The edition · Orthopaedics
One in ten patients with spinal metastases now reaches five years
A modern registry puts five-year survival in spinal metastatic disease at 8.9% — enough to change how durable a construct needs to be. Also: the pooled risk factors for infection after knee replacement, and why a previous arthroscopy matters at the knee and shoulder but not the hip.
The edition in brief
A healthcare system registry followed 926 patients presenting with spinal metastatic disease between 2017 and 2025, 60% treated surgically. Kaplan-Meier five-year survival was 8.9% (95% CI 7.2 to 10.9), lowest in lung cancer at every time point. Adjusting for age, sex, race, comorbidity, immunotherapy and treatment, both prognostic scores predicted five-year survival: the SORG nomogram (HR 0.98 per point, 95% CI 0.98-0.99) and the New England Spinal Metastasis Score (HR 0.61 per point, 95% CI 0.56-0.66). An updated systematic review pooled 25 observational studies of periprosthetic joint infection after total knee arthroplasty. Associated factors included BMI 30 or above (OR 5.72, 95% CI 2.65-12.36), combined pulmonary disease (5.54, 1.93-15.96), history of hormone therapy (4.88, 2.90-8.22), postoperative urinary tract infection (3.59, 1.15-11.21), ASA score 3 or above (2.73, 1.02-7.32), rheumatoid arthritis (2.64, 1.38-5.02), blood transfusion (2.27, 1.59-3.25), drain in place 24 hours or longer (2.23, 1.50-3.32), type 2 diabetes (2.09, 1.45-3.01), preoperative anaemia (1.82, 1.67-1.99), smoking (1.65, 1.34-2.04), intraoperative blood loss above 200 ml (1.51, 1.03-2.22) and male sex (1.39, 1.27-1.51). A meta-analysis of 31 observational studies found previous arthroscopy raised the odds of any infection after arthroplasty (OR 1.33, 95% CI 1.14-1.56) and deep infection (OR 1.38, 1.17-1.63). Prior knee arthroscopy was associated with raised infection risk and prior shoulder arthroscopy with markedly raised deep infection risk, while hip arthroscopy showed no significant association. Pooled overall and deep infection rates were both 2%.
Five-year survival in spinal metastatic disease, and what it means for the construct you build
Five-year survival in spinal metastatic disease is now about 8.9%, and both SORG and NESMS predict it — enough to identify the minority who need a construct that lasts, and to keep operations short and simple for the majority who do not.
What actually predicts infection after knee replacement
Obesity, pulmonary disease, hormone therapy history, postoperative urinary infection and ASA 3 or above carried the largest odds of infection after knee replacement — but the actionable ones are anaemia, smoking, glycaemic control, transfusion and drain duration.
The preoperative haemoglobin is a modifiable risk factor, not a baseline
Treat a low preoperative haemoglobin as a reason to move the date and find the cause — it carries its own infection risk and it drives the transfusion that carries another.
A previous arthroscopy raises infection risk after arthroplasty — at the knee and shoulder, not the hip
Previous arthroscopy raised deep infection odds after arthroplasty by about 38%, driven by the knee and shoulder with no signal at the hip — worth asking about, recording, and putting into the consent conversation.
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