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Posted: Jan 23 2022 #(C101950)
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Multifocal Metastatic Renal Cell Carcinoma in 76M

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HPI

The patient is a 76-year-old male with a history of renal cell carcinoma (RCC) diagnosed 11 years ago who presented to clinic due to worsening right hip pain. He underwent a nephrectomy at the time of his initial RCC diagnosis. 18 months ago he sustained a pathologic fracture treated at another institution with retrograde intramedullary nailing. He was doing well until 3 months ago, when he started developing right hip pain that has progressively gotten worse and now limits his ability to ambulate. No other extremity pain. Denies fevers, chills, and night sweats. He endorses recent weight loss, but thinks it is due to lack of appetite.

PMH

Renal Cell Carcinoma

PE

A focused physical exam demonstrates pain with hip flexion and abduction. He is neurovascularly intact to his right lower extremity and ambulates with an antalgic gait.

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If you choose Operative management, would you combine surgical treatment with chemotherapy?
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If you choose Operative management, what would surgical technique would you use?
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P: 144138
If you choose Total femoral replacement (TFR) + acetabular component, what variable influences your decision to resurface the acetabulum the MOST?
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If you choose Total femoral replacement (TFR) only, what variable influences your decision NOT to resurface the acetabulum the MOST?
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If you choose Total femoral replacement (TFR) only or TFR + acetabular component, what would your weight-bearing status be post-operatively?
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