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The Journal of Bone and Joint Surgery (American) 86:1684-1689 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Patient Survival After Hip Arthroplasty for Metastatic Disease of the Hip

Michaela M. Schneiderbauer, MD1, Marius von Knoch, MD2, Cathy D. Schleck, BS1, William S. Harmsen, MS1, Franklin H. Sim, MD1 and Sean P. Scully, MD, PhD1

1 Departments of Orthopaedics and Statistics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for S.P. Scully: sscully{at}med.miami.edu
2 Orthopaedie, Pattbergstrasse 1, 45239 Essen, Germany

Investigation performed at the Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The hip joint is a common location for metastatic disease. Actual as well as impending fractures at this site are frequently due to mechanical instability after tumor invasion and are usually treated surgically with hip arthroplasty. The objective of this study was to analyze survival and influences on survival after hip arthroplasty for metastatic hip disease.

Methods: Two hundred and ninety-nine patients who had undergone a total of 306 hemiarthroplasty or total hip arthroplasty procedures for treatment of a pathologic or an impending pathologic hip fracture between 1969 and 1996 at our institution were included in this study. Data that had been acquired prospectively within the total joint registry of our institution were reviewed retrospectively.

Results: The median duration of survival after the arthroplasty was 8.6 months. The duration of survival was significantly associated with the site of the fracture, location of the primary tumor, and time from the diagnosis of the primary tumor to the surgery for the fracture (p ≤ 0.05). The time from the diagnosis to the arthroplasty was a significant independent predictor of survival.

Conclusions: Patients undergoing hip arthroplasty for metastatic disease have a limited life expectancy, with only 40% (120) of the 299 patients in our series still alive at one year after the surgery. By identifying prognostic factors regarding life expectancy, this study provides surgeons and oncologists with information with which to weigh risks and benefits of hip arthroplasty for individual patients preoperatively.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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