How to perform surgical treatment for bone metastasis of proximal femur

Bone cancer caused by malignant tumors metastasizing to the proximal femur can be treated through surgery. There are various surgical treatment methods, including two major types: reconstruction based on tumor resection and joint replacement, and surgery based on lesion scraping, bone cement filling, and internal fixation. There is no significant difference in the operation time between the two.

The main purpose of surgery for patients with bone metastases is to relieve pain and restore function. For patients with lower limb bone metastases, surgery should be effective and lasting, avoid reoperation, and meet the requirements of early weight bearing.

The weight borne by the proximal femur is equivalent to 6 times the body weight. Compared with other parts, the choice of internal fixation method should be strong enough and durable. The MSTS93 score of patients who underwent joint replacement was significantly higher than that of patients who underwent lesion scraping, indicating that tumor-type joint prosthesis is significantly better than the internal fixation group in improving the quality of life of patients.

The surgical method of tumor segment resection is also better than that of lesion curettage in controlling tumors. This is because patients who undergo lesion curettage usually need radiotherapy after surgery to control local disease. While increasing the patient's treatment cycle, radiotherapy also causes fractures to heal slowly or even fail to heal, which makes it difficult to ensure effective postoperative weight bearing using DHS, intramedullary nails, and bone cement filling. There may also be a risk of internal fixation failure over time.