Konala et al. Journal of Medical Case Reports 2011, 5:67 http://www.jmedicalcasereports.com/content/5/1/67 Page 2 of 5 Figure 1 Pre-operative antero-posterior pelvic (left) and true lateral (right) radiographs of the left hip showing bilateral osteoarthritis of the hip and a calcified uterine myoma. muscle around the upper urinary tract predisposes these patients to early local invasion and metastasis. Urothelial tumours spread by local invasion as well as lymphatic and haematogenous spread. The incidence of bone metastasis in upper urothelial tumours is hard to com- pute in view of its rarity and the lack of large data sets. Studies of metastatic urinary tract tumours by Sengeløv et al. [12,13] showed that the most common sites of metastasis are lymph nodes (26%-57%) and bone (35%- 40%). Among those with bone metastasis, the spine was involved in 40% of the cases, followed by pelvis in 26% [12,13]. Figure 2 Initial postoperative antero-posterior pelvic (left) and true lateral (right) hip radiographs with acceptable implant position.