METASTATIC INSTABILITY AT THE PROXIMAL END OF THE FEMUR - COMPARISON OF ENDOPROSTHETIC REPLACEMENT AND PLATE OSTEOSYNTHESIS

A retrospective study was performed of the surgical treatment of metas tatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis wa s performed in another 25 consecutive patients. Indications for surgic al treatment were pathological fractures or, for prophylactic treatmen t, lesions of the femoral cortex exceeding 2.5 cm in diameter or affec ting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-b earing stability was obtained in all patients. Group analysis showed t hat the functional rating of the hip joint was unchanged, i.e., good o r excellent, in all patients with compound osteosynthesis, compared to only 68% in the endoprosthesis group. Pain relief was excellent or go od in 84% and 88% respectively. Dislocation of the tumor prosthesis oc curred in 3 patients. Closed reduction was possible in 2 cases. Local recurrence was higher in the patients undergoing plate osteosynthesis, as was the frequency of tumor-related implant failure. Postoperative survival averaged 14.7 months and 12.1 months respectively.