Elective palliative total hip replacement in a patient with lymphoma and advanced lung cancer

Abstract

Total hip replacement is among the most effective procedures in medicine, providing sustained relief of hip pain in more than 90% of recipients, with perioperative mortality rates less than 1% (1–3). The procedure is highly cost-effective and may even be cost-saving (4). Originally introduced in the 1960s, total hip replacement is presently performed on more than 260,000 persons annually in the US (5). The indications for elective total hip replacement have traditionally included advanced joint destruction and severe pain-related functional loss in otherwise healthy older adults. Data have emerged in the last decade showing that patients operated on later in the course of disease experience worse functional outcome (6). Consequently, the indications for total hip replacement are broadening to include patients with less severe functional loss. Although the indications for total joint replacement are expanding, the procedure is typically reserved for patients who are generally healthy. Texts suggest that medical conditions that might influence the outcome of total joint replacement should be recognized and stabilized prior to surgery (7). We report the case of an 82-year-old woman with advanced metastatic lung cancer (not involving the hip) and severely symptomatic hip osteoarthritis (OA) who underwent elective left total hip replacement in order to provide pain relief in her last year or two of life. We discuss the limited literature on the use of elective total hip replacement and similar procedures as palliative care for patients with terminal conditions not involving the index joint. We suggest that total joint replacement be considered as a therapy for patients with symptomatic, advanced OA who are receiving palliative care for terminal medical conditions. More generally, we suggest that a wide range of elective procedures traditionally contraindicated in patients with terminal illness may in fact be entirely appropriate when viewed in a palliative care context.