Grant: Project Grant

This study will help surgeons decide the best way to stabilize the hip bone in adults whose cancer has spread to the upper thigh (proximal femur). When cancer weakens this bone, it can crack or break, causing pain, disability and long hospital stays. Today, surgeons most often insert metal rods or screws (internal fixation) to shore up the bone. Another option that is becoming more common removes the diseased bone and replaces it with a metal "endoprosthesis" (reconstruction). Early reports suggest reconstruction may last longer, but it is a more complex operation with higher upfront risks. To find out which approach truly works better, the PERFORM trial will enroll 334 patients at 23 hospitals in Canada, the U.S. and internationally. Each patient will be randomly assigned to receive either internal fixation or reconstruction, and then will be followed for one year. Researchers will compare: •Survival at 12 months •How well people can move and care for themselves •How many days they spend at home rather than in hospital or care facilities By looking at these outcomes together, the study will show which treatment gives patients the best overall results. Because both procedures are standard surgical techniques, this trial is pragmatic and feasible. The results of the trial will fill a key evidence gap and guide surgeons in choosing the approach that reduces repeat operations, speeds recovery, and helps people spend more time at home. Ultimately, the PERFORM trial aims to improve individual patients' health, inform guidelines for all hospitals treating patients with cancer metastasized to bone, and make orthopaedic surgical care more effective and patient-centered.