Surgical Treatment of Metastatic Lesions with or without Pathologic Fractures in Proximal Femurs

Purpose: Metastatic lesions in proximal femurs are not uncommon. However, the influence of primary malignancy, effective surgical techniques, post-operative survival period, and surgical complications have not been well clarified. The aim of this retrospective study was to evaluate outcome after surgical treatment for metastatic lesions in proximal femurs. Methods: Seventy-eight patients with 81 metastatic lesions with or without pathologic fractures in proximal femurs were surgically treated and regularly followed-up until patient death. Patient demographics, primary malignancy, surgical methods, implant selection, survival period after surgery, and complications were recorded and analyzed. Results: The average life span for 78 patients was 8.8 months (range, 0.1-42.5 months). The overall survival rates in 1 year and 2 years were 28% and 9%, respectively. Female patients lived longer than male patients (11.1 versus 5.6 months, p= 0.002). Additionally, female patients with breast cancer had longer survival time than female patients with lung cancer (p=0.020). Three patients (3.8%) sustained systemic complications and seven lesions (8.6%) sustained implant-related complications. The complication rates for patients treated with dynamic hip screws and intramedullary nails were 5.9% and 4.2%, respectively (p=0.411). The complication rate for patients treated with hemiarthroplasty and other implants were 25% and 100%, respectively. Conclusions: Among patients with surgical treatment of metastatic lesions in proximal femurs, female patients live longer than male patients. Female patients with breast cancer live longer than those with lung cancer. Surgical treatment using intramedullary nails has similar implant-related complication rates as that using dynamic hip screws. Surgical treatment using intramedullary nails or dynamic hip screws for metastatic lesions in the proximal femur is a safe, economical, and reasonable method as compared with endoprosthesis.