Marco, J Bone Joint Surg Am 2000 - Functional and Oncological Outcome of Acetabular Reconstruction for the Treatment of Metastatic Disease - Article Summary

Functional and Oncological Outcome of Acetabular Reconstruction for the Treatment of Metastatic Disease

Marco, Healey, et al.·J Bone Joint Surg Am·2000·172 citations·Retrospective cohort

Background

Metastatic disease of the acetabulum can be painful and disabling. Operative intervention is indicated for patients who fail to respond adequately to nonoperative treatment. We evaluated the functional and oncological outcome of acetabular reconstruction after curettage for the treatment of refractory symptomatic acetabular metastases.

Methods

55 patients with metastatic disease of the acetabulum were treated with operative acetabular reconstruction combined with a total hip replacement.
The most common primary tumor was carcinoma of the breast (18 patients), followed by carcinoma of the kidney (7 patients) and carcinoma of the prostate (7 patients).
40 (73 percent) of the patients presented with multiple skeletal metastases, and 18 (33 percent) had associated visceral metastases.
28 (51 percent) had severe pain requiring continuous use of narcotics, 24 (44 percent) had moderate pain requiring periodic use of narcotics, and the remaining 3 (5 percent) had mild pain requiring use of non-narcotic analgesics.
18 (33 percent) of the patients could not walk, 23 (42 percent) needed a walker or crutches, 12 (22 percent) used a single cane, and 2 (4 percent) walked without assistive devices.
Intralesional curettage of the tumor was performed in all of the patients.
54 of the hips were reconstructed with a protrusio cup and one, with a hemipelvis endoprosthesis.
Large defects were reinforced with cement and pin or screw fixation (the modified Harrington technique), which allowed transmission of weight-bearing forces to the remaining intact pelvis.
36 acetabular reconstructions were performed with antegrade pins or cannulated screws; 15, with long retrograde screws; and 4, with cement.

Results

The median period of survival was 9 months.
Patients with visceral metastases had a median period of survival of 3 months compared with 12 months for patients without visceral metastases (p < 0.001).
Patients with breast cancer presented later in the disease process (p < 0.004) and lived longer than did those with other carcinomas (p < 0.004).
45 patients were evaluated 3 months after reconstruction.
34 (76 percent) of them had relief of pain as determined by decreased use of narcotics.
9 of the 18 patients who could not walk preoperatively regained the ability to walk.
14 of the 17 patients who originally were able to walk in the community retained that ability.
33 patients were available for evaluation at 6 months.
25 (76 percent) still had relief of pain, and 19 (58 percent) were able to walk and function in the community.
Overall, 14 (25 percent) of the 55 patients had moderate local progression of the disease, and 5 of these patients had failure of the fixation.
14 early complications developed in 12 (22 percent) of the patients.
One patient (2 percent) died perioperatively.

Conclusions

Patients who have acetabular metastases that are refractory to radiation and chemotherapy have a short life expectancy. The early, gratifying results of reconstruction validate the role of operative treatment as a short-term palliative procedure. Protrusio acetabular cups presumably compensate for deficiencies of the medial wall, while cement and pin fixation can be used effectively to reconstruct large defects in the acetabular column and dome. The low rate of fixation failure supports the biomechanical principles of the reconstruction. Generally, the reconstructions are sufficiently durable to exceed the life expectancy of the patients.

Supplemental

Functional and Oncological Outcome of Acetabular Reconstruction for the Treatment of Metastatic Disease.

Marco, Healey, et al.J Bone Joint Surg Am2000172 citationsRetrospective cohort