Partial long-stem resection Austin-Moore hip endoprosthesis in the treatment of metastases to the proximal femur.

Background. The proximal femur is a frequent location of bone metastases, and pathological fractures in this area are common. A pathological fracture and/or pain associated with bone destruction are indications for surgery. Among many methods of surgical treatment, partial resection and subsequent arthroplasty appears to be the most efficient. The low cost of the implant and the relatively simple surgical technique incline us to apply long-stem (305mm) partial Austin-Moore hip prosthesis in these cases. Material and methods. Between June 2003 and February 2005 we operated 31 patients (10 men and 21 women) for pathological fracture or proximal femur metastasis. The average age of these patients was 63.8 years. The most common primary neoplasmatic focus among the women was breast cancer (17 cases, 80%), and among the men, clarocellular renal cancer (3 cases, 34%). Results. In most cases - 21 patients (67%) - we achieved excellent or good outcome according to the Merle d'Aubigne Functional Test, as well as reasonable pain relief. Endoprosthesis dislocation occurred in 2 cases and early postoperative death in 2 other cases. Conclusions. Surgical treatment is needed in cases of actual or impending pathological fracture of the proximal femur. Resection arthroplasty is the method of choice in bone metastases to proximal femur. This procedure is well tolerated by patients. The use of long-stem partial Austin-Moore hip prosthesis appears to be a good alternative to costly modular implants, while its long stem protects the femoral shaft against fractures in cases where additional metastatic lesions are found there.