Local experience in the surgical treatment of primary malignant and metastatic bone tumors of the proximal femur.

Background. The introduction of new techniques for fixation of long bones and postresectional prosthetic replacement, combined with chemotherapy and radiotherapy, have created new possibilities for the surgical treatment of primary and metastatic bone tumors. The main problem is still the time of diagnosis and the proper choice of operative treatment. Material and methods. We examined a group 67 patients operated for tumor of the proximal femur between 1985 and 2004, consisting of 48 females (average age 57) and 19 males (average age 46.8). The follow-up period ranged from 1 to 24 years (average 5.7 years). Metastatic bone tumors were found in 51 cases, as compared to 16 primary bone tumors. The clinical outcomes were evaluated by orthopedic and radiological examination, using Enneking's functional scale, depending on the treatment method applied. Results. Following surgical excision of the bone tumor, total postresectional arthroplasty was performed, or, in some patients, hip hemiarthroplasty. In some cases resection of the tumor was followed by plate fixation or the application of an intramedullary device after the resection bone defect had been filled with methylmethacrylate. Conclusions. Excellent or good postoperative outcomes were obtained by 76% of the patients. In 18% of the patients there was tumor recurrence. The most common complication was either surgical wound infection caused by lowered immunity after chemotherapy or breakage of the stabilizing plates.