The Surgical Treatments Of Metastasis Of Proximal Femur Background

Background Metastasis of proximal femur is one of more common matastasis among the matastasis of extremities.But few large series have been reported.Object The purpose of this paper is to report thirty-one cases by one group of orthopaedic oncologic surgeans and to discuss the best surgical treatment of metastasis of proximal femur according to our studies and related records.Methods Forty-two patients with metastasis of proximal femur were treated between 1991 January and 2004 December. We were able to obtain historical data, imaging studies,histological finding,and adequate personal or telephone follow-up to determine the outcome for thirty-one. We analyzed the data retrospectively and referred to corresponding literature.Result There were nineteen males and twelve females in this group, with meso age 54(from 26 to 70). The follow-up of all patients were four months to eighty-four months,averaged nineteen months. There were no infection or skin necrosis after operation in these cases. In the DHS group, screw cutout was found in 1 case, plate breakout in 1 case whosuffered secondary fracture and hip screw loosen in lease. This case who suffered secondary fracture underwent prosthetic replacement. 12 of the 13 patients increased mobility and relieved of pains after operation. Tumor endoprosthetic reconstructions were done for 15 patients who had a little limp in the endoprosthetic reconstructions group. 3 patients replaced by common endoprostheses had little limp. There were dislocation and loose of the prosthesis for one patient each. Secondary ?fracture was found in distal femur for one patient because metastsis happened in distal femur. 17 of the 18 patients increased mobility and relieved of pains after operation. The function of the hip was evaluated according to Charnley ' scale, the results of DHS group showed excellent in 3 cases, good in 4 cases, fair in 4 cases, poor in 2 cases;the results of endoprosthetic reconstructions group were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 1 case. According to Log-rank,the difference of the survival rate of these three groups whose primary tumors were different was significant(P < 0.01);the difference of the survival rate of the different surgical methods was of no significance(P > 0.05).Conclusion Appropraite indications based on comprehensive understanding of predictive life-time and local tensions are criticalimportant for the surgical treatments of metastasis of proximal femur. Each case shoud be dealt with on an individual basis in order to adopt the most approprait technique in accomplishing the goals of improving quality of life and function of the hip. The function of the hip by endoprosthetic reconstructions was better than that by DHS.