Outcomes of Long Bones Treated With Carbon-Fiber Nails for Oncologic Indications: International Multi-institutional Study.

Journal

The Journal of the American Academy of Orthopaedic Surgeons

ISSN: 1940-5480

Titre abrégé: J Am Acad Orthop Surg

Pays: United States

ID NLM: 9417468

Informations de publication

Date de publication:
31 Oct 2023

Historique:

received: 06 12 2022

accepted: 27 07 2023

pubmed: 12 10 2023

medline: 12 10 2023

entrez: 12 10 2023

Statut: aheadofprint

Résumé

Intramedullary nail fixation is commonly used for prophylactic stabilization of impending and fixation of complete pathological fractures of the long bones. However, metallic artifacts complicate imaging evaluation for bone healing or tumor progression and postoperative radiation planning. Carbon-fiber implants have gained popularity as an alternative, given their radiolucency and superior axial bending. This study evaluates incidences of mechanical and nonmechanical complications. Adult patients (age 18 years and older) treated with carbon-fiber nails for impending/complete pathological long bone fractures secondary to metastases from 2013 to 2020 were analyzed for incidences and risk factors of mechanical and nonmechanical complications. Mechanical complications included aseptic screw loosening and structural failures of host bone and carbon-fiber implants. Deep infection and tumor progression were considered nonmechanical. Other complications/adverse events were also reported. A total of 239 patients were included; 47% were male, and 53% were female, with a median age of 68 (IQR, 59 to 75) years. Most common secondary metastases were related to breast cancer (19%), lung cancer (19%), multiple myeloma (18%), and sarcoma (13%). In total, 17 of 30 patients with metastatic sarcoma received palliative intramedullary nail fixation for impending/complete pathological fractures, and 13 of 30 received prophylactic nail stabilization of bone radiated preoperatively to manage juxta-osseous soft-tissue sarcomas, where partial resection of the periosteum or bone was necessary for negative margin resection. 33 (14%) patients had complications. Mechanical failures included 4 (1.7%) structural host bone failures, 7 (2.9%) implant structural failures, and 1 (0.4%) aseptic loosening of distal locking screws. Nonmechanical failures included 8 (3.3%) peri-implant infections and 15 (6.3%) tumor progressions with implant contamination. The 90-day and 1-year mortalities were 28% (61/239) and 53% (53/102), respectively. The literature reported comparable failure and mortality rates with conventional titanium treatment. Carbon-fiber implants might be an alternative for treating impending and sustained pathological fractures secondary to metastatic bone disease. The seemingly comparable complication profile warrants further cohort studies comparing carbon-fiber and titanium nail complications.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Adult patients (age 18 years and older) treated with carbon-fiber nails for impending/complete pathological long bone fractures secondary to metastases from 2013 to 2020 were analyzed for incidences and risk factors of mechanical and nonmechanical complications. Mechanical complications included aseptic screw loosening and structural failures of host bone and carbon-fiber implants. Deep infection and tumor progression were considered nonmechanical. Other complications/adverse events were also reported.

RESULTS RESULTS

A total of 239 patients were included; 47% were male, and 53% were female, with a median age of 68 (IQR, 59 to 75) years. Most common secondary metastases were related to breast cancer (19%), lung cancer (19%), multiple myeloma (18%), and sarcoma (13%). In total, 17 of 30 patients with metastatic sarcoma received palliative intramedullary nail fixation for impending/complete pathological fractures, and 13 of 30 received prophylactic nail stabilization of bone radiated preoperatively to manage juxta-osseous soft-tissue sarcomas, where partial resection of the periosteum or bone was necessary for negative margin resection. 33 (14%) patients had complications. Mechanical failures included 4 (1.7%) structural host bone failures, 7 (2.9%) implant structural failures, and 1 (0.4%) aseptic loosening of distal locking screws. Nonmechanical failures included 8 (3.3%) peri-implant infections and 15 (6.3%) tumor progressions with implant contamination. The 90-day and 1-year mortalities were 28% (61/239) and 53% (53/102), respectively. The literature reported comparable failure and mortality rates with conventional titanium treatment.

CONCLUSIONS CONCLUSIONS

Carbon-fiber implants might be an alternative for treating impending and sustained pathological fractures secondary to metastatic bone disease. The seemingly comparable complication profile warrants further cohort studies comparing carbon-fiber and titanium nail complications.

Identifiants

DOI: 10.5435/JAAOS-D-22-01159 PMID: 37824083

pubmed: 37824083

doi: 10.5435/JAAOS-D-22-01159

pii: 00124635-990000000-00819

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of interest by the authors: Each author certifies that there are no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

Références

Bongers MER, Groot OQ, Thio QCBS, et al.: Prospective study for establishing minimal clinically important differences in patients with surgery for lower extremity metastases. Acta Oncologica 2021;60:714-720.

Bonnevialle P, Descamps J, Niglis L, et al.: Surgical treatment of tibial metastases: Retrospective, multicenter, observational study of 25 patients. Orthop Traumatol Surg Res 2020;106:1039-1045.

Brockett CL, John G, Williams S, Jin Z, Isaac GH, Fisher J: Wear of ceramic-on-carbon fiber-reinforced poly-ether ether ketone hip replacements. J Biomed Mater Res B: Appl Biomater 2012;100B:1459-1465.

Damron TA, Mann KA: Fracture risk assessment and clinical decision making for patients with metastatic bone disease. J Orthop Res 2020;38:1175-1190.

Errani C, Mavrogenis AF, Cevolani L, et al.: Treatment for long bone metastases based on a systematic literature review. Eur J Orthop Surg Traumatol 2017;27:205-211.

Forsberg JA, Wedin R, Boland PJ, Healey JH: Can we estimate short- and intermediate-term survival in patients undergoing surgery for metastatic bone disease?. Clin Orthop Relat Res 2017;475:1252-1261.

Janssen SJ, Kortlever JTP, Ready JE, et al.: Complications after surgical management of proximal femoral metastasis: A retrospective study of 417 patients. J Am Acad Orthop Surg 2016;24:483-494.

Janssen SJ, Paulino Pereira NR, Raskin KA, et al.: A comparison of questionnaires for assessing physical function in patients with lower extremity bone metastases. J Surg Oncol 2016;114:691-696.

Janssen SJ, Pereira NRP, Thio QCBS, et al.: Physical function and pain intensity in patients with metastatic bone disease. J Surg Oncol 2019;120:376-381.

Janssen SJ, Teunis T, Hornicek FJ, Bramer JAM, Schwab JH: Outcome of operative treatment of metastatic fractures of the humerus: A systematic review of twenty three clinical studies. Int Orthop 2015;39:735-746.

Janssen SJ, Teunis T, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH: Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies. J Surg Oncol 2016;114:507-519.

Janssen SJ, van Dijke M, Lozano-Calderón SA, et al.: Complications after surgery for metastatic humeral lesions. J Shoulder Elbow Surg 2016;25:207-215.

Zimel MN, Hwang S, Riedel ER, Healey JH: Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging. Skeletal Radiol 2015;44:1317-1325.

Jockisch KA, Brown SA, Bauer TW, Merritt K: Biological response to chopped-carbon-fiber-reinforced peek. J Biomed Mater Res 1992;26:133-146.

Hak DJ, Mauffrey C, Seligson D, Lindeque B: Use of carbon-fiber-reinforced composite implants in orthopedic surgery. Orthopedics 2014;37:825-830.

Steinberg EL, Rath E, Shlaifer A, Chechik O, Maman E, Salai M: Carbon fiber reinforced PEEK Optima--a composite material biomechanical properties and wear/debris characteristics of CF-PEEK composites for orthopedic trauma implants. J Mech Behav Biomed Mater 2013;17:221-228.

Li CS, Vannabouathong C, Sprague S, Bhandari M: The use of carbon-fiber-reinforced (CFR) PEEK material in orthopedic implants: A systematic review. Clin Med Insights: Arthritis Musculoskelet Disord 2015;8:CMAMD.S20354-45.

Tedesco G, Gasbarrini A, Bandiera S, Ghermandi R, Boriani S: Composite PEEK/Carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors. J Spine Surg 2017;3:323-329.

Takayanagi A, Siddiqi I, Ghanchi H, et al.: Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations. World Neurosurg 2021;152:61-70.

Fleege C, Makowski M, Rauschmann M, et al.: Carbon fiber-reinforced pedicle screws reduce artifacts in magnetic resonance imaging of patients with lumbar spondylodesis. Sci Rep 2020;10:16094.

Fragomen AT, Teplensky J, Robert Rozbruch S: Carbon-fiber-Reinforced polymer intramedullary nails perform poorly in long-bone surgery. HSS J ® 2019;15:109-114.

Rijs Z, Weekhout A, Lozano-Calderon SA, et al.: Complications of patients with bone tumors treated with carbon-fiber plates: An international multicenter study. Sci Rep 2022;12:18969.

Herzog LN, Traven SA, Walton ZJ, Leddy LR: The use of carbon fiber implants for impending or existing pathologic fractures. J Orthop Trauma 2022;36:E260-E264.

Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: Strengthening the reporting of observational studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007;335:806-808.

Katagiri H, Okada R, Takagi T, et al.: New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med 2014;3:1359-1367.

Thio QCBS, Karhade AV, Ogink PT, et al.: Development and internal validation of machine learning algorithms for preoperative survival prediction of extremity metastatic disease. Clin Orthop Relat Res 2020;478:322-333.

Depauw N, Pursley J, Lozano-Calderon SA, Patel CG: Evaluation of carbon fiber and titanium surgical implants for proton and photon therapy. Pract Radiat Oncol 2023;13:256-262.

Soriani A, Strigari L, Petrongari MG, et al.: The advantages of carbon fiber based orthopedic devices in patients who have to undergo radiotherapy. Acta Biomed 2020;91:e20-200577.

Steensma M, Healey JH: Trends in the surgical treatment of pathologic proximal femur fractures among Musculoskeletal Tumor Society members. Clin Orthop Relat Res 2013;471:2000-2006.

Tanaka T, Imanishi J, Charoenlap C, Choong PFM: Intramedullary nailing has sufficient durability for metastatic femoral fractures. World J Surg Oncol 2016;14:80.

Mavrogenis AF, Angelini A, Vottis C, et al.: Modern palliative treatments for metastatic bone disease: Awareness of advantages, disadvantages, and guidance. The Clin J Pain 2016;32:337-350, .

Miller KD, Fidler‐Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL: Cancer statistics for adolescents and young adults. CA: A Cancer J Clinicians 2020;70:443-459.

Moon BS, Dunbar DJ, Lin PP, Satcher RL, Bird JE, Lewis VO: Is it appropriate to treat sarcoma metastases with intramedullary nailing?. Clin Orthops Relat Res 2017;475:212-217.

Ofluoglu O, Erol B, Ozgen Z, Yildiz M: Minimally invasive treatment of pathological fractures of the humeral shaft. Int Orthop 2009;33:707-712.

Piccioli A, Piana R, Lisanti M, et al.: Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: A national multicentric experience of the Italian orthopedic society (SIOT) bone metastasis study group. Injury 2017;48:S55-S59.

Yeung CM, Bhashyam AR, Groot OQ, et al.: Comparison of carbon fibre and titanium intramedullary nails in orthopedic oncology. Bone Jt Open 2022;3:648-655.