A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options

Gusho, Charles A; Chapman, Reagan; Blank, Alan T.

doi:10.4081/or.2020.9011

Cited by 7 publications

(15 citation statements)

References 8 publications

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“…Due to the heterogeneous nature of the patients, tumours, and acetabular involvement, a variety of implants have been used in the management of the defects. 2,5,8,9 The classically described technique by Harrington 6 and subsequent modifications provide reasonable early outcomes. 2,7 However, in view of the improving prognosis and longevity of these patients, a more robust reconstruction is required.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,8,9 The classically described technique by Harrington 6 and subsequent modifications provide reasonable early outcomes. 2,7 However, in view of the improving prognosis and longevity of these patients, a more robust reconstruction is required.…”

Section: Discussionmentioning

confidence: 99%

“…Due to improvements in oncological treatment, patients with cancer are living longer, and symptomatic bone metastases and haematological malignancies are becoming more prevalent. 2,3 Management requires a multidisciplinary approach, and patients may benefit from timely surgical intervention. 1,4,5 Various surgical procedures have been described for the management of these patients reflecting the spectrum and heterogeneity of disease.…”

Section: Introductionmentioning

confidence: 99%

“…Good early outcomes have been presented, however a failure rate of 9% has also been reported, particularly in patients with a prognosis beyond five years. 2,7 Alternative procedures have been described, including the use of porous implants, trabecular augments, pelvic cones, custom endoprostheses, and acetabular cages. 2,5,8,9 However, these are typically palliative procedures aimed at Survivorship analysis for all-cause revision with death as a competing risk.…”

Section: Introductionmentioning

confidence: 99%

“…2,7 Alternative procedures have been described, including the use of porous implants, trabecular augments, pelvic cones, custom endoprostheses, and acetabular cages. 2,5,8,9 However, these are typically palliative procedures aimed at Survivorship analysis for all-cause revision with death as a competing risk. At eight years postoperatively, the probability of revision was 3.6%.…”

Section: Introductionmentioning

confidence: 99%

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Survival of the GAP II cage in the management of metastatic disease of the acetabulum

Kennedy

Farhan-Alanie

Young

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to assess the clinical and radiological outcomes of an antiprotrusio acetabular cage (APC) when used in the surgical treatment of periacetabular bone metastases. Methods This retrospective cohort study using a prospectively collected database involved 56 patients who underwent acetabular reconstruction for periacetabular bone metastases or haematological malignancy using a single APC between January 2009 and 2020. The mean follow-up was 20 months (1 to 143). The primary outcome measure was implant survival. Postoperative radiographs were analyzed for loosening and failure. Patient and implant survival were assessed using a competing risk analysis. Secondary parameters included primary malignancy, oncological treatment, surgical factors, length of stay in hospital, and postoperative complications. Results A total of 33 patients (59%) died during the study period at a mean of 15 months postoperatively (1 to 63). No patient had radiological evidence of loosening or failure. Acetabular component survival was 100%. Three patients (5.4%) had further surgery; one (1.8%) underwent revision of the femoral component for dislocation, one required debridement with implant retention for periprosthetic joint infection, and one required closed reduction for dislocation. Using death as a competing risk, at 100 months, the probability of revision was 0.036 and the risk of death was 0.84. Conclusion With appropriate patient selection, the antiprotrusio cage offers good implant survival, with a reasonable perioperative complication rate in this high-risk group of patients when managing metastatic disease or haematological malignancy around the acetabulum. Cite this article: Bone Joint J 2022;104-B(4):504–509.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Survival of the GAP II cage in the management of metastatic disease of the acetabulum

Kennedy

Farhan-Alanie

Young

et al. 2022

The Bone & Joint Journal

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Improved functional status in patients undergoing cement and rebar reconstruction with total hip arthroplasty for uncontained metastatic tumors of the acetabulum

Mittal

Tamer

Shapton

et al. 2023

Journal of Surgical Oncology

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Background and Objective: Metastatic cancer of the acetabulum can produce marked pain and disability for patients. Several reconstruction techniques for such lesions have been described, with variable outcomes. The purpose of this study was to determine functional outcomes and complication rate for patients undergoing cement rebar reconstruction using posterior column screws with total hip arthroplasty for large, uncontained lesions of the acetabulum.Methods: Twenty-two consecutive patients who underwent cement rebar reconstruction with posterior column screws and total hip arthroplasty for metastatic tumors of the acetabulum between 2014 and 2017 were identified. All cases were reviewed for patient demographics, surgical parameters, implant survival, complications, and functional status following these procedures.Results: There was a significant increase in the proportion of patients able to ambulate post-surgery (95.5%) compared with presurgery (22.7%) (p < 0.001). Mean musculoskeletal tumor society score postoperatively was 17.9 (60%). Average operative time was 174 min and average estimated blood loss was 689 mL. Seven patients required an intraoperative or postoperative blood transfusion. Three patients had postoperative complications (14%), two of whom required revision (9%). Conclusion:Reconstruction using cement rebar with posterior column screws and total hip arthroplasty is a safe, reproducible approach that may greatly improve functional outcomes with a low rate of intraoperative or postoperative complications.

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Minimally invasive management of pathologic fractures of the pelvis and sacrum: Tumor ablation and fracture stabilization

Lee

Schutz

Myhre

et al. 2023

Journal of Surgical Oncology

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Background Pathologic fractures of the pelvis/sacrum due to metastatic bone disease (MBD) cause pain and dysfunction due to mechanical instability of the pelvic ring. This study presents our multi‐institutional experience with percutaneous stabilization of pathologic fractures and osteolytic lesions from MBD throughout the pelvic ring. Methods The records of patients undergoing this procedure from 2018 to 2022 were reviewed retrospectively from two institutions. Surgical data and functional outcomes were recorded. Results Fifty‐six patients underwent percutaneous stabilization, with a median operative duration of 119 min (interquartile range [IQR]: 92.8, 167) and median estimated blood loss of 50 mL (IQR: 20, 100). The median length of stay was 3 days (IQR: 1, 6), and 69.6% (n = 39) of patients were discharged home. Early complications included one partial lumbosacral plexus injury, three acute kidney injuries, and one case of intra‐articular cement extravasation. Late complications included two infections and one revision stabilization procedure for hardware failure. Mean Eastern Cooperative Oncology Group (ECOG) scores improved from 3.02 (SD 0.8) preoperatively to 1.86 (SD 1.1) postoperatively (p < 0.001). Ambulatory status also improved (p < 0.001). Conclusions Percutaneous stabilization of pathologic fractures and osteolytic defects of the pelvis and sacrum is a procedure that improves patient function, ambulatory status and is associated with a limited complication profile.

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A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options

Cited by 7 publications

References 8 publications

Survival of the GAP II cage in the management of metastatic disease of the acetabulum

Survival of the GAP II cage in the management of metastatic disease of the acetabulum

Improved functional status in patients undergoing cement and rebar reconstruction with total hip arthroplasty for uncontained metastatic tumors of the acetabulum

Minimally invasive management of pathologic fractures of the pelvis and sacrum: Tumor ablation and fracture stabilization

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