FACTORS PREDICTING SURVIVAL IN PATHOLOGICAL FRACTURES OF THE PROXIMAL FEMUR

Abstract

Introduction: The proximal femur is the most common long bone to be affected by metastatic disease. The prognosis of patients with bone metastases is variable and depends on a number of factors. Risk factors affecting survival in this subgroup of patients need to be clearly determined.

Patients and Methods: We studied the survival of 32 consecutive patients with metastatic disease of the proximal femur in order to identify any clinical, radiological or physiological parameters that predict survival.

Results: Mean age of patients was 71 years (range 41–91 SE 2.2) and mean survival 393 days (95 % CI 236 to 550), cumulative survival at three years was 0.12. Univariate analysis showed that sex, serum haemoglobin < 10gm/dl, white cell count > 12, serum urea and the presence of a postoperative complication were all significant predictors of survival. However, multivariate analysis revealed that only sex, serum haemoglobin < 10 gm/dl, white cell count > 12 and a postoperative complication were independent risk factors predicting survival (p < 0.05).

Discussion: Perioperative factors should be optimised for all patients. Identification of risk factors adversely affecting survival can be used in conjunction with clinical and radiological information as a tool to predict outcome and to aid consenting and counselling of patients. Simple measures such as preoperative transfusion of blood or the administration of blood products may improve survival. The presence of an elevated white cell count may indicate more advanced systemic disease. Aggressive postoperative rehabilitation and the prevention of complications may also improve survival.