• Ajay Malviya and Craig Gerrand.
• Freeman Hospital, Newcastle upon Tyne, UK. amalviya@nhs.net
• Palliat Med. 2012 Sep 1;26(6):788-96.

BackgroundThe decision to offer orthopaedic surgery to patients with metastatic bone disease is often difficult and requires an understanding of the underlying disease, the patient's needs or wishes, the expected outcomes and the principles of surgery.AimWe aimed to look at the literature to support the role of orthopaedic surgery for skeletal metastasis in improving key outcomes such as pain, quality of life and physical functioning.DesignReview article.Data SourcesThe 'Dialog Datastar' database was used to access Medline and other resources from 1951 to December 2009 using keywords 'Metasta$' AND 'Bone or Skeletal' AND 'Results Or Outcome Or Surg$ Or Management'.ResultsThe majority of the studies that have looked at these key outcomes are limited by their design and their use of non-validated outcome measures. This study has detailed the measures to assess outcome, predict survival, predict fracture and how to arrive at key decisions, such as when to operate and when not to operate on these patients.ConclusionTimely and appropriate surgical intervention reliably alleviates pain and improves quality of life and can be undertaken with few complications in most patients. Although most procedures can be undertaken by non-specialists, consultation with other members of the multidisciplinary team is mandatory, and in complex cases, referral to a specialist orthopaedic oncology centre can be helpful.

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