LETTER TO THE EDITOR Modified Unipolar Hemiarthroplasty for the Treatment of Metastatic Lesions of Proximal Femur with Pathological Fractures: Case Series of Six Patients

We read with great interest the case series by Lim et al in the November 2019 issue entitled “Modified Unipolar Hemiarthroplasty for the Treatment of Metastatic Lesions of Proximal Femur with Pathological Fractures: Case Series of Six Patients”1 . In their paper, they presented their experience in using “modified unipolar hemiarthroplasty for reconstruction after proximal femur resection for pathological fracture of the proximal femur secondary to metastatic lesions. This innovative, cost-effective implant can replace the otherwise expensive endoprosthesis. The aim of treating patients with pathological fracture of the proximal femur secondary to metastatic lesion is to alleviate pain, improve function and quality of life and to prevent further surgery1-3 . Surgical options include reconstruction with hemiarthroplasty and stabilisation with cephalomedullary nailing with/without cement augmentation. The factors to consider when considering the surgical option include site of fracture (neck, intertrochanteric or subtrochanteric), the patient’s prognosis (predicted survival time) and patient’s suitability for surgery. In the case series presented by the authors, all patients had poor prognosis. All except one patient had modified Baur score of 0-1, indicating a median overall survival of 4.8 months. On top of that, all patients had at least two of the negative prognostic factors (pathological fracture, visceral metastasis, lung cancer and anemia) based on the Scandinavian Sarcoma Group skeletal metastasis register, implicating an extremely short survival. All but one patient deceased within four months after the surgery. Besides that, two of the patients had other long bone lesions (one tibia and one femur) that may complicate the healing and ambulatory status of the patients.