The edition · Orthopaedics
About one in ten patients with spinal metastases lives five years — plan the operation for them too
A 926-patient registry puts a long-term number on spinal metastatic disease, a JBJS review makes periprosthetic fracture prevention part of every hip replacement, and joint replacement under 25 works but carries more revisions.
The edition in brief
A Boston registry of 926 patients treated with or without surgery for spinal metastases between 2017 and 2025 found a five-year survival of 8.9% (95% CI 7.2% to 10.9%), lowest in lung cancer. Both the SORG nomogram and the New England Spinal Metastasis Score predicted survival up to five years. About one patient in ten will outlive the usual assumptions, so scores should guide both the decision to operate and the durability of the construct. A JBJS review warns that periprosthetic femoral fractures after hip replacement are rising, with mortality comparable to hip fragility fractures, and argues that prevention — bone health, implant choice and fall prevention — belongs in routine arthroplasty care. A meta-analysis of 44 studies of hip and knee replacement in patients under 25 found large functional gains but all-cause revision of 8.7% after hip and 12.4% after knee replacement, improving in more recent cohorts. A UK register study of 182 secondary patellar resurfacings found meaningful gains in Oxford Knee Score and about 80–86% satisfaction, best when done more than 2.5 years after the primary knee.
Periprosthetic femoral fractures are rising — prevention has to start at the primary hip
Treat periprosthetic fracture as a foreseeable complication: address bone health, implant choice and falls at the time of the primary hip.
Hip and knee replacement under 25 improves function but revision runs at 9–12%
Joint replacement under 25 works, but consent must cover a higher, and likely lifetime, revision risk.
Secondary patellar resurfacing helps most when done more than 2.5 years after the primary knee
Offer secondary patellar resurfacing selectively, favouring patients who were once satisfied and are more than 2.5 years from their primary knee.
Every arthroplasty clinic is a fracture liaison clinic
Use the arthroplasty pre-assessment to start bone protection and falls prevention.
Five-year survival with spinal metastases is about 9% — and the prognostic scores still work that far out
Use SORG or NESMS to identify the one in ten patients with spinal metastases who will live five years, and plan their surgery for durability.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free