JAAOS - 2026-05-18 - Journal Article
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.
Rizk PA, Gonzalez MR, Morse AS, Lozano-Calderón SA
Topics
Key Takeaway
Carbon fiber and titanium intramedullary nails for pathologic femoral fractures show equivalent total inpatient and 30-day costs with comparable 30-day complication rates (25% vs. 20%, P=0.50) in propensity-matched cohorts.
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Summary
This study asked whether carbon fiber IMNs incur higher costs or complication rates compared to titanium IMNs for impending or completed pathologic femoral fractures due to metastatic bone disease. Propensity-matched retrospective analysis of patients treated 2016–2023 compared inpatient and 30-day costs (reported as cost units) and 30-day outcomes. Mean LOS was 8 days in both groups; 30-day readmission was 25% in both; revision surgery rates were 1% vs. 2%; no statistically significant differences were found in any cost or complication metric.
Key Limitation
Follow-up is limited to 30 days, precluding assessment of implant survival, local tumor progression, and hardware failure in a population with variable but often extended survival, particularly for breast and renal primary tumors.
Original Abstract
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.