Preventing Femoral Fractures in Patients with Bone Metastases

Metastatic bone disease occurs when cancer cells spread from a primary organ site to the skeleton. Bone metastases can damage and weaken the bone, increasing the risk for a pathological fracture. Since such fractures can have severe consequences in metastatic patients, prophylactic (preventive) surgery is advised when the risk for fracture is high. The most common location for prophylactic surgery is the proximal femur, where mechanical stabilization is typically provided by intra- or extramedullary implants. Femoroplasty is an alternative, less invasive procedure in which bone cement is injected percutaneously into the lesion. However, uncertainty remains whether the latter procedure provides sufficient mechanical strengthening to a weight-bearing bone such as the femur.

Clinicians face the task of evaluating whether prophylactic surgery is necessary for a specific patient and which treatment method is the most optimal one. This decision is currently based on the individual judgment of the surgeon and/or oncologist, lacking an objective, biomechanics-based assessment. To support the decision-making process, the goal of this thesis was to develop a computational tool for (1) assessing the risk for fracture in patients with femoral bone metastases and (2) evaluating the mechanical effect of femoroplasty as a prophylactic treatment method.