Comparison of Costs and Postoperative Complications Between Carbon Fiber and Titanium Intramedullary Nails in the Treatment of Impending or Completed Pathologic Femoral Fractures: A Propensity-Matched Study

Aims: Despite the benefits of carbon fiber (CF) implants, concerns over their higher cost relative to titanium implants have limited their broader adoption in orthopaedic oncology. Our study compared the costs and postoperative complications associated with titanium and CF intramedullary nails (IMNs) in patients with femoral bone metastases. Methods: We conducted a retrospective analysis of patients treated with titanium or CF IMNs for impending or completed pathologic femoral fractures due to metastatic bone disease between 2016 and 2023. Inpatient costs, 30-day costs, and 30-day postoperative complications were assessed. Mean and median total, direct, and indirect costs were evaluated using cost units. Propensity-score matching was conducted to minimize potential confounders. Results: After propensity-score matching, we included 91 and 45 patients treated with titanium and CF femur IMNs, respectively. No differences in age, sex, primary tumor, or comorbidity profile were found between groups. Mean and median total costs, direct costs, and indirect costs during the inpatient stay and at 30 days postoperatively were similar between the titanium and CF groups. The mean length of stay was 8 days in both groups ( P = 0.70). Thirty-day complication rates were 25% and 20% in the titanium and CF group, respectively ( P = 0.50). No differences in 30-day readmission (25% in both; P = 0.35), mortality (4% versus 9%; P = 0.29), and revision surgery (1% versus 2%; P = 0.61) rates were observed between the titanium and CF groups. Conclusion: We found comparable inpatient costs, 30-day costs, and short-term postoperative complications between titanium and CF IMNs for impending or completed pathologic femoral fractures. Level of Evidence: III