A comparative study of the role of carbon fibre reinforced polyetheretherketone and titanium intramedullary nails in patients with metastatic bone disease

Carbon fibre reinforced polyetheretherketone (CFR-PEEK) implants have gained interest because of reported biomechanical advantages and radio-lucent properties. The aim of this study was to evaluate the role of CFR-PEEK nails in patients with metastatic bone disease (MBD). We performed a retrospective cohort study evaluating patients with MBD undergoing intramedullary (IM) nailing for prophylaxis or fixation of pathological fractures using CFR- PEEK or titanium implants. Patient survival, implant failure rates, ability to visualise disease progression on post- operative CT/MRI, and post-operative radiotherapy dose were reported. Fifty patients underwent 56 IM nails (26 CFR-PEEK and 30 titanium). Median survival was 8 months for the entire cohort, 6 months for patients with CFR- PEEK nails and 8 months for those with conventional nails (p=0.691). No implant failures were recorded in either group. There was no correlation between implant type and post-operative radiotherapy dose given (χ 2 = 0.139, p=0.710). Artefact on MRI was less evident with CFR-PEEK nails when hybrid imaging and metal artefact reduction techniques were used. The advantages of CFR-PEEK nails might not be realised in clinical practice for most patients with MBD requiring IM nailing except for in those likely to require prolonged disease surveillance.