Pathological Fractures Around the Hip: Approach to Diagnosis and Management

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Abstract

Pathological fractures due to metastatic disease are common around the hip (proximal femur and acetabulum) and represent an escalating concern in musculoskeletal oncology. These fractures should not be fixed straight away and management should focus on comprehensive clinical, laboratory, imaging workup and biopsy, and treatment plan should be tailored and personalized after inputs from medical and radiation oncologists. The goal of surgery is relief of pain, achievement of skeletal stability, restoration of function and mobility, and improvement in quality of life. Proactive identification of impending fractures and their fixation is crucial for better outcomes. When only the head and neck of femur are involved by the lesion, cemented hemiarthroplasty or total hip arthroplasty are ideal. For intertrochanteric and subtrochanteric pathological fractures, cephalon-medullary nailing and proximal femur endoprosthesis reconstruction are the viable options. For small or contained acetabular lesions, minimally invasive cementoplasty can provide pain relief and stabilization. When the bone stock is adequate, a standard cemented total hip arthroplasty may be performed. In cases with significant bone loss, additional support structures such as antiprotrusio cages or Harrington/modified Harrington techniques are often used to reinforce stability. For extensive pelvic destruction, pelvic endoprosthetic replacements might be necessary. The present review article is aimed at providing a comprehensive overview for decision-making and treatment approach of patients with pathological fractures around hip due to metastatic bone disease.