Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive, deep-seated hip pain, exacerbated by weight-bearing and movement. Pain is localized to the periacetabular region, unresponsive to conservative analgesia. History of known primary malignancy (specify: [Primary Site]). Associated symptoms include mechanical instability, night pain, and functional decline in ambulation. No reports of neurological deficit or bowel/bladder dysfunction.
Clinical Examination Findings
Physical examination reveals antalgic gait with limited hip range of motion in all planes. Tenderness to palpation over the greater trochanter and groin. Positive Trendelenburg sign. Neurovascular status intact distally. Imaging (X-ray/CT/MRI) confirms lytic/blastic lesions involving the acetabular column/roof with cortical thinning and risk of impending pathological fracture. Mirelsโ score calculated as [Score].
Treatment Protocol
Plan: 1. Orthopedic oncology consultation for stabilization assessment. 2. Protected weight-bearing (crutches/walker) to prevent pathological fracture. 3. Palliative radiotherapy referral for pain control and local tumor regression. 4. Bisphosphonate or RANK-ligand inhibitor therapy initiation. 5. Surgical consideration: Open reduction and internal fixation (ORIF) or total hip arthroplasty (THA) with acetabular reconstruction if structural integrity is compromised.