Outcome of surgical treatment for metastatic bone disease of the distal femur - Observational single-center study of 47 patients

Sep 30, 2026

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There is limited evidence on surgical management of distal femoral metastatic lesions. This retrospective single-center analysis evaluates outcomes after surgery for pathological fractures of the distal third of the femur, including implant-related local complications, revision needs, pain and ambulatory function, and overall survival. Forty-seven patients (48 fractures) treated between 2000 and 2024 were categorized by reconstruction type, comparing prostheses with osteosynthesis plates and nails.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Methods

Results

Discussion

Introduction

Materials and methods

SICOT-J 2025, 11, 60 􀀁 The Authors, published by EDP Sciences, 2026 [https://doi.org/10.1051/sicotj/2025062](https://doi.org/10.1051/sicotj/2025062) Available online at: [www.sicot-j.org](www.sicot-j.org) ORIGINAL ARTICLE OPEN ACCESS Outcome of surgical treatment for metastatic bone disease of the distal femur: Observational single-center study of 47 patients Adam Mellgren 1 and Panagiotis Tsagkozis2,3,* 1 Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden 2 Karolinska Institutet, Department of Molecular Medicine and Surgery, 17177 Stockholm, Sweden 3 Department of Acute and Reparative Medicine, Karolinska University Hospital, Solna, 17176 Stockholm, Sweden Received 15 October 2025, Accepted 26 November 2025, Published online 6 January 2026 Abstract – Introduction: There is a paucity of data regarding the surgical treatment of distal femoral metastatic lesions. In this retrospective study, we aim to describe the outcome of surgery in this location and further analyze the ﬁndings based on the type of surgical reconstruction. Methods: 47 patients (48 fractures) who underwent surgery due to pathological fractures of the distal third of the femur, between 2000 and 2024, were included in the analysis. There were 29 prostheses and 19 osteosyntheses (10 plates, 9 nails) . Local complications, implant revision rate, functional outcome regarding pain and ambulatory capacity, and overall survival were analyzed depending on the typeof surgical treatment. Results: The complication pattern was different among implants used, with severe infections seen in prostheses (3/29 implants) and tumor recurrence in osteosynthesis (2/19 implants) . In cases of osteosynthesis, failures resulting in revision surgery were documented only in cases of plate reconstruction (none when nails were used), resulting in a marginally higher revision rate (p = 0.14) . Surgical treatment resulted in the restoration of the ambulatory capacity in 85% of patients, and pain levels were minor or moderate in 93%, without any signiﬁcant difference between the surgical methods. Prostheses were used in patients with better overall survival (p = 0.015) . Discussion: The patterns of local complications and their management differed between the different reconstruction techniques. Plate osteosynthesis had the highest risk for re-operation. The overall postoperative result was satisfactory, and functional outcomes were generally comparable. Patients with a good prognosis should be considered for reconstruction with a prosthesis when the bone quality does not allow nail osteosynthesis. Level of evidence: IV, retrospective study. Key words: Bone metastasis, Pathological fracture, Distal femur, Prosthesis, Osteosynthesis. Introduction In the appendicular skeleton, the femur is the most common location of metastatic bone disease. Treatment of impending or completed pathological fractures of this major weight-bearing bone is generally surgical. Metastases in the distal part of the bone are far less frequent than in the proximal [1] . There are only two previous studies describing surgical treatment in this location, reporting on 29 [2] and 16 [3] patients respectively. Since the number of patients reported in the medical literature is low, there is a noticeable knowledge gap resulting in the absence of treatment recommendations [4] . In this location, a variety of implants can be used, and the associated complications, their severity, and management, as well as the functional outcome, are poorly described. This renders decision-making on the proper surgical strategy difﬁcult. *Corresponding author: [panagiotis. tsagkozis@ki. se](panagiotis. tsagkozis@ki. se) Generally, reconstruction of metastatic skeletal defects relies on either osteosynthesis (OS) or endoprosthesis(EP) [5] . Each strategy has advantages and disadvantages, and there is no consensus among orthopedic surgeons regarding the most appropriate method to be used; treatment choices

FAQs

What was the purpose of the study for distal femur metastases?

To describe surgical outcomes for distal femoral metastatic lesions and to analyze findings based on the surgical reconstruction type.

What patients and fractures were included?

Forty-seven patients (48 fractures) undergoing surgery for pathological fractures of the distal third of the femur between 2000 and 2024.

How did complications differ between prostheses and osteosynthesis?

Severe infections were reported with prostheses, while tumor recurrence was seen with osteosynthesis; plate reconstructions also showed failures requiring revision surgery, with nails associated with none in the study results.

Sep 30, 2026

Uploaded by dawugda