Possibilities of surgical treatment of bone metastases to the proximal epiphysis of the femur: a review of the literature and own experience.

Background. The most common complication of bone metastases to the hip is pathological fracture of the proximal epiphysis. The present study presents the indications and contraindications for surgery and the choice of particular surgical techniques, based on the literature and the authors' own experience.
Material and methods. In the period 1992-2002 we treated 25 patients with bone metastases to the proximal epiphysis of the femur. All had suffered pathological fractures. Various surgical procedures were used, depending on the indications. In two cases we used pallative treatment.
Results. There were no intraoperative or immediate post-operative deaths. In all cases but one we observed reduced pain after surgery. 23 patients recovered hip mobility. 22 patients could walk with elbow crutches after surgery. A functional evaluation performed on day 14 post-surgery produced an average score of 13.2, which on Merle d'Aubigne's scale is a "good" outcome. The survival time ranged from 6 weeks to 4 years (average 13.5 months).
Conclusions. Surgical treatment is essential, both in existing and imminent pathological fractures of the proximal epiphysis of the femur, in order to provide relief from persistent pain and enable independent movement. A patient with advanced neoplastic disease and bone metastases to the hip should be operated even before a pathological fracture occurs, which enables the use of a less invasive surgical technique and prevents immobility and worsening of the patient's physical and mental status.