Surgical management of metastatic disease of bone at the hip

Concordant advances in cancer chemotherapy, radiotherapy, and surgical technique have been of apparent benefit to many cancer patients suffering from skeletal involvement at the hip. Consideration of the effects of underlying disease and prior treatment must be evaluated prior to developing a surgical plan. Acetabular involvement can be treated by either conventional or augmented total hip arthroplasty using protrusio rings and acetabular meshes, depending upon minor or major degrees of tumor destruction. Girdlestone resection arthroplasty for massive degrees of acetabular involvement yields only modest results. Femoral neck fractures can be treated by endoprosthetic replacement. However, the association of acetabular disease should be considered, and if present, total hip arthroplasty should be performed. Intertrochanteric fractures can be stabilized with the use of a stout tubeplate nail device plus cement. Subtrochanteric fractures can be stabilized with a Zickel nail device plus cement. The goals of treatment are to relieve pain and restore function by using a device with an anticipated fatigue life which should exceed the patient's life expectancy.