Surgical Management Update in Metastatic Disease of the Pelvis Operative Techniques in Orthopaedics

Joint-sparing reconstruction for extensive periacetabular metastases: Literature review and a novel minimally invasive surgical technique

“…Outside of this area, we do not believe screw osteosynthesis is necessary. This is confirmed by the biomechanical principle that the sacroiliac joint, iliac wing, pubis, and ischium have very little contribution to weight-bearing capacity [13] . In the absence of pathologic fracture displacement in these less vital areas, cement can provide enough compressive support and pain control owing to its thermal and cytotoxic effect on tumor [13] .…”

“…In the individual management of bone metastasis, one must always consider expected survival, tumor histology, prior systemic or radiation therapy and bony metastatic response, isolated metastasis, and presence of pathologic fracture [12] . The periacetabular area is both a unique and challenging location owing to its crucial role in load transmission [13] . Therefore, there is an urgency to restoring weight-bearing capacity that will allow painless and immediate mobility to the patient within their limited lifespan.…”

“…While the Harrington classification and MAC system are based on radiologic images, Muller and Capanna’s classification takes into additional consideration prognosis, disease-free interval since detection of primary, and whether lesions are osteoblastic or osteolytic. However, what is common across all classifications, is that the minimum threshold for proceeding with a joint replacement would be any defect compromising hip joint stability, a pathologic fracture, or a lesion resistant to radiotherapy [1] , [4] , [7] , [13] .…”

“…Interventional techniques like percutaneous cementoplasty and thermal ablation have been typically useful in patients with metastatic acetabular lesions without impending fractures or instability, who experience refractory pain to radiation therapy and medical management, and/or are non-surgical candidates [1] , [13] , [18] . With the addition of screws to the percutaneous osteoplasty technique, some surgeons have extended this indication to include impending fractures, minimally displaced fractures and unstable lesions involving the posterior or anterior column [8] , [10] , [11] , [14] , [17] , [19] .…”