Hip reconstruction with a combination of prosthesis and recycled autograft treated with liquid nitrogen in metastatic subtrochanteric fracture can improve quality of life: A case report

INTRODUCTION AND IMPORTANCE: Palliative surgery with rigorously selected patients in treating metastatic bone tumour has become more popular recently. This article presents the use of autograft treated by liquid nitrogen in combination with hip prosthesis to reconstruct pathologically subtrochanteric fracture. CASE PRESENTATION: A 54-year-old male suffered left subtrochanteric fracture due to metastatic lesion from his lung cancer. He underwent one-stage surgery for hip tumour resection and reconstruction using the composite of tumour-bearing LNTA and hip prosthesis. He was able to sit in upright position on POD 1 and then to walk without support one month after the operation. His EORTC QLQ-C30 and EORTC QLQ-BM22 scores have significantly improved from 71 and 63 on POD 3 to 53 and 36 at one month after surgery, respectively. CLINICAL DISCUSSION: Limb salvage surgery for pathological proximal hip fracture due to metastasis is always challenging. The goal of treatment must include pain-free affected limb with enough function to improve the QoL during the patient's end stage. Several reports on using frozen recycled autograft showed good results regarding anatomical matching, bone healing, function, and cost-effectiveness. We combined prosthesis and LNTA to manage the patient with end stage lung cancer and pathological proximal hip fracture. The patient was satisfied with the 6-month postoperative results before being deceased due to the widespread metastases. CONCLUSION: Composite of LNTA and prosthesis might be a good alternative for treating metastatic fracture due to its anatomical matching, preservation of bone stock and cost-effectiveness where allograft and megaprosthesis are not available.