Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Operative Treatment for Metastatic Disease of the Pelvis and the Proximal End of the Femur*†

The prognosis for patients who have invasive cancer continues to improve. According to the statistics of the American Cancer Society3 for 1988 through 1992, the five-year survival rate for patients who have prostate cancer is 90 percent for whites and 75 percent for blacks and the five-year survival rate for patients who have breast cancer is 86 percent for whites and 70 percent for blacks. However, estimates suggest that 50 percent of the 1,228,600 new cases of invasive cancer diagnosed each year will eventually metastasize to bone3. Many of these metastatic lesions involve the pelvis and the proximal end of the femur. In fact, the pelvis is second only to the spine in terms of the frequency of osseous involvement by metastatic disease, and the proximal end of the femur is the most common site of long-bone involvement by metastatic disease. While the recent introduction of bisphosphonates, which counteract the destruction of bone in patients who have metastatic cancer, has resulted in substantial delays in the development of initial skeletal complications and in a reduced prevalence of such complications over the short-term in patients who have breast cancer or multiple myeloma, the long-term efficacy of bisphosphonates has not been proved. Therefore, the appropriate orthopaedic treatment of skeletal metastases to the pelvis and the proximal end of the femur remains vital to the care of patients who have invasive cancer. A number of technological advances during the last decade have simplified the treatment of metastases to the pelvis and the proximal end of the femur. With regard to the acetabulum, new off-the-shelf protrusio ring devices are available for challenging acetabular reconstructions. Superior fixation of these devices is achieved either through several types of superior flanges, with or without screw-holes, or through dual narrow plates. Inferior fixation is achieved …

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