Surgical treatment of pathologic hip lesions in patients with metastatic disease

Impending and pathologic fractures about the hip due to metastatic tumors are debilitating to patients secondary to pain and loss of mobility. The results of internal fixation of impending or complete pathologic fracture about the hip in 29 patients undergoing 32 procedures were retrospectively reviewed. Operative procedures included total hip arthroplasty with protrusio cup acetabular reconstruction in 5 patients, bipolar hip replacement in 7 patients, compression screw and sideplate in 6 patients, placement of reconstruction intramedullary nail in 12 patients, proximal femoral replacement in 1 patient, and placement of pins and polymethylmethacrylate in 1 patient. Every patient in this series had relief of pain postoperatively, and all had improved ambulation. There were no operative or anesthesia related complications, no intraoperative or perioperative deaths, an no failures of fixation. A single postoperative complication occurred in a patient in whom a sacral decubitus developed that resolved with local wound care. This study shows that operative fixation of pathologic hip lesions can be performed with low morbidity and mortality in a debilitated patient population with good results postoperatively.