[Radiation lesions of the hip]

Irradiation lesions of the hip are much better known than they used to be, and problems diagnosis no longer arise. Study of these 49 cases of irradiation lesions of the hip shows that they occur in 1 to 36 per cent of patients irradiated for pelvic cancer. The rate of occurrence may be reduced by selection and improvement in the techniques of radiotherapy. The extent of the lesions is determined from the time that irradiation is stopped. The lesions appear after a delay of several months and develop progressively throughout their extent. This confer on them a false appearance of a progressive lesion. There are severe lesions, which seriously threaten ambulation. Trans-cervical fractures should be considered separately; these are usually isolated lesions, simple to treat and of good prognosis. Fractures of the acetabulum and necroses of the acetabular roof or of the femoral head, developing usually as paired lesions or in the context of an irradiation coxopathy, constitute another group, in which treatment by total prosthesis raises numerous technical problems. Total prosthesis has however given to these hips; in almost 2 cases out of 3, a function which is at present satisfactory but whose future is unknown. The abnormality high levels of infection and in particular loosening are related to the extent to which the lesions have progressed. Resection of these prosthesis in cases of failure is similar to resection of the head and neck, and has its place as a salvage operation since its allows mobility and pain relief to be obtained at the price of stability.