This retrospective series from Memorial Sloan-Kettering evaluated 55 patients who underwent acetabular reconstruction with total hip replacement for refractory metastatic acetabular disease. It asks whether operative reconstruction delivers meaningful pain relief and restored ambulation in patients who have failed radiation and chemotherapy. The series also introduces an anatomically based classification of acetabular defects and describes technical refinements to the original Harrington reconstruction.
The key clinical question with acetabular metastases is not whether to operate, but who will benefit enough to justify the risk. This paper gives you the answer: operate when pain persists after 1-3 months of radiation or when structural instability prevents ambulation — and expect 76% of survivors to have meaningful relief.
When you see a patient with acetabular metastases, check for visceral disease first. A positive visceral workup predicts median survival of only 3 months. That changes the risk-benefit calculus for a 290-minute operation with a 22% complication rate.
For the technical side: large defects with a deficient inner table require two-stage cementing to avoid forcing cement into the pelvis. Antegrade pins or cannulated screws are anchored in the intact iliac wing to redirect load away from destroyed bone. The construct is designed to outlast the patient, and in most cases, it does.
Breast cancer patients are the outliers here: median survival of 19 months vs. 6.3 months for all other primaries. They are the patients most likely to live long enough to stress the reconstruction.
This retrospective series from Memorial Sloan-Kettering evaluated 55 patients who underwent acetabular reconstruction with total hip replacement for refractory metastatic acetabular disease. It asks whether operative reconstruction delivers meaningful pain relief and restored ambulation in patients who have failed radiation and chemotherapy. The series also introduces an anatomically based classification of acetabular defects and describes technical refinements to the original Harrington reconstruction.
The key clinical question with acetabular metastases is not whether to operate, but who will benefit enough to justify the risk. This paper gives you the answer: operate when pain persists after 1-3 months of radiation or when structural instability prevents ambulation — and expect 76% of survivors to have meaningful relief.
When you see a patient with acetabular metastases, check for visceral disease first. A positive visceral workup predicts median survival of only 3 months. That changes the risk-benefit calculus for a 290-minute operation with a 22% complication rate.
For the technical side: large defects with a deficient inner table require two-stage cementing to avoid forcing cement into the pelvis. Antegrade pins or cannulated screws are anchored in the intact iliac wing to redirect load away from destroyed bone. The construct is designed to outlast the patient, and in most cases, it does.
Breast cancer patients are the outliers here: median survival of 19 months vs. 6.3 months for all other primaries. They are the patients most likely to live long enough to stress the reconstruction.