Functional and Survival Outcomes of Patients following the Harrington Procedure for Complex Acetabular Metastatic Lesions

Abstract

Background: The Harrington surgical technique makes it possible to manage complex, extensive bone lesions using pins and cement to consolidate bone for acetabular cup positioning. However, it may be associated with a high reoperation rate, and the functional results of this surgery are not precisely described in the literature. Methods: In a monocentric retrospective study including all patients operated on using the Harrington procedure associated with THA between 2005 and 2020, we aimed to assess preoperative and postoperative function, reoperation-free survival, and overall survival. Results: Functional improvement was significant for Parker scores (preoperative: 3.6 ± 2.0; 6-month follow-up: 6.6 ± 3.2; 12-month follow-up: 7.6 ± 2.1) and Musculoskeletal Tumor Society (MSTS) scores (preoperative: 31.1 ± 16.2%; 6-month follow-up: 67.7 ± 30.6%; 12-month follow-up: 82.4 ± 24.0%). Of the 21 patients included, the reoperation-free survival rate was 76.1% [CI 95%: 58.1–99.7] at six and twelve months, with the main complications being pin migration (50.0%) and infection (25%). The patient overall survival rate was 76.2% [95% CI: 59.9–96.7] at six months and 61.9% [95% CI: 59.9–96.7] at 12 months. Discussion: These results underlined significant functional improvements following a conventional Harrington procedure, with acceptable reoperation rates.

Surgical robot-assisted tripod percutaneous reconstruction technique combined with bone cement filling technique for the treatment of acetabular metastasis

“…Without the help of the TINAVI robot, surgeons spend more time locating the surgical site, multiple rounds of radiation are required, and most parts of the final positioning are not as precise as when using the TINAVI robot. When comparing the clinical outcomes with the other surgical methods in the treatment of acetabular metastasis reported by Yang et al (2020), Lavignac et al (2020), Houdek et al (2020), and Plaud et al (2022, our treatment has the shortest surgical time (45 ± 10) and has minimal intraoperative blood loss (42 ± 8.37). None of the complications reported by others have appeared in our research so far (Table 3).…”

“…Frontiers in Bioengineering and Biotechnology frontiersin.org higher than in young patients, as confirmed by studies that have shown that the main complications are pin migration and infection in acetabular metastasis patients who undergo open surgery (Houdek et al, 2020;Lavignac et al, 2020;Plaud et al, 2022). Therefore, open surgery may not be suitable for treating acetabular metastasis patients who are elderly and with multiple diseases.…”

Surgical treatments of metastatic bone disease of the hip joint：A scoping review protocol

“…Periarticular metastatic damage often causes gradual displacement of the femoral head towards the top and inner side of the acetabulum, sometimes resulting in acute acetabular fractures or collapse; despite effective radiotherapy, this site may experience local bone dissolution and necrosis, leading to pathological fractures or joint collapse [14]. In these critical situations, surgical treatment is necessary, and hip joint surgery itself is complex [15]. The most used classi cation system for periacetabular bone metastases is the Harrington classi cation [16].…”