{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T12:22:13Z","timestamp":1789820533315,"version":"4.0.1"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T00:00:00Z","timestamp":1574380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Patients suffering from bone metastasis are at high risk for pathological fractures and especially hip fractures. Osteolytic metastases can induce a high morbidity rate (i.e., pain, facture risk, mobility impairment), and operation on them can be difficult in this frail population having a reduced life expectancy. Several medical devices have been investigated for the prevention of these pathological hip fractures. Materials and Methods: To investigate these solutions, a literature review and a meta-analysis of primary studies was performed. Data sources included electronic databases (PubMed, CENTRAL and ClinicalTrials.gov) from 1990 until 1 January 2019. Titles, abstracts and full-text articles were reviewed in order to select only studies evaluating the performance of the studied solution to prevent osteoporotic and\/or pathological hip fracture. The main outcomes were the occurrence of hip fracture, pain evaluation (VAS score) and adverse events occurrence (including severe adverse events and deaths). All randomised controlled trials (RCTs) and cohort studies were considered. A Bayesian cumulative meta-analysis was undertaken on the primary studies conducted in patients with bone metastasis. Results: A total of 12 primary studies were identified, all were cohort studies without a control group, and one compared two devices, and were thereafter considered separately. In those 12 samples, 255 patients were included, mean age 61.7 years. After implantation, the cumulative risk of fracture was 5.5% (95% confidence interval, 3.0% to 8.6%), and adverse event occurrence was 17.4% (95%CI, 12.6 to 22.8%), with a median follow-up of 10 months. The posterior probability of a fracture rate below 5% was 40.3%. Conclusions: The literature about medical devices evaluation for preventing hip fractures in metastatic patients is poor and mostly based on studies with a limited level of evidence. However, this systematic review shows promising results in terms of efficacy and tolerance of these devices in patients with bone metastases. This treatment strategy requires further investigations.<\/jats:p>","DOI":"10.3390\/medicina55120755","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T09:02:52Z","timestamp":1574413372000},"page":"755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Prevention of Pathological Fracture of the Proximal Femur: A Systematic Review of Surgical and Percutaneous Image-Guided Techniques Used in Interventional Oncology"],"prefix":"10.3390","volume":"55","author":[{"given":"La\u00ebtitia","family":"Rodrigues","sequence":"first","affiliation":[{"name":"INSERM UMR 1153, Team ECSTRRA, Department of Biostatistics and Medical Information, AP-HP Saint Louis Hospital\/Paris Diderot Universit\u00e9, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-0884","authenticated-orcid":false,"given":"Fran\u00e7ois H.","family":"Cornelis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tenon Hospital, Sorbonne Universit\u00e9, 4 rue de la Chine, 75020 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Pierre-Paul-Riquet Hospital, CHU de Toulouse, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Chevret","sequence":"additional","affiliation":[{"name":"INSERM UMR 1153, Team ECSTRRA, Department of Biostatistics and Medical Information, AP-HP Saint Louis Hospital\/Paris Diderot Universit\u00e9, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1002\/jor.20555","article-title":"Lytic lesions in the femoral neck: Importance of location and evaluation of a novel minimally invasive repair technique","volume":"26","author":"Kaneko","year":"2008","journal-title":"J. Orthop. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s00264-009-0838-6","article-title":"Proximal femoral replacements for metastatic bone disease: Financial implications for sarcoma units","volume":"34","author":"Ashford","year":"2010","journal-title":"Int. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1038\/nrc867","article-title":"Metastasis to bone: Causes, consequences and therapeutic opportunities","volume":"2","author":"Mundy","year":"2002","journal-title":"Nat. Rev. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.2106\/00004623-200408000-00011","article-title":"Patient survival after hip arthroplasty for metastatic disease of the hip","volume":"86","author":"Schneiderbauer","year":"2004","journal-title":"J. Bone Jt. Surg. Am. Vol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00198-009-0840-2","article-title":"\u201cPathologic\u201d fractures: Should these be included in epidemiologic studies of osteoporotic fractures?","volume":"20","author":"Curtis","year":"2009","journal-title":"Osteoporos. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s00270-015-1138-8","article-title":"Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept","volume":"39","author":"Kelekis","year":"2016","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"526","DOI":"10.5301\/HIP.2011.8654","article-title":"Survival after Pathological Fractures of the Proximal Femur","volume":"21","author":"Parker","year":"2011","journal-title":"HIP Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.diii.2016.12.005","article-title":"Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur","volume":"98","author":"Mavrovi","year":"2017","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1007\/s11999-010-1326-4","article-title":"In Brief: Classifications in Brief: Mirels\u2019 Classification: Metastatic Disease in Long Bones and Impending Pathologic Fracture","volume":"468","author":"Jawad","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.diii.2017.06.014","article-title":"Augmented osteoplasty for proximal femur consolidation in cancer patients: Biomechanical considerations and techniques","volume":"98","author":"Cornelis","year":"2017","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejrad.2017.02.022","article-title":"Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological\/insufficiency fractures of the femoral neck in non-surgical cancer patients","volume":"90","author":"Cazzato","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_12","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2019, June 04). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analysis. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Biau, D.J., Boulezaz, S., Casabianca, L., Hamadouche, M., Anract, P., and Chevret, S. (2017). Using Bayesian statistics to estimate the likelihood a new trial will demonstrate the efficacy of a new treatment. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0401-x"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1007\/s00270-017-1613-5","article-title":"A Novel Implant for the Prophylactic Treatment of Impending Pathological Fractures of the Proximal Femur: Results from a Prospective, First-in-Man Study","volume":"40","author":"Cornelis","year":"2017","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_16","first-page":"144","article-title":"Intramedullary nailing without curettage and cement augmentation for the treatment of impending and complete pathological fractures of the proximal or midshaft femur","volume":"80","author":"Shemesh","year":"2014","journal-title":"Acta Orthop. Belg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1007\/s11999-012-2656-1","article-title":"Prophylactic stabilization for bone metastases, myeloma, or lymphoma: Do we need to protect the entire bone?","volume":"47","author":"Alvi","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_18","first-page":"429","article-title":"The Long Gamma Nail for stabilisation of existing and impending pathological fractures of the femur: An analysis of 48 cases","volume":"70","author":"Moholkar","year":"2004","journal-title":"Acta Orthop. Belg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0020-1383(00)00218-7","article-title":"The treatment of impending and existing pathological femoral fractures using the long gamma nail","volume":"32","author":"Edwards","year":"2001","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1302\/0301-620X.78B3.0780400","article-title":"Pathological fractures of the proximal femur with impending shaft fractures treated by THR and cemented intramedullary nailing","volume":"78","author":"Voggenreiter","year":"1996","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1302\/0301-620X.73B4.2071657","article-title":"Intramedullary nailing for impending pathological subtrochanteric fractures","volume":"73","author":"Weikert","year":"1991","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1007\/s00270-011-0330-8","article-title":"Percutaneous stabilization of impending pathological fracture of the proximal femur","volume":"35","author":"Deschamps","year":"2012","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00270-015-1133-0","article-title":"Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur","volume":"39","author":"Tian","year":"2015","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_24","first-page":"1","article-title":"Comparative Analysis of Durable Responses on Immune Checkpoint Inhibitors Versus Other Systemic Therapies: A Pooled Analysis of Phase III Trials","volume":"3","author":"Latouche","year":"2019","journal-title":"JCO Precis. Oncol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/12\/755\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:36:41Z","timestamp":1760189801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/12\/755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,22]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["medicina55120755"],"URL":"https:\/\/doi.org\/10.3390\/medicina55120755","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,22]]}}}