{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:22:42Z","timestamp":1792466562376,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,3]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Bone metastases represent the most frequent cause of cancer-related pain, affecting health-related quality of life and creating a substantial burden on the healthcare system. Although most bony metastatic lesions can be managed nonoperatively, surgical management can help patients reduce severe pain, avoid impending fracture, and stabilize pathologic fractures. Studies have demonstrated functional improvement postoperatively as early as 6 weeks, but little data exist on the temporal progress of these improvements or on the changes in quality of life over time as a result of surgical intervention.<\/jats:p>\n <\/jats:sec>\n \n Questions\/purposes<\/jats:title>\n (1) Do patients\u2019 functional outcomes, pain, and quality of life improve after surgery for long bone metastases? (2) What is the temporal progress of these changes to 1 year after surgery or death? (3) What is the overall and 30-day rate of complications after surgery for long bone metastases? (4) What are the oncologic outcomes including overall survival and local disease recurrence for this patient population?<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A multicenter, prospective study from three orthopaedic oncology centers in Quebec, Canada, was conducted between 2008 and 2016 to examine the improvement in function and quality of life after surgery for patients with long bone metastases. During this time, 184 patients out of a total of 210 patients evaluated during this period were enrolled; of those, 141 (77%) had complete followup at a minimum of 2 weeks (mean, 23 weeks; range, 2-52 weeks) or until death, whereas another 35 (19%) were lost to followup but were not known to have died before the minimum followup interval was achieved. Pathologic fracture was present in 34% (48 of 141) of patients. The median Mirel\u2019s score for those who underwent prophylactic surgery was 10 (interquartile range, 10-11). Surgical procedures included intramedullary nailing (55), endoprosthetic replacement (49), plate osteosynthesis (31), extended intralesional curettage (four), and allograft reconstruction (two). Seventy-seven percent (108 of 141) of patients received radiotherapy. The Musculoskeletal Tumor Society (MSTS), Toronto Extremity Salvage Score (TESS), Brief Pain Inventory (BPI) form, and Quality Of Life During Serious Illness (QOLLTI-P) form were administered pre- and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. Analysis of variance followed by post hoc analysis was conducted to test for significance between pre- and postoperative scores. The Kaplan-Meier estimate was used to calculate overall survivorship and local recurrence-free survival. A p value of < 0.05 was considered statistically significant.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n MSTS and BPI pain scores improved at 2 weeks when compared with preoperative scores (MSTS: 39% \u00b1 24% pre- versus 62% \u00b1 19% postoperative, mean difference [MD] 23, 95% confidence interval [CI], 16-32, p < 0.001; BPI: 52% \u00b1 21% pre- versus 30% \u00b1 21% postoperative, MD 22, 95% CI, 16-32, p < 0.001). Continuous and incremental improvement in TESS, MSTS, and BPI scores was observed temporally at 6 weeks, 3 months, 6 months, and 1 year; for example, the TESS score improved from 44% \u00b1 24% to 73% \u00b1 21% (MD 29, p < 0.001, 95% CI, 19-38) at 6 months. We did not detect a difference in quality of life as measured by the QOLLTI-P score (6 \u00b1 1 pre- versus 7 \u00b1 4 postoperative, MD 1, 95% CI, -0.4 to 3, p = 0.2). The overall and 30-day rates of systemic complications were 35% (49 of 141) and 14% (20 of 141), respectively. The Kaplan-Meier estimates for overall survival were 70% (95% CI, 62.4-78) at 6 months and 41% (95% CI, 33-49) at 1 year. Local recurrence-free survival was 17 weeks (95% CI, 11-24).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Surgical management of metastatic long bone disease substantially improves patients\u2019 functional outcome and pain as early as 2 weeks postoperatively and should be considered for impending or pathologic fracture in patients whose survival is expected to be longer than 2 weeks provided that there are no immediate contraindications. Quality of life in this patient population did not improve, which may be a function of patient selection, concomitant chemoradiotherapy regimens, disease progression, or terminal illness, and this merits further investigation.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level II, therapeutic study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000065","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T16:11:12Z","timestamp":1524845472000},"page":"535-545","source":"Crossref","is-referenced-by-count":41,"title":["Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease"],"prefix":"10.1097","volume":"476","author":[{"given":"Anas","family":"Nooh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Goulding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc H.","family":"Isler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Mottard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Arteau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Dion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Turcotte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,5]]},"reference":[{"key":"R1-20231015","first-page":"S129","article-title":"Treatment of bone tumors in the femoral trochanteric area","volume":"95","author":"Asavamongkolgul","year":"2012","journal-title":"J Med Assoc Thai."},{"key":"R2-20231015","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jpainsymman.2010.05.008","article-title":"Using confirmatory factor analysis to evaluate construct validity of the Brief Pain Inventory (BPI)","volume":"41","author":"Atkinson","year":"2011","journal-title":"J Pain Symptom Manage."},{"key":"R3-20231015","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/000164700317413111","article-title":"The incidence of acute cardiorespiratory and vascular dysfunction following intramedullary nail fixation of femoral metastasis","volume":"71","author":"Barwood","year":"2000","journal-title":"Acta Orthop Scand."},{"key":"R4-20231015","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1302\/0301-620X.87B5.16021","article-title":"Controversies in the surgical management of skeletal metastases","volume":"87","author":"Bauer","year":"2005","journal-title":"J Bone Joint Surg Br."},{"key":"R5-20231015","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/01.blo.0000165857.12676.00","article-title":"Function after resection of humeral metastases: analysis of 59 consecutive patients","volume":"437","author":"Bickels","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R6-20231015","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/00003086-200006000-00027","article-title":"Reconstruction of hip stability after proximal and total femur resections","volume":"375","author":"Bickels","year":"2000","journal-title":"Clin Orthop Relat Res."},{"key":"R7-20231015","first-page":"1518","article-title":"Metastatic bone disease: diagnosis, evaluation, and treatment","volume":"91","author":"Biermann","year":"2009","journal-title":"J Bone Joint Surg Am."},{"key":"R8-20231015","first-page":"521","article-title":"The surgical treatment of bony metastases of the spine and limbs","volume":"84","author":"B\u00f6hm","year":"2002","journal-title":"Bone Joint J."},{"key":"R9-20231015","first-page":"108","article-title":"Modular endoprosthetic replacement for tumours of the proximal femur","volume":"91","author":"Chandrasekar","year":"2009","journal-title":"Bone Joint J."},{"key":"R10-20231015","first-page":"391","article-title":"Measurement of pain by subjective report","volume":"12","author":"Cleeland","year":"1989","journal-title":"Adv Pain Res Ther."},{"key":"R11-20231015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jor.1100180102","article-title":"Evaluation of the feasibility of and results of measuring health status changes in patients undergoing surgical treatment for skeletal metastases","volume":"18","author":"Clohisy","year":"2000","journal-title":"J Orthop Res."},{"key":"R12-20231015","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1177\/026921639500900306","article-title":"The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability","volume":"9","author":"Cohen","year":"1995","journal-title":"Palliat Med."},{"key":"R13-20231015","doi-asserted-by":"crossref","first-page":"6243s","DOI":"10.1158\/1078-0432.CCR-06-0931","article-title":"Clinical features of metastatic bone disease and risk of skeletal morbidity","volume":"12","author":"Coleman","year":"2006","journal-title":"Clin Cancer Res."},{"key":"R14-20231015","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1007\/BF00540024","article-title":"Development of a measure of physical function for patients with bone and soft tissue sarcoma","volume":"5","author":"Davis","year":"1996","journal-title":"Qual Life Res."},{"key":"R15-20231015","first-page":"535","article-title":"Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures","volume":"160","author":"Dijstra","year":"1994","journal-title":"Eur J Surg."},{"key":"R16-20231015","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199301000-00035","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","volume":"286","author":"Enneking","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R17-20231015","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/S0936-6555(05)81063-5","article-title":"The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases","volume":"4","author":"Hardman","year":"1992","journal-title":"Clin Oncol."},{"key":"R18-20231015","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1007\/s11999-011-2038-0","article-title":"Endoprostheses last longer than intramedullary devices in proximal femur metastases","volume":"470","author":"Harvey","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"R19-20231015","doi-asserted-by":"crossref","first-page":"e871","DOI":"10.3928\/01477447-20111021-13","article-title":"Modular megaprosthesis in metastatic bone disease of the femur","volume":"34","author":"Hattori","year":"2011","journal-title":"Orthopedics."},{"key":"R20-20231015","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/jso.24345","article-title":"Outcome after fixation of metastatic proximal femoral fractures: a systematic review of 40 studies","volume":"114","author":"Janssen","year":"2016","journal-title":"J Surg Oncol."},{"key":"R21-20231015","first-page":"302","article-title":"Mortality and complications following stabilization of femoral metastatic lesions: a population-based study of regional variation and outcome","volume":"52","author":"Jenkinson","year":"2009","journal-title":"Can J Surg."},{"key":"R22-20231015","first-page":"698","article-title":"Prognostic factors and a scoring system for patients with skeletal metastasis","volume":"87","author":"Katagiri","year":"2005","journal-title":"Bone Joint J."},{"key":"R23-20231015","doi-asserted-by":"crossref","first-page":"S219","DOI":"10.1097\/01.blo0000093843.72468.3a","article-title":"Treatment of metastatic disease of the tibia","volume":"415","author":"Kelly","year":"2003","journal-title":"Clin Orthop Relat Res."},{"key":"R24-20231015","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/0269216311419882","article-title":"Evidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: a review article","volume":"26","author":"Malviya","year":"2012","journal-title":"Palliat Med."},{"key":"R25-20231015","doi-asserted-by":"crossref","first-page":"62151","DOI":"10.1155\/2007\/62151","article-title":"The use of massive endoprostheses for the treatment of bone metastases","volume":"2007","author":"Park","year":"2007","journal-title":"Sarcoma."},{"key":"R26-20231015","doi-asserted-by":"crossref","first-page":"665","DOI":"10.2106\/00004623-197052040-00002","article-title":"Surgical treatment for secondary neoplastic fractures","volume":"52","author":"Parrish","year":"1970","journal-title":"J Bone Joint Surg Am."},{"key":"R27-20231015","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s11999-016-4810-7","article-title":"What are the functional results and complications with long stem hemiarthroplasty in patients with metastases to the proximal femur?","volume":"475","author":"Peterson","year":"2017","journal-title":"Clin Orthop Relat Res."},{"key":"R28-20231015","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.injury.2010.08.015","article-title":"Surgical treatment of pathologic fractures of humerus","volume":"41","author":"Piccioli","year":"2010","journal-title":"Injury."},{"key":"R29-20231015","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.suronc.2008.08.007","article-title":"Endoprosthetic proximal femur replacement: metastatic versus primary tumors","volume":"18","author":"Potter","year":"2009","journal-title":"Surg Oncol."},{"key":"R30-20231015","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/BF00443814","article-title":"Metastatic instability at the proximal end of the femur","volume":"113","author":"Rompe","year":"1994","journal-title":"Arch Orthop Trauma Surg."},{"key":"R31-20231015","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.arth.2006.11.016","article-title":"Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur","volume":"23","author":"Selek","year":"2008","journal-title":"J Arthroplasty."},{"key":"R32-20231015","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/082585971002600204","article-title":"Quality of life in terminally ill cancer patients: contributors and content validity of instruments","volume":"26","author":"Shahidi","year":"2010","journal-title":"J Palliat Care."},{"key":"R33-20231015","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/01.blo.0000170721.07088.2e","article-title":"Function and health status in surgically treated bone metastases","volume":"438","author":"Talbot","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R34-20231015","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.1097\/01.blo.0000093849.72468.82","article-title":"Metastatic disease of the femur: surgical treatment","volume":"415","author":"Ward","year":"2003","journal-title":"Clin Orthop Relat Res."},{"key":"R35-20231015","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1002\/1097-0142(20010715)92:2<257::AID-CNCR1317>3.0.CO;2-R","article-title":"Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients","volume":"92","author":"Wedin","year":"2001","journal-title":"Cancer."},{"key":"R36-20231015","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00003086-199002000-00036","article-title":"Metastatic bone disease: a study of the surgical treatment of 166 pathologic humeral and femoral fractures","volume":"251","author":"Yazawa","year":"1990","journal-title":"Clin Orthop Relat Res."}],"container-title":["Clinical Orthopaedics & Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00003086-201803000-00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T08:29:37Z","timestamp":1697358577000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00003086-201803000-00018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,5]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1007\/s11999.0000000000000065","relation":{},"ISSN":["0009-921X"],"issn-type":[{"value":"0009-921X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,5]]}}}