Tumorous destruction of the periacetabular region and the proximal femur is a typical consequence of either primary malignant bone tumor manifestation or skeletal metastatic diseases. Pathological fractures of the proximal femur and periacetabular regions due to primary manifestation or metastatic disorders are frequent.

A new study published in The Orthopedist aimed to present the most common complications of tumor endoprostheses at the hip, as well as a description of management strategies – including therapeutic recommendations and concepts for complication avoidance.

It was noted that compared to elective/primary total hip arthroplasty, megaprosthetic reconstructions, following tumor resections, have an increased rate of postoperative deep infections, dislocations, incidence of pathological and periprosthetic fractures and of deep vein thrombosis. While the postoperative mortality and local tumor recurrence along with deep infections represent the most serious complications.

Hence, it was concluded that relative to primary arthroplasty, the risk of failure and complications following tumor-endoprosthetic replacement is higher. Thus, precise surgical planning and careful selection and preoperative preparation of suitable patients should be practiced in close interdisciplinary cooperation with final decision-making on an interdisciplinary tumor board. In addition, wide resection and advanced reconstruction, as well as complicated palliative stabilization due to malignant bone tumor growth around the hip joint should be done in musculoskeletal tumor centers with profound expertise in osteosynthetic and endoprosthetic reconstruction and consecutive complication management of the pelvis and the proximal femur.

Source: The Orthopedist. 2020 Jan 31. doi: 10.1007/s00132-020-03879-8.