Development and Evaluation of a Percutaneous Technique for Repairing Proximal Femora With Metastatic Lesions

Metastatic lesions in the proximal femur are a common and serious manifestation of breast cancer. These lesions can be painful and can lead to pathological fracture. Prophylactic surgical fixation is advised in patients thought to be at high risk of fracture and typically involves placement of a prosthetic implant or compression hip screw. This study is investigating whether proximal femora with metastatic lesions can be repaired by simply filling the defect with bone cement (polymethylmethacrylate), an innovative procedure that could be performed percutaneously and could eliminate the need for implanting hardware in many cases. If defects could be repaired using this technique, patients would benefit from shorter and less invasive surgical procedures, less pain and discomfort, greatly reduced recovery time, and shorter hospital stays - all at much lower cost. To date, mechanical testing and finite element modeling of femora with and without repaired simulated tumors support the feasibility of this repair technique. The finite element modeling method has been calibrated to produce accurate estimates of measured fracture load and validated on an independent data set. This method is being used to develop clinical guidelines for assessing the need for prophylactic fixation and for using the proposed percutaneous repair procedure.