title: [Surgical classification and therapeutic strategy for metastases of proximal femur].
abstract: OBJECTIVE
  To establish a surgical classification system for metastases of proximal femur and discuss the therapeutic strategy with retrospective analysis and literature review.
  
  
  METHODS
  The data of 99 patients who underwent a total of 102 operations for femoral metastatic lesions from January 2003 to December 2011 was analyzed. There were 50 males and 49 females, and the median age was 56 years (range 15-87 years). The most common diagnosis was lung cancer (30 cases), followed by breast cancer (17 cases). All femoral lesions were divided into 4 types (I-IV) with different anatomic site and biomechanic characteristic. The patients with various surgical reconstruction mode and postoperative follow-up data were recorded.
  
  
  RESULTS
  There were 65 side who received widely or marginal resection and 37 side who received intralesional resection. The patients were operated with bipolar hip prosthesis (n = 3), ordinary total hip replacement (THR) (n = 10), bipolar tumor prosthesis (n = 48), THR with tumor prosthesis (n = 8), intramedullary nailing (n = 21), and plate/screw (n = 12). The estimated survival for the 99 patients was 10.3 months. Type I, II, III and IV patients with postoperative American Society of bone and soft tissue tumors-93 rating were 86.5%, 77.3%, 81.3% and 69.1%. Patients with type IV were worse compared with the other 3 groups (t = 4.763, P = 0.031). The 10 operations were followed by complications of any kind. Complication rate of patients with type IV were 3/12, and it was significantly higher than the other 3 groups of patients (χ(2) = 4.018, P = 0.045).
  
  
  CONCLUSIONS
  The classifications and corresponsive surgical methods for upper femur metastases had some superiority in hinting prognosis and guiding treatment.
authors: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing 100044, China.
authors: Yi
authors: Y
authors: Yang
authors: Wei
authors: W
authors: Guo
authors: Rong-li
authors: RL
authors: Yang
authors: Xiao-dong
authors: XD
authors: Tang
authors: Tai-qiang
authors: TQ
authors: Yan
authors: Ran
authors: R
authors: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D005266:Femoral Neoplasms / Q000145:classification* / Q000556:secondary / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult