Bone is the third most common site of metastasis following the lung and the liver1. Within the appendicular skeleton, the proximal femur is the most commonly affected site accounting for over 30% of all bone metastases2, 3. Due to its weight-bearing function, which subjects it to higher mechanical stress, metastatic bone lesions on the proximal femur often lead to pathological fractures (PF)4, 5. In the setting of an ever-increasing life expectancy of patients with metastatic disease, the frequency of PF has drastically increased6. Mainstay treatment consists of surgical fixation by means of nailing, plating or endoprosthetic reconstruction and seeks to stabilize the fracture, control pain and restore function5, 6, 7.

Although surgical treatment has improved functional outcomes and survival rates of patients with hip fractures, management of this condition poses significant risks for post-operative complications. Compared to native hip fractures, pathologic hip fractures carry a higher risk of thromboembolic (TE) events5. The literature reports a 0.5-1% of deep venous thrombosis in patients with native hip fracture undergoing prophylactic anticoagulation8; in PF, that rate can be as high as 11%8, 9. Although rates of TE events are high in this cohort of patients, pathologic hip fractures have also been associated with a higher risk of post-operative bleeding than native hip fractures5.

Previous literature has described post-operative outcomes between pathologic and non-pathologic hip fractures5, 10, 11, 12. However, limitations include significantly different populations or combination of neoplastic and non-neoplastic (eg, osteoporosis) pathologic hip fractures in the same group. Our study sought to answer the following questions: (1) Are neoplastic PF of the hip associated with worse 30-day post-operative outcomes than native hip fractures? (2) Are neoplastic PF of the hip associated with worse 30-day post-operative outcomes than non-neoplastic PF?