Comparative evaluation of treatment strategies for femoral metastases: endoprosthesis reconstruction versus intramedullary nailing.

Abstract

Advances in cancer treatment have increased survival rates, leading to a higher incidence of femoral metastases, affecting approximately 20,000 patients annually. Surgical management typically involves intramedullary nailing (IMN) or endoprosthesis (EP). This meta-analysis compares IMN and EP outcomes regarding infection rates, reoperations, and implant failures across short- and intermediate-term follow-up periods. A systematic review following PRISMA guidelines identified studies from PubMed evaluating IMN and EP for metastatic femoral disease. Eligible studies, in English and with > 10 patients, underwent qualitative and quantitative analysis using fixed or random-effects models. Data from 10 studies (1,047 patients) were analyzed. Short-term superficial infection rates were 2.5% for IMN and 3.5% for EP (p = 0.00308). Implant failure rates were 5.3% for IMN and 5.0% for EP (p = 0.00660). Deep infections were 0.4% (IMN) and 3.5% (EP, p = 0.0106). Reoperation rates were 2.5% (IMN) versus 4.8% (EP, p = 0.00667). After 6 months, reoperations occurred in 6.7% (IMN) versus 3.3% (EP, p = 0.0245), while deep infections were 0% (IMN) and 1.4% (EP, p = 0.00749). Meta-analysis showed no significant differences between groups for these outcomes. Both IMN and EP are effective for femoral metastases, with each having unique risks and benefits. Patient-specific factors should guide treatment choice. Further studies are needed to refine surgical selection criteria and improve outcomes.