Minimally Invasive Stabilization with or without Ablation for Metastatic Periacetabular Tumors. J Bone Joint Surg Am 2021 Jul 07;103(13):1184-1192
Date
05/27/2021Pubmed ID
34038393DOI
10.2106/JBJS.20.00546Scopus ID
2-s2.0-85112119824 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
BACKGROUND: Metastatic bone disease in the periacetabular region represents a potentially devastating problem for patients. Surgical treatment can offer pain relief and restore function. We describe a series of patients treated with minimally invasive osteoplasty and screw fixation with or without ablation.
METHODS: Thirty-eight patients with 16 different metastatic tumor subtypes were managed with osteoplasty and screw fixation with or without ablation at a single institution. A retrospective review was performed to determine functional outcomes with use of the 1993 Musculoskeletal Tumor Society (MSTS) score as well as changes in narcotic usage.
RESULTS: MSTS scores improved for all patients following surgery. Narcotic usage decreased in >80% of patients. Approximately half of the operations were outpatient procedures. Complications were minimal, there were no delays in chemotherapy or radiation due to surgical wound concerns, and there were no surgery-related deaths. The mean duration of follow-up was 9 months, with a 39% survival rate at the time of writing. Six of the 12 patients who survived for >1 year required additional procedures at a mean of 12 months (range, 4 to 23 months).
CONCLUSIONS: Treatment of periacetabular metastatic disease with minimally invasive stabilization with or without ablation provides pain relief and functional improvement with lower complication rates than previously reported open reconstruction techniques. The minimally invasive approach allows for rapid initiation of chemotherapy and radiation. Patients with particularly aggressive cancers that are poorly responsive to systemic therapies and radiation may have progression of disease and may require additional procedures. Conversion to total hip arthroplasty was uncomplicated, and the cement and screw constructs were retained, providing a stable base for the arthroplasty reconstruction.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Author List
English DI, Lea WB, King DM, Tutton SM, Neilson JCAuthors
David M. King MD Chair, Professor in the Orthopaedic Surgery department at Medical College of WisconsinJohn C. Neilson MD Associate Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AcetabulumAged
Analgesics, Opioid
Antineoplastic Agents
Arthroplasty, Replacement, Hip
Bone Cements
Bone Neoplasms
Bone Screws
Female
Follow-Up Studies
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
Postoperative Complications
Radiotherapy
Reoperation
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome