Hemiartroplastia de quadril em pacientes com mieloma múltiplo: Uma série de casos retrospectivos e revisão da literatura

Resumo

Objetivos As fraturas do colo femoral em pacientes com mieloma múltiplo são geralmente tratadas com hemiartroplastia ou artroplastia total do quadril de acordo com a presença de infiltração acetabular. Devido à escassez de relatos nesta área, o objetivo deste estudo é revisar os desfechos clínicos da hemiartroplastia do quadril em pacientes com mieloma múltiplo e os resultados e a sobrevida neste subconjunto de pacientes.

Métodos Um total de 15 pacientes (16 casos), com idade média de 71,7 anos e portadores de mieloma, foram submetidos à hemiartroplastia de quadril para tratamento de fraturas de colo femoral com luxação. Suas radiografias e dados clínicos foram avaliados. Destes casos, 13 passaram pela hemiartroplastia bipolar e três pela unipolar.

Resultados Após um acompanhamento médio de 18,2 meses desde o momento da cirurgia, 3 casos sofreram fraturas periprotéticas (18,75%), 4 casos (25%) tiveram ossificação heterotópica e 1 caso (6,25%) apresentou erosão acetabular. A mortalidade dos pacientes em 1 e 5 anos foi de 53,3 e 73,3%, respectivamente.

Conclusão A hemiartroplastia de quadril ainda é uma opção terapêutica viável em pacientes com mieloma. No entanto, a morbidade e a mortalidade podem ser altas nesses pacientes e devem ser compreendidas com sensatez antes da cirurgia para atingir bons resultados.

Palavras-chave

colo do fêmur - fraturas do quadril - hemiartroplastia - mieloma múltiplo

Suporte Financeiro

Os autores declaram que não receberam suporte financeiro de agências nos setores público, privado ou sem fins lucrativos para realizar este estudo.

Estudo desenvolvido no Departamento de Cirurgia Ortopédica, Geisinger Medical Center, Danville, PA, Estados Unidos.

Publication History

Received: 19 February 2024

Accepted: 30 August 2024

Article published online:
16 January 2025

• Referências

• 1 Guedes A, Becker RG, Teixeira LEM. Multiple Myeloma (Part 1) - Update on Epidemiology, Diagnostic Criteria, Systemic Treatment and Prognosis. Rev Bras Ortop 2023; 58 (03) 361-367
• 2 Guedes A, Becker RG, Teixeira LEM. Multiple Myeloma (Part 2) - Update on The Approach to Bone Disease. Rev Bras Ortop 2023; 58 (03) 368-377
• 3 Gianakos AL, Patel JN, Miller JM, Sonnylal L, Wittig JC. Metastatic Disease, Myeloma, and Lymphoma Affecting the Hip. J Hip Surg 2019; 3 (01) 34-40
• 4 Papagelopoulos PJ, Galanis EC, Greipp PR, Sim FH. Prosthetic hip replacement for pathologic or impending pathologic fractures in myeloma. Clin Orthop Relat Res 1997; (341) 192-205
• 5 Moura M, Sanches DP, Pinto ÁF, Milano SS, Villela MM. Evaluation of Intramedullary Methods with Polymethylmethacrylate for Fixation of Bone Lesions of the Extremities. Rev Bras Ortop 2021; 56 (06) 772-776
• 6 Park KJ, Menendez ME, Mears SC, Barnes CL. Patients With Multiple Myeloma Have More Complications After Surgical Treatment of Hip Fracture. Geriatr Orthop Surg Rehabil 2016; 7 (03) 158-162
• 7 Schneiderbauer MM, Sierra RJ, Schleck C, Harmsen WS, Scully SP. Dislocation rate after hip hemiarthroplasty in patients with tumor-related conditions. J Bone Joint Surg Am 2005; 87 (08) 1810-1815
• 8 Parker MJ, Khan AZ, Rowlands TK. Survival after pathological fractures of the proximal femur. Hip Int 2011; 21 (05) 526-530
• 9 Alvi HM, Damron TA. Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone?. Clin Orthop Relat Res 2013; 471 (03) 706-714
• 10 Peterson JR, Decilveo AP, O'Connor IT, Golub I, Wittig JC. What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?. Clin Orthop Relat Res 2017; 475 (03) 745-756
• 11 Stevenson JD, Kumar VS, Cribb GL, Cool P. Hemiarthroplasty proximal femoral endoprostheses following tumour reconstruction: is acetabular replacement necessary?. Bone Joint J 2018; 100-B [phone]
• 12 Saglam F, Baysal O, Sirin E, Sofulu O, Kesimer MD, Erol B. Is bipolar hemiarthroplasty an appropriate type of hip articulation following proximal femoral or total femoral resections for musculoskeletal malignancies?. Arch Orthop Trauma Surg 2022; 142 (02) 331-341
• 13 Schwarzkopf E, Sachdev R, Flynn J, Boddapati V, Padilla RE, Prince DE. Occurrence, risk factors, and outcomes of bone cement implantation syndrome after hemi and total hip arthroplasty in cancer patients. J Surg Oncol 2019; 120 (06) 1008-1015
• 14 Hayden BL, Varady NH, Abdeen A, Lozano-Calderon SA, Chen AF, Ready JE. Pathologic Fracture Study Group. No Difference Between Hemiarthroplasty and Total Hip Arthroplasty in the Treatment of Pathologic Femoral Neck Fractures. J Arthroplasty 2021; 36 (11) 3662-3666
• 15 Lin JS, Santiago-Torres JE, Everhart JS, Zayan NE, Mayerson JL, Scharschmidt TJ. When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?. J Surg Oncol 2017; 116 (08) 1132-1140
• 16 Thein R, Herman A, Chechik A, Liberman B. Uncemented arthroplasty for metastatic disease of the hip: preliminary clinical experience. J Arthroplasty 2012; 27 (09) 1658-1662
• 17 Swanson KC, Pritchard DJ, Sim FH. Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg 2000; 8 (01) 56-65
• 18 Harrington KD. Orthopaedic management of extremity and pelvic lesions. Clin Orthop Relat Res 1995; (312) 136-147
• 19 Rock M. The use of Bateman bipolar proximal femoral replacement in the management of proximal femoral metastatic disease. In: Yamamuro T. ed. New developments for limb salvage in musculoskeletal tumours. Tokyo: Springer-Verlag; 1989: 437
• 20 Randall RL, Aoki SK, Olson PR, Bott SI. Complications of cemented long-stem hip arthroplasties in metastatic bone disease. Clin Orthop Relat Res 2006; 443 (443) 287-295
• 21 Nucci M, Anaissie E. Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents. Clin Infect Dis 2009; 49 (08) 1211-1225
• 22 Stanley A, Young A. Primary prevention of venous thromboembolism in medical and surgical oncology patients. Br J Cancer 2010; 102 (Suppl 1, Suppl 1) S10-S16
• 23 Nucci M, Anaissie E. Infections in patients with multiple myeloma. Semin Hematol 2009; 46 (03) 277-288
• 24 Tsukamoto S, Errani C, Kido A, Mavrogenis AF. What's new in the management of metastatic bone disease. Eur J Orthop Surg Traumatol 2021; 31 (08) 1547-1555
• 25 Masters J, Metcalfe D, Ha JS, Judge A, Costa ML. Surgical site infection after hip fracture surgery: a systematic review and meta-analysis of studies published in the UK. Bone Joint Res 2020; 9 (09) 554-562
• 26 de Jong L, Klem TMAL, Kuijper TM, Roukema GR. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J 2017; 99-B [phone]
• 27 SEER*Explorer: An interactive website for SEER cancer statistics [Internet]. Surveillance Research Program, National Cancer Institute [accessed february 23, 2023] Available from: https://seer.cancer.gov/explorer/on
• 28 DeVita VT, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 12th ed.. Philadelphia: Wolters Kluwer; 2022
• 29 Miceli TS, Colson K, Faiman BM, Miller K, Tariman JD. International Myeloma Foundation Nurse Leadership Board. Maintaining bone health in patients with multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs 2011; 15 (0, Suppl) 9-23
• 30 Moura M. Treatment of Metastasis in the Appendicular Skeleton. Rev Bras Ortop 2022; 57 (02) 200-206
• 31 Seraj SM, Al-Zaghal A, Østergaard B, Høilund-Carlsen PF, Alavi A. Identification of Heterotopic Ossification Using 18F-NaF PET/CT. Clin Nucl Med 2019; 44 (04) 319-320
• 32 Corrigan CM, Greenberg SE, Sathiyakumar V. et al. Heterotopic ossification after hemiarthroplasty of the hip - A comparison of three common approaches. J Clin Orthop Trauma 2015; 6 (01) 1-5
• 33 Weber W, Moore J, Cheema N. Traumatic Acetabular Protrusion. Clin Pract Cases Emerg Med 2018; 2 (03) 260-261
• 34 Bible MW, Pinals RS, Palmieri GM, Pitcock JA. Protrusio acetabuli in osteoporosis and osteomalacia. Clin Exp Rheumatol 1983; 1 (04) 323-326
• 35 Karayiannis P, Walls A, Cassidy R, Beverland D. Rapidly Progressive Osteoarthritis and Acetabular Bone Loss Outcomes for Patients Undergoing Primary Total Hip Replacement. Arthroplast Today 2020; 6 (03) 289-295
• 36 Adenikinju A, Slover JD, Egol KA. Rapid Acetabular Chondrolysis following Hemiarthroplasty of the Hip: A Poor Prognostic Sign. Case Rep Orthop 2019; 2019: 7328526
• 37 Trueba Davalillo C, Minueza Mejía T, Gil Orbezo F, Ponce Tovar V, García Velazco R. Factores de riesgo que influyen en la erosión acetabular posterior a una hemiartroplastía de cadera en el tratamiento de las fracturas subcapitales. [Risk factors that have influence on acetabular erosion after a hip hemiarthroplasty in the treatment of subcapital fractures] Acta Ortop Mex 2007; 21 (03) 121-127
• 38 Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate. J Arthroplasty 2017; 32 (01) 150-154
• 39 Theil C, Möllenbeck B, Gosheger G. et al. Acetabular Erosion After Bipolar Hemiarthroplasty in Proximal Femoral Replacement for Malignant Bone Tumors. J Arthroplasty 2019; 34 (11) 2692-2697
• 40 Emre F, Ertaş ES, Bozkurt M. Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty. Genel Tip Derg 2022; 32 (05) 564-570
• 41 Guedes A, Oliveira MBDR, Melo AS, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2021; 58 (02) 179-190