The proximal femur remains a challenging site for orthopedic surgeons due to its critical weight-bearing role and anatomical complexity. Benign bone tumors and tumor-like lesions in this region often cause structural instability or pathological fractures. However, the heterogeneous nature of these lesions means that one standard fixation method rarely fits all cases. A recent retrospective analysis of 100 patients has introduced a modified proximal femur surgical strategy designed to standardize decision-making and enhance postoperative functional recovery.

The Modified Proximal Femur Surgical Strategy Classification

The study proposes a comprehensive five-type classification system based on lesion location, size, and the degree of femoral head destruction. This structured approach allows surgeons to tailor their intervention to the specific mechanical needs of the bone. For instance, Type 1 and Type 2 lesions involve mild cortical thinning and relatively stable structures. Consequently, these cases are best managed with curettage and bone grafting, occasionally supplemented by internal fixation. Moreover, this conservative approach prioritizes joint preservation while ensuring adequate local tumor control.

Conversely, Types 3 through 5 represent more aggressive bone loss or significant structural deformities. These complex cases require advanced techniques such as Limited Internal Fixation combined with External Fixation (LIFEF), corrective osteotomy, or even Endoprosthetic Replacement (EPR). By categorizing these lesions early, surgeons can anticipate the need for more robust mechanical support. Furthermore, this classification helps in identifying cases where joint-preserving treatment is still feasible despite severe bone destruction.

Functional Recovery and Clinical Outcomes

The effectiveness of this proximal femur surgical strategy was measured using the Musculoskeletal Tumor Society (MSTS-93) scoring system. In a cohort with a mean age of 37.3 years, the average postoperative score reached 26.1 ± 1.0 at the final follow-up. Bayesian analysis confirmed that the classification system successfully differentiated clinical outcomes between stable and complex lesion types. Additionally, the study reported a low overall complication rate of just 5%, including manageable issues like mild limping and transient pain.

Standardizing the surgical approach for these tumors provides a practical framework that minimizes trial and error in the operating room. This framework not only optimizes functional results but also supports the long-term goal of maintaining the patient's natural joint whenever possible.

Frequently Asked Questions

How does the 5-type classification aid surgical planning?

The classification categorizes lesions based on their anatomical location and mechanical impact. This allows surgeons to choose between simple curettage for stable Type 1-2 lesions and more complex reconstructions, like EPR or osteotomy, for Type 3-5 lesions.

What are the typical functional outcomes after this procedure?

Patients in this study achieved a high mean MSTS score of 26.1 out of 30. This indicates excellent functional recovery, with most patients returning to near-normal daily activities with a low risk of major complications.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of a physician or other qualified health provider with any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Chen Z et al. A modified surgical strategy for proximal femur benign tumors: a retrospective analysis of 100 patients. BMC Musculoskelet Disord. 2026 Feb 23. doi: 10.1186/s12891-026-09544-z. PMID: 41731472.

Okuno K et al. Retrospective Validation Study of a Treatment Strategy for Benign Bone Lesions in the Proximal Femur. MDPI. 2025 Aug 22. doi: 10.3390/diagnostics15161234.