DOS 2017

DOS Kongressen 2017 ·

193

Is revision surgery a risk factor for decreased sur-

vival in patients with metastatic bone disease?

Thea Bechmann Hovgaard, Peter Frederik Horstmann, Michael Mørk Petersen,

Michala Skovlund Sørensen

Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospi-

talet, University of Copenhagen

Background:

Patients experiencing a pathological fracture or painful bony le-

sion due to metastatic bone disease in the appendicular skeleton (MBDA) are

frequently treated with a total joint replacement (TJR), which is in risk of revision

surgery.

Purpose / Aim of Study:

To estimate implant and patient survival after pri-

mary and revision TJR due to MBDA.

Materials and Methods:

A retrospective study of patients having primary and

revision TJR due to MBDA from 01/01/03 to 31/12/13. 287 patients (mean

age 64 (21-90) years, 170 males/117 females) received 289 primary TJR (in

270 patients) and 22 revision TJR (in 17 patients). Survival time was calculated

from the day of surgery until death or end of study (09/30/16). Statistics:

Kaplan-Meier survival analysis (95%-CI) and log-rank test for comparison of

subgroups.

Findings / Results:

The 1-, 2- and 5-year survival rates after surgery for pri-

mary TJR was 44% (95%-CI: 39-50), 32% (95%-CI: 26-37), and 13% (95%-

CI: 8-17) and 45% (95%-CI: 23-67), 30% (95%-CI: 10-50), and 10% (95%-

CI: 0- 23) for revision TJR, p=0.465. No difference in the amount of major com-

plications between primary TJR (17 major complications=5.88%) and revision

TJR (2 major complications=9.09%). The cumulative 1-, 2- and 5-years implant

survival rate for primary TJR was 98% (95%-CI: 96-100), 93% (95%-CI: 89-

98), and 85% (95%-CI: 76-94) and 90% (95%- CI: 71-100), 90% (95%-CI:

71-100) and NA for revision TJR (p=0.273).

Conclusions:

No differences in implant or patient survival were found be-

tween primary and revision TJR. It indicates that MBDA-surgery does not re-

duce patients expected survival even though several procedures are performed.

We suggest not refraining from revision surgery in MBDA patients, and always

choosing a primary implant that is expected to outlive the patient.

No conflicts of interest reported

145.