Abstract
The orthopaedic surgeon may need to act as an important adjunct to the oncologist in management of the cancer patient with metastatic hip disease. Management of the cancer patient with routine hip pathology may be relatively straightforward but the surgeon should note that the cancer patient may be on treatment protocols which affect wound healing, the immune system and the risk of DVT. The principles of managing metastatic disease include recognising the presence of lesions in bone about the hip, the occasional need for biopsy, the use of radiation in sensitive tumors and finally surgical stabilisation or replacement when needed. In some cases percutaneous cementation of metastatic disease or radiofrequency ablation may be appropriate. Factors which may complicate management of patients who have completed treatment of peri-pelvic cancer, may include radiation therapy which can lead to osteonecrosis of the acetabulum. Greater than 500 Cgy of radiation has been associated with high rates of acetabular fixation failure regardless of fixation type in several series. Decision making in these patients can be aided by consultation with previous radiation therapy providers to estimate the dose sustained by the local tissues under consideration. Increased rates of infection and wound healing have also been noted secondary to long term lymphatic obliteration caused by radiation. These concerns also affect the surgeon who must manage patients with acute metastatic disease who may also be undergoing chemotherapy as well as radiation.
