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

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 type of 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.