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World J Orthop. Jul 18, 2020; 11(7): 319-327
Published online Jul 18, 2020. doi: 10.5312/wjo.v11.i7.319
Current concepts in the surgical treatment of skeletal metastases
Jessica Ehne, Panagiotis Tsagozis
Jessica Ehne, Panagiotis Tsagozis, Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
Author contributions: Both Ehne J and Tsagozis P performed literature searches, contributed to the intellectual input and writing.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jessica Ehne, MD, Surgeon, Department of Orthopedic Surgery, Karolinska University Hospital, Eugeniavägen 3, Solna 171 76, Sweden. jessica.ehne@sll.se
Received: February 28, 2020
Peer-review started: February 28, 2020
First decision: April 29, 2020
Revised: May 20, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: July 18, 2020
Processing time: 135 Days and 9.6 Hours
Abstract

Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.

Keywords: Pathological fracture; Bone cancer; Adjuvant radiotherapy; Survival analysis; Fracture fixations; Fixation devices; Orthopaedic

Core tip: Patients with metastatic bone disease are a heterogenous group. Complication rates are higher than for the native fracture group. To avoid unnecessary complications, preoperative planning is crucial and allows correct surgical timing. Adjuvant treatment should be considered.