Management of Metastatic Bone Disease of the Acetabulum

Abstract

Metastatic acetabular disease can be severely painful and may result in loss of mobility. Initial management may consist of diphosphonates, narcotic analgesics, radiation therapy, protected weight bearing, cementoplasty, and radiofrequency ablation. Patients with disease affecting large weight-bearing regions of the acetabulum and with impending failure of the hip joint are unlikely to gain much relief from nonsurgical treatment and interventional procedures. The profound osteopenia of the acetabulum, limited healing potential of the fracture, and projected patient life span and function necessitate surgical techniques that provide immediate stable fixation to reduce pain and restore ambulatory function. Current reconstructive procedures, including cemented total hip arthroplasty, the saddle or periacetabular endoprosthesis, and porous tantalum implants, are based on the quality of remaining acetabular bone as well as the patient's level of function and general health. Well-executed acetabular reconstructions can provide durable hip joints with good pain relief and function.

Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease

“…The MDM liners were cemented in approximately 20° of anteversion and 40° of abduction with equal cement distribution around the liner . A cemented femoral component was utilized in all cases, including 17 Omnifit EON femoral stems, one GMRS Proximal Femoral Replacement, and one Accolade femoral stems (Stryker Orthopaedics) . Before closure, all wounds underwent a 3‐minute dilute betadine soak followed by pulsatile lavage of 3 L of isotonic sodium chloride solution .…”

“…Several techniques of acetabular reconstruction, developed to shift forces to the intact bony aspects of the pelvic ring, along with numerous constructs to increase stability have been described . From the use of structural allograft, custom endoprostheses, and cemented antiprotrusio cage THAs, to more recent dual‐mobility bearings cemented into an acetabular cage device, no consensus for the optimal management of patients with large periacetabular osseous defects especially in the setting of metastatic disease have been determined.…”

The best of both worlds — managing the cancer, saving the bone

“…However, when utilized, surgery is primarily palliative with the primary objective to decrease pain and improve overall function. Appropriate work-up should precede surgery to establish the diagnosis of metastatic cancer, its type and address possible complications (for example, hypercalcaemia) 189,190 . Indications for surgery are pathologic fractures 191 and apparent alterations in the structural integrity of bone, to the extent that these elicit bone pain and/or increase the risk of fractures 192 .…”

Management of Pathologic Fractures Around the Hip: Part 2–Acetabulum

“…An alternative classification system is the metastatic acetabular classification (MAC). 7,8 This classification is broken down by affected anatomic zones. Type 1 includes lesions of the acetabular roof with intact subchondral bone and may be managed with acetabuloplasty or cemented THA depending on the strength of the remaining subchondral bone.…”