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hemiarthroplasty.
29%
40/137
radiation therapy.
3%
4/137
percutaneous pinning.
7%
10/137
total hip arthroplasty.
40%
55/137
cephalomedullary fixation.
17%
23/137
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The radiographs reveals the characteristic appearance of metastatic bone disease. If the primary is unknown, biopsy should be considered prior to treatment. Radiation therapy can be used to treat local bony disease, but is not recommended in the setting of an acute fracture. Although the fracture is minimally displaced, percutaneous pinning is not indicated with diffusely metastatic disease. Cephalomedullary fixation would be an option, however, but may not be optimal for the fracture location. Furthermore, a small study comparing intramedullary fixation with arthroplasty in proximal femoral metastatic disease found a lower rate of implant failure and reoperation with arthroplasty (8% versus 16%). Hemiarthroplasty could be an option, given the patient's advanced stage of disease, and likely limited lifespan; however, the cystic changes in the acetabulum indicate the presence of metastatic disease there. Additionally, studies have shown that total hip arthroplasty pain and functional outcomes at 6 months through 2 years are superior to hemiarthroplasty when the procedure is performed for elderly patients with hip fractures. Total hip arthroplasty is the recommended treatment for patients with metastatic femoral neck fractures.
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