The Harrington reconstruction for advanced periacetabular metastatic destruction: Good outcome in 32 patients

Nilsson, Jan; Gustafson, Pelle; Fornander, Per; Ornstein, Ewald

doi:10.1080/000164700317362226

Cited by 59 publications

(42 citation statements)

References 11 publications

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“…Similar to other studies [1,8,13,16,19,23,25,26], we observed frequent complications, and one patient died perioperatively. One patient had early recurrent instability and was considered for revision surgery with implantation of a constrained liner, but he died of disease progression before surgery was performed.…”

Section: Discussionsupporting

confidence: 91%

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Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

Khan

Rose

Yanagisawa

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail. Description of Technique After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium. Patients and Methods We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months).

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Section: Discussionsupporting

confidence: 91%

“…Patients experienced good relief of pain, improvement in ambulatory status, and improvements in HHS. Our observations are similar to those of others who used the Harrington technique and its modifications (Table 2) [1,8,13,16,19,25,26]. The largest reported series is from Marco et al [16].…”

Section: Discussionsupporting

confidence: 90%

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

Khan

Rose

Yanagisawa

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Since Harrington's report, several authors have published their experience of his technique (Walker 1993, Vena et al 1999, Kunisada and Choong 2000, Marco et al 2000, Nilsson et al 2000. In all reports, either threaded Steinman pins or cancellous screws were used and none of the authors found a pin dislocation.…”

Section: Discussionmentioning

confidence: 99%

“…Class III is a lesion with deficiencies in the lateral cortices and the superior part of the wall, as in our case. A number of reconstruction techniques have been described with total hip arthroplasty using support rings or other materials such as the saddle prosthesis, with or without reinforcement with pelvic pins and bone cement, allografts and autografts (Harrington 1981, 1992, Levy et al 1982, Walker 1993, Aboulafia et al 1995, Allan et al 1995, Stark and Bauer 1996, Kusuzaki et al 1998, Durr et al 1999, 2002, Vena et al 1999, Nilsson et al 2000.…”

Section: Discussionmentioning

confidence: 99%

Intrapelvic pin migration after periacetabular reconstruction and arthroplasty of the hip in metastatic pelvic disease—a case report

2005

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“…Surgical options include the use of autogenous bone grafts, allografts, compound osteosynthesis and/or an endoprosthesis [9,10]. Especially in cases of a less extended bony destruction of the peri-acetabular region (Harrington class II), several authors have described the use of acetabular support rings in combination with THA or reconstruction using saddle prostheses following excision of primary and metastatic peri-acetabular tumours [11][12][13]. Although they have reported good results immediately after surgery or during early follow-up, reconstruction failures or degradation of the functional status have been observed in a considerable portion of the patients, especially following implantation of saddle prostheses.…”

Section: Discussionmentioning

confidence: 99%

The modified Harrington procedure for metastatic peri-acetabular bone destruction

Vielgut

Sadoghi

Gregori

et al. 2013

International Orthopaedics (SICOT)

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Purpose We describe the outcome in a series of patients treated for metastatic peri-actetabular and iliac bone destruction using a modified technique of Harrington's procedure. Methods Between 2006 and 2012, nine patients with a mean age of 62.2 years (42-75 years) were treated using a modified Harrington technique. Thereby, total hip replacement implants augmented by two to three threaded pins and cement were used to restore bony continuity of the pelvis and to achieve a stable construction allowing immediate full-weight bearing mobilisation. Results Acetabular destruction was graded according to Harrington's classification of peri-acetabular metastatic destruction, as class IV in one case, class III in six, and class II in two cases. The pre-operative ASA score ranged from II-IV. There were no intra-operative deaths or major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations at final follow-up. Eight patients achieved an improvement of their functional status postoperatively. One reconstruction required revision and four patients died due to their underlying disease ten to 36 months after surgery. Conclusion We found this technique an effective, reproducible, and long-lasting method to relieve pain and improve or restore function in patients with destructive metastatic lesions of the peri-acetabular bone and the iliac wing. Although we performed surgery even in severely ill patients with extended, generalised metastatic disease we had no intra-or postoperative death and observed no major complications.

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The Harrington reconstruction for advanced periacetabular metastatic destruction: Good outcome in 32 patients

Cited by 59 publications

References 11 publications

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

Intrapelvic pin migration after periacetabular reconstruction and arthroplasty of the hip in metastatic pelvic disease—a case report

The modified Harrington procedure for metastatic peri-acetabular bone destruction

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