Subchondral Insufficiency Fracture of the Femoral Head in a Terminal Cancer Patient Treated by Total Hip Arthroplasty

Introduction: Proper fracture management is crucial for maintaining quality of life in cancer patients with metastatic bone lesions. Subchondral insufficiency fracture (SIF) of the femoral head can lead to severe pain and functional decline. When accompanied by metastatic acetabular lesions, implant stability becomes difficult to achieve, making surgical decision-making highly complex, particularly in terminal cancer patients with limited life expectancy. Case Report: We report an 80-year-old woman with terminal lung adenocarcinoma who developed a SIF of the femoral head and an acetabular metastatic lesion, resulting in debilitating pain and loss of mobility. After conservative treatment failed to control pain, she and her family requested surgical intervention. Total hip arthroplasty was performed using the restoration GAP II reinforcement ring combined with a cemented cup. Pain relief was immediate, and independent ambulation was achieved by post-operative week 2. Although the acetabular metastasis progressed, implant stability was preserved due to the large surface area of the reinforcement ring. The patient remained pain-free and ambulatory until her death 14 months postoperatively. Conclusion: A careful assessment of the systemic conditions and a well-planned surgery can achieve substantial pain relief and functional restoration even in terminal cancer patients, contributing meaningfully to their quality of life. Keywords: Locomotive syndrome, terminal cancer patients, total hip arthroplasty, metastatic acetabular lesion, subchondral insufficiency fracture.