Functional outcome and complications following reconstruction for Harrington class II and III periacetabular metastasis

Abstract

BackgroundMetastatic bone disease involving the acetabulum is a debilitating condition causing significant pain and disability for patients. Many methods of reconstruction have been described for treating Harrington class II and III lesions with different results and complications. Our objectives were to report functional results, implant survival and complications following reconstruction for Harrington class II and III periacetabular metastases by using anti-protusio cages, screws and joint replacement.MethodsWe reviewed 22 patients undergoing acetabular reconstruction for metastatic disease. There were 5 Harrington class II and 17 class III lesions. Intralesional curettage, multiple screws and cemented total hip replacement were performed in all patients. Anti-protusio cages were used in 19 hips. No Steinmann pins were used. Sixteen patients died at a median survival time of 12 months (range, 4 to 28 months) after surgery. Six patients were alive at last follow-up at a median of 8 months (range, 3 to 15 months).ResultsPostoperatively, the average ECOG score was improved from 3.1 to 1.7 and Visual Analog Scale was improved from 8.4 to 2.2. One patient developed hip dislocation and one patient developed superficial infection. The mean Musculoskeletal Tumor Society (MSTS) functional score was 70 (range, 27 to 87). There was no prosthetic loosening or revision. Twenty patients were able to walk. Eight patients became community ambulators, twelve became household ambulators and two were bed-bound.ConclusionsGood functional outcome and better ambulation could be expected following class II and III periacetabular reconstruction using anti-protusio cages, screws and cemented hip replacement. Few complications were noted and manageable. Although most of these patients with metastatic disease had limited life expectancies, their quality of life would be improved with appropriate patient selection and surgical reconstruction.

Pseudopterosin Inhibits Proliferation and 3D Invasion in Triple-Negative Breast Cancer by Agonizing Glucocorticoid Receptor Alpha

“…TAMs are the drivers of breast-cancer-cell invasion [ 33 , 34 ]. A main characteristic of inflammatory breast cancer is the secretion of proinflammatory cytokines such as IL-6 or IL-8 by macrophages, regulating angiogenesis and promoting tumor progression [ 35 , 36 ]. Previously, we verified a blockade of NF-κB-dependent cytokine expression and secretion after pseudopterosin treatment in both MDA-MB-231 and THP-1 cells [ 16 ].…”

Uncemented Arthroplasty After Hip Metastatic Disease and Multiple Myeloma

“…To date, cemented components are the traditional surgical technique when a hip arthroplasty is indicated for pain or fracture after metastatic disease or multiple myeloma in the hip area. 3 , 11 - 13 Previous studies have described the use of composite allograft with uncemented arthroplasty in the treatment of primary bone tumors, 14 arguing that the cardiovascular risks associated with the use of cement could be avoided. This is also a strong argument in relation to patients with metastatic disease and multiple myeloma, as their overall health status is frequently compromised.…”

“… 2 Currently, cemented hip arthroplasty is considered the treatment of choice for such fractures. 3 However, such procedures are associated with an increased rate of adverse events, 4 , 5 specially given the common occurrence of comorbid conditions. 6 In face of this high rate of complications, it would be plausible to consider the use of uncemented arthroplasty but, to our knowledge, there is no adequate evaluation of whether it would be a viable alternative.…”

Biomechanical Study of Simulated Metastatic Peri-Acetabular Defects

“…Surgical intervention with acetabular involvement poses a unique challenge to surgeons due to the region's complex anatomy and proximity to neurovascular structures [10]. There have been several reports on the treatment of metastatic acetabular lesions, most of which employ the Harrington Classification System [4].…”

“…Based on this classification system, defects are categorized into one of four categories depending on the extent of pelvic involvement and treated accordingly ( Table 1). Despite management of these various stages being previously studied, there remains a lack of a reliable data demonstrating the indication for surgical management in relation to the amount of bone loss and the risk of pathologic fracture [5,10,11].…”