Treatment of Pathologic Proximal Femur Fractures Using the Improvised Megaprosthesis: Combination of the Hip Prosthesis and Intramedullary Nail.

Abstract

Introduction: The proximal femur is the most common long bone affected by metastatic disease. Pathologic fractures in this area are frequent, secondary to weight-bearing and deforming forces. Long-stem endoprosthetic replacement is often used to replace and bypass segments affected by metastases. However, implant cost remains prohibitive for patients in low-resource settings. An improvised megaprosthesis using a hip implant combined with Kuntscher nail provides an economic option.

Material and methods: This is a case series of three patients diagnosed with pathologic fracture of the hip secondary to metastatic bone disease who underwent proximal femoral resection with reconstruction using an improvised endoprosthesis in a single tertiary hospital. Outcomes determined include total blood loss, total surgical time, length of hospital stay, latest functional score using the Musculoskeletal Tumour Society (MSTS) score, and pain scale using the numerical rating scale (NRS).

Results: For case 1, a 42-year-old female with metastatic breast carcinoma, currently alive with disease and able to perform activities of daily living (ADLs) with minimal assistance; for case 2, a 77-year-old male diagnosed with prostatic carcinoma, able to ambulate with assistive device before expiring 2 years post-surgery; and for case 3, a 57-year-old female with metastatic breast carcinoma, able to resume unassisted ADLs at 3 months post-surgery before refusing systemic treatment in her second year of surveillance monitoring.

Conclusion: An improvised megaprosthesis is a cost-effective implant option in low-resource settings, which may help decrease complications related to immobilisation for patients undergoing palliative surgery for metastatic bone disease.