Combination of Radiofrequency Ablation and Intramedullary Nailing for the Treatment of Femoral Metastases: Single-center, Retrospective Observational Study

Background : Radiofrequency ablation (RFA) has gained attention as a palliative treatment for bone metastases, offering pain relief and local tumor control. While its use in trunk lesions is well documented, its application in long bones remains limited because ofconcerns about postablationfractures. These risks may be mitigated by combining RFA with prophylactic intramedullary nailing (IMN). Methods : Five consecutive patients with femoral metastases who underwent combined RFA and IMN, either as a single-stage procedure with intraoperative fluoroscopic guidance or in two stages using CT-guided RFA followed by IMN, were included. Pain relief, function, radiographic response, histology, and complications were retrospectively assessed. Results : All patients experienced early pain relief and regained mobility. The average amount of intraoperative blood loss was 48 ml, which was significantly lower than the historical control cases. At the final follow-up, one lesion had slightly progressed, three remained stable, and one decreased in size. The complicationsincluded one nonunion case requiring revision and one case of skin burn from electrode pad placement. While immediate pain relief was notable, the isolated midterm effect of RFA was difficult to evaluate because of concurrent IMN and frequent postoperative radiotherapy. No adverse interactions were observed with combined radiotherapy. Conclusion : RFA combined with IMN offers a minimally invasive, effective option for local control and functional recovery in patients with femoral metastases. Ideal candidates include those with impending fractures with preserved continuity of the femoral shaft, lesser trochanter avulsions, hypervascular tumors, or radiotherapy-resistant lesions. This approach may serve as an alternative to extensive resection in selected patients.