The surgical management of metastatic lesions of the femur

ABSTRACT BACKGROUND: Malignant tumours commonly metastasise to bone. When this occurs in the femur, surgical intervention is required reduce pain and restore mobility post fracture, or as a prophylactic measure when fracture anticipated. This typically form of replacement with hemi- total arthroplasty stabilisation an intramedullary device. The indications for one modality over other are debatable reported outcomes complications varied. purpose study assess management algorithm bony metastasis femur at tertiary bone tumour unit, strategies employed METHODS: A retrospective cohort was performed all patients presenting our institution femoral metastasis, both without pathological who were managed surgically from April 2016 February 2020. Fractures neck cemented arthroplasty. All fractures nailing, lesions requiring stabilisation. Data recorded regarding demographics, primary pathology, location lesion, type surgery, implant used. incidence including radiological failure fixation, infection, thromboembolic phenomena, re-operation mortality RESULTS: Eighty-five femurs 77 included (mean age 61 years, range 20-90). Lesions located (19/85, 22%), intertrochanteric (20/85, 24%), subtrochanteric (40/85, 47%), diaphyseal (2/85, 2%) metaphyseal/per-condylar (4/85, 5%) regions femur. 64/85 (753%) procedures 21/85 (25%) prophylactically. Eighteen 85 (21%) underwent long-stemmed bipolar hemiarthroplasty, 1/85 (1%) hip (THR), 62/85 (73%) cephalomedullary 4/85 (5%) retrograde nailing. Mean follow-up eight months (range 1-36). There no dislocations periprosthetic group. One (1/66, fixation occurred nailing Six deaths group (6/64, 9%) 24 (24/66, 36%) during period. Four suffered phenomena (4/77, 5%). Of 13 sustained followed up least year, had achieved clinical union CONCLUSION: Femoral can be appropriately prophylac-tically event low rate expectation that healing will occur once stabilised. Intracapsular risk subsequent dislocation Level evidence: 4 Keywords: