% CI, 1.4–50.6; P = 0.02) and performance status (aOR, 10.9; 95% CI, 1.7–71.0; P = 0.01) at discharge and a restoration of ambulation (aOR, 7.5; 95% CI, 1.9–29.8; P < 0.01) at final follow-up. Conclusions: In patients with pathologic acetabular fracture due to osseous metastatic disease, functional improvements in pain, performance status, and ambulation were observed following open acetabular reconstruction in carefully selected patients, with no impact on survival, while noninferior improvements were observed in patients receiving nonoperative management when considering their larger clinical context. Level of evidence: Level III, therapeutic study. © 2023 |
| Keywords: | survival; adult; controlled study; treatment outcome; aged; major clinical study; bone metastasis; conference paper; follow up; pain; cohort analysis; odds ratio; retrospective study; confidence interval; hospitalization; conservative treatment; hospital discharge; functional status; performance; orthopedic surgery; mobilization; open surgery; human; male; female; acetabulum fracture; metastatic bone disease; pathologic acetabular fracture |
| Journal Title | Journal of Orthopaedics |
| Volume: | 44 |
| Conference Dates: | 2021 Oct 6-8 |
| Conference Location: | Baltimore, MD |
| ISBN: | 2589-9082 |
| Publisher: | Reed Elsevier India Pvt. Ltd. |
| Date Published: | 2023-10-01 |
| Start Page: | 22 |
| End Page: | 30 |
| Language: | English |
| DOI: | 10.1016/j.jor.2023.08.001 |
| PROVIDER: | scopus |
| PMCID: | PMC10466429 |
| PUBMED: | 37654617 |
| DOI/URL: | |
| Notes: | Conference paper -- Source: Scopus |
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