الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Metastatic bone disease in developed countries is more than 280,000 new cases per year. Bone is the third most common site of metastatic disease after the lung and the liver. The most common primary cancers are lung, breast, prostate, thyroid, and renal cancer. The femur is the most common long bone involved in bony metastasis with an incidence of 30 to 50%, two-thirds of which are in the proximal femur.
Bone metastases are infrequently silent, they are usually associated with:
Severe bone pain, which can be intractable.
Pathological fractures, Osteolysis is also accompanied by increased bone fragility; susceptibility to fracture is markedly increased, and pathological fractures frequently occur.
Other consequences are anemia, bone deformity, hyperkalemia, and hypercalcemia, and nerve-compression syndromes such as spinal cord compression.
Bone metastasis is classified as osteolytic, osteoblastic, or mixed, according to the primary mechanism of interference with normal bone remodeling.
Diagnosis of metastatic lesion:
- Full history from the patient (known primary cancer or not)
- Full Examination including the site of tenderness and all the body.
- Radiological examination through (plain x-ray on pelvis and femur, CT, MRI, and bone scan)
- Lab investigation through (tumor markers, CBC, liver and kidney functions, and plasma electrophoresis ……).
The goal of treatment to relieve the pain, restore limb function, and improve the patient’s quality of life to a satisfying degree.
20 patients were selected from Menoufia university hospital who had metastatic lesion proximal femur managed by traditional arthroplasty (THR or bipolar hemiarthroplasty) retrospectively and prospectively, then evaluated according to MSTS.
12 patients were managed by THR and 8 patients managed by bipolar hemiarthroplasty. The mean score according to MSTS was 18.5 ± 5.29 range (13-25) for bipolar hemiarthroplasty and 24.67 ± 4.37 range (13- 28) for THR.
We noticed that all cases of THR needed a blood transfusion, three of them admitted to ICU for longer operation than bipolar hemiarthroplasty.
Also noticed a low-grade infection in four cases (two THR and two bipolar hemiarthroplasties), superolateral migration in a case had bipolar hemiarthroplasty with an acetabular metastatic lesion, dislocation in only two cases of THR, and no periprosthetic fracture in any cases.
In this study, 12 patients had no pain postoperative (60%), didn’t require regular analgesia, while 8 patients had intermediate pain that required regular analgesics (30 %).6 patients restored walking ability without assistance (30%), while 10 patients required assistance (canes, walkers) (50%), 4 patients didn’t restore the ability to walk (20%).
In this study, survival rate, at 6 months was 85%, at 12 months was 75%, at one year was 70% and after two years follow-up was 65%.