Prosthesis for the treatment of metastatic bone disease of the hip: effects of radiotherapy.

Twenty-eight patients with metastatic involvement of the proximal femur were all treated by resection and prosthetic replacement. A large femoral prosthetic component was routinely fixed with polymethylmetacrylate bone cement. Local radiotherapy was delivered preoperatively in two patients and postoperatively in seven patients. Postoperative pain relief according to Habermann et al off excellent in 81% and good in 15% of the patients. The functional results according to the hip-rating scale of Merle d'Aubigné were rated as excellent in 19%, very good in 22% and good in 22% of the hips. The prognosis for survival was superior in those patients with a preoperative Karnofsky performance status index of more than 60 points (p < 0.01) and in those patients without postoperative pulmonary complications (p < 0.01). The radiographs of the eighteen patients surviving three months or longer showed formation of a new bony envelope around the femoral prosthetic component in 11 cases (61%) and bone remodelling of the distal femur in 12 cases (67%). When analyzed according to local radiotherapy these radiographic changes occurred only if no local radiotherapy had been delivered to the femur (p < 0.01).