Surgical strategy for benign lesions in proximal femur: internal fixation or endoprosthetic replacement

The purpose of this study was to explore the indications for the two most frequently applied surgical procedures for benign lesions in the proximal femur.

We retrospectively reviewed 142 patients with benign lesions in the proximal femur from January 2010 to January 2015. Internal fixation (IF) was adopted in 110 patients, while endoprosthetic replacement (EPR) was applied in 32 patients. Clinical data, including operation time, blood loss, hospitalization time, and hospitalization expenses, were compared between the groups. Limb mobilization was evaluated by the Musculoskeletal Tumor Society Score-93 (MSTS-93) and Harris Hip Score (HHS). Local recurrences and complications were statistically compared.

The average follow-up was 66 months (range 32-84 months). In the EPR group, operation time and hospitalization time were significantly shorter (p < 0.05 and p < 0.05, respectively), while blood loss and hospitalization expenses were significantly higher (p < 0.05 and p < 0.05, respectively). Functional outcomes of the MSTS-93 and HHS were higher at the three week follow-up in the EPR group (p < 0.001 and p < 0.001, respectively) but lower at 6 months (p = 0.031 and p = 0.042, respectively). No differences were observed in the two scores at three  months (p = 0.261 and p = 0.134, respectively). Local recurrence and complication rates were similar in the two groups (p = 0.895 and p = 0.942, respectively).

The strategy for benign proximal femur lesions should depend on the site, size, initial diagnosis, and thinning degree of cortical bone. IF and EPR both result in satisfactory local control and functional and radiological results, while EPR is more suitable for aggressive and recurrent lesions and serves as an effective measure after IF failure.