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DOS Kongressen 2017 ·
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Patient survival following joint replacement due
to metastatic bone disease: comparison of overall
survival between cohorts treated in two different
time periods
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 suffering from a pathological/impending fracture due to
metastatic bone disease in the appendicular skeleton (MBDA) will often benefit
from a total joint replacement (TJR). We hypothesize that improvements in pri-
mary cancer treatment will be reflected in an improved survival for patients who
undergoes TJR due to MBDA.
Purpose / Aim of Study:
To test if patient survival has improved over time
after TJR due to MBDA.
Materials and Methods:
A retrospective study of patients receiving primary
TJR due to MBDA from 01/01/03 to 31/12/13. Survival was calculated from
the day of surgery until death or to end of study (09/30/16). Statistics: Ka-
plan-Meier survival analysis (with 95%-CI), log-rank test and non-parametric
tests for comparison of subgroups: patients having TJR in the early period be-
tween 2003-2008 (n=130) and patients having TJR in the late period between
2009-2013 (n=140).
Findings / Results:
270 patients (mean age 64 (21-90) years, 160males/110
females) received 270 primary TJR. The cumulative 1-, 2- and 5- year sur-
vival rates after surgery for the early cohort was 41% (95%-CI: 32-49), 29%
(95%-CI: 21-37), and 13% (95%-CI: 7-19) and 48% (95%-CI: 40-56), 34%
(95%-CI: 26-42), and 11% (95% CI: 5-17) for the late cohort, p=0.458. The
time from diagnosis of cancer to MBDA-surgery was shorter in the early cohort
(p<0.001). A minor difference was found when comparing residual cancer dis-
ease after MBD surgery (p=0.045), showing a greater amount of patients was
cancer-free after surgery in the late cohort.
Conclusions:
Our study indicates that improved treatment of primary disease
postpone time to surgical intervention for MBDA, but does not prolong the sur-
vival after surgical intervention. These findings can be due to lead time bias and
further studies are needed.
No conflicts of interest reported
147.