Metastatic Disease of the Lower Extremity: Management and Minimally Invasive Techniques

Metastatic bone disease is becoming more frequent as new systemic therapies are allowing patients with carcinoma to live longer. Orthopaedic surgeons will encounter impending and pathologic fractures related to bone metastases and be relied on to provide surgical options to improve pain and function. The lower extremity is the most common appendicular site involved, is weight bearing, and provides many unique anatomic regions and joints that demand knowledge of different surgical techniques. The surgical goals are to provide immediate stability for weight bearing and improved pain control and function, and it is optimal to address impending fractures before they complete. In general, hip or knee arthroplasty procedures are best when the tumor is uncontained and involves the articular surface or much of the weight bearing portion of the epiphysis in that region. When the joint and epiphysis are largely uninvolved and the metaphysis bears the burden of disease, internal fixation with locking plates with or without cement augmentation is best around the knee, while load sharing cephalomedullary nails is better in the proximal femur. Diaphyseal metastases should be addresses with reamed and locked, intramedullary nails with or without cement. (C) 2021 Elsevier Inc. All rights reserved.