![]() Harrington designed a larger acetabular component that would distribute the mechanical load to areas of less involved bone. In 1981, Harrington reported on the use of total hip prostheses in patients with acetabular lesions. Good to excellent results were obtained in all of the patients treated with either an Austin- Moore Hemiarthroplasty or a total hip replacement. Impending fracture and a life expectancy of more than 1 month was considered adequate indication for surgical intervention. reported endoprosthetic replacement for pathologic lesions of the hip. He reported 94% ambulation rate in his series. excised the lesion and then performed internal fixation or prosthetic replacement and reinforcement with PMMA. In a series of 375 patients, Harrington et al. In 1976, Harrington started advocating the use of polymethyl methacrylate (PMMA) cement as an adjunct to internal fixation in patients with bone loss in metastatic disease. They reported good outcome of their 19 patients in the series. They believed that resection would provide rapid pain relief and quicker rehabilitation and it will help reducing surgical complications. However, failed internal fixation of pathologic femoral neck fractures led Francis et al., in 1962, to advocate resection of the femoral head and neck as a primary treatment for lesions involving those structures. Internal fixation of impending or actual fractures also became popular at the same time. In 1950, tumor resection and replacement with bulk allograft was reported with favourable outcome for tumors involving the upper extremity. Their emphasis then shifted to identifying and treating symptomatic lesions before fracture. Coley and Higinbotham initially reported that pathologic fractures could be prevented by the use of calliper splints to decrease the load on the affected bone. Use of light traction was the most primitive form of treatment. The management of metastatic hip lesions has evolved considerably over the past 60 years. This article aim to focus on metastatic tumors of the hip and proximal femur and present a narrative review of surgical management options of this unique clinical entity. Management of these lesions varies from benign neglect to internal fixation and recently to prosthetic reconstruction for optimum function. It is estimated that 40% of patients with pathologic fractures survive for at least 6 months after their fracture, and 30% survive for more than 1 year. The tumor that metastasizes to the hip with the greatest frequency is carcinoma of the breast, , ] Pathologic lesions in this important weight-bearing zone weaken its ability to sustain load causing pain and impending pathologic fracture. ![]() ![]() These lesions frequently arise from breast, prostate, lung, renal, and thyroid carcinomas, , ]. Management involves general care physicians, medical oncologists and reconstructive hip surgeons. Metastatic lesions of the proximal femur and hip joint are common and present with multiple management issues. ![]()
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