Abstract
Multiple myeloma may be associated with extensive bone destruction, impending or present pathological fracture, and intractable pain. However, surgical intervention is rarely indicated since local bone crises are effectively managed with chemotherapy and radiotherapy in the majority of the patients. The current retrospective analysis of patients who eventually required surgical intervention emphasized indications for surgery, surgical technique, and functional and oncological outcomes.
Materials and Methods: Between 1982 and 2000, the authors operated on 18 patients with multiple myeloma. There were 11 females and 7 males whose age ranged from 4 to 67 years (median, 59 years). Anatomic locations: proximal humerus – 5, proximal femur – 4, distal femur – 5, proximal tibia – 3. One patient had total femur involvement. Preoperatively, 11 patients were treated with chemotherapy and 4 received radiotherapy. Seven patients were referred with a bone lesion as their initial presentation and, therefore, did not receive pre-operative treatment.
Indications for surgery: pathological fractures – 11 patients, impending pathological fractures – 5 patients, and intractable pain in 2 patients. Surgeries included 12 marginal resections with cryosurgery and 6 wide resections with endoprosthetic reconstructions. Postoperative radiotherapy was given to three patients and chemotherapy to 11. Follow-up included physical and radiological evaluation and functional evaluation according to the American Musculoskeletal Tumor Society System.
Results: Fifteen patients (83%) survived more than 1 year and 12 patients (66%) survived more than 2 years after surgery. There were no postoperative deep wound infections, thromboembolic complications, or local tumor recurrences. Functional outcome was good to excellent in 14 patients (78%), moderate in 3 (16%), and poor in one patient (6%).
Conclusions: Multiple myeloma rarely may require surgical intervention because of impending or present pathological fracture or intractable pain. The relatively prolonged survival of patients with multiple myeloma justifies an aggressive surgical approach. Resection of these tumors was shown to be safe, reliable, and associated with good local tumor control and functional outcome.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
