Surgical management of bone metastasis located in the proximal femur-review of literature

Neoplasms are the second leading cause of death worldwide. The increase in diagnostic possibilities and development of new treatments has led to an increase in life expectancy among cancer patients.

The proximal region of the femur is a favorite site for bone metastases, these lesions being accompanied by increased mortality and morbidity.

The methods of treatment for metastatic bone disease can be surgical or non-surgical.

Bone metastases and pathological bone fractures in the proximal femur are most commonly located in the intertrochanteric or subtrochanteric region. Patients with bone metastases at this level most often require osteosynthesis with a centromedullary nail, but also plates and screws or dynamic hip screw can be used.

Bone metastases located in the femoral neck or femoral head can be treated surgically by hemiarthroplasty (HA) or total hip arthroplasty (THA). Both HA and THA have been shown to be successful surgeries in patients with bone metastases.

In patients with multiple bone metastases located in the head or neck of the femur and trochanteric region, but with increased life expectancy, resection and reconstruction using endoprostheses is a viable solution.

Given the complexity of oncological pathologies, the therapeutic decision in the case of a patient with secondary bone determinations must be established by a multidisciplinary team comprising the oncologist, orthopedic surgeon, pathologist, anesthetist, and radiotherapist.

Surgical treatment of symptomatic bone metastases that cause pain and functional impotence with limited patient mobility increases survival and quality of life regardless of the type of surgery and the implant chosen.