This 1981 case series by Harrington describes the surgical management of 58 patients with pathological fractures of the acetabulum from metastatic cancer. It asks: how should reconstruction strategy differ based on the pattern and extent of periacetabular bone destruction, and can durable fixation be achieved despite tumor osteolysis and postoperative radiation?
When you see a cancer patient with hip pain and periacetabular lysis, classify the destruction by Harrington class before planning reconstruction: intact rim allows conventional THA (Class I), isolated medial wall loss calls for a protrusio ring (Class II), and combined medial plus superior destruction requires Steinmann pins anchored into the ilium and sacrum to bypass the destroyed zone entirely (Class III).
Always consider preoperative embolization for hypervascular primary tumors (kidney, myeloma) to prevent catastrophic intraoperative hemorrhage.
This 1981 case series by Harrington describes the surgical management of 58 patients with pathological fractures of the acetabulum from metastatic cancer. It asks: how should reconstruction strategy differ based on the pattern and extent of periacetabular bone destruction, and can durable fixation be achieved despite tumor osteolysis and postoperative radiation?
When you see a cancer patient with hip pain and periacetabular lysis, classify the destruction by Harrington class before planning reconstruction: intact rim allows conventional THA (Class I), isolated medial wall loss calls for a protrusio ring (Class II), and combined medial plus superior destruction requires Steinmann pins anchored into the ilium and sacrum to bypass the destroyed zone entirely (Class III).
Always consider preoperative embolization for hypervascular primary tumors (kidney, myeloma) to prevent catastrophic intraoperative hemorrhage.