Total Hip Arthroplasty for Periacetabular Metastatic Disease. An Original Technique of Reconstruction According to the Harrington Classification

Wegrzyn, Julien; Malatray, Matthieu; Alqahtani, Turki Hassan; Pibarot, Vincent; Confavreux, Cyrille; Freyer, Gilles

doi:10.1016/j.arth.2018.02.096

Cited by 35 publications

(53 citation statements)

References 39 publications

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“…There were no dislocations in our series, compared with previous studies with rates of dislocation ranging from 0%‐21% . Similarly, our rate of revision for aseptic loosening or mechanical failure was comparable with the current literature .…”

Section: Discussionsupporting

confidence: 87%

“…Obtaining stable implant fixation and ultimately functional improvement remains a difficult challenge in patients with large osseous acetabular defects secondary to periacetabular metastatic disease. Dual mobility bearings provide greater ROM, a greater head‐to‐neck ratio, and a physiologic head size ultimately offering greater resistance to dislocation Our findings are similar to other studies showing patients treated, by cementing dual mobility cups into an acetabular cage, with this technique are able to return to full ambulatory status and have low rates of dislocation and or revision …”

Section: Discussionsupporting

confidence: 86%

“…All these factors place patients at an increased risk of postoperative complications. In our series, two patients were treated for postoperative infections, an incidence rate similar to previous studies . Both of the infections occurred in patients who received radiation therapy before surgery, and one of the patients was on hemodialysis, placing them at an even higher risk for infection .…”

Section: Discussionsupporting

confidence: 73%

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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

Plummer

Passen

Alexander

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Large acetabular defects secondary to metastatic disease frequently require extensive acetabular reconstruction. Techniques of acetabular reconstruction have been described, but no consensus for the management of these defects has been reached so far. We present our technique and patient outcomes for acetabular reconstruction by cementing a dual mobility cup into an acetabular cage. Methods We reviewed 152 total hip arthroplasties and identified 19 patients with periacetabular metastatic disease and large defects who required acetabular reconstruction utilizing a dual mobility cup cemented into an acetabular reconstructive cage. The following outcomes were evaluated: pain relief, functional improvement, postoperative complications. Results Mean follow‐up was 3 years, with 13 of the 19 patients eligible for 2‐year follow‐up. Patients reported a significant improvement in both pain and functional outcomes. There were no dislocations or signs of loosening. Two patients developed postoperative infections. One patient required hemipelvectomy 16 months postop due to recurrence of metastatic disease. Conclusions Cementing a dual mobility cup into an acetabular cage provides a highly stable and durable option for patients with periacetabular metastatic disease and large defects. Patients are able to return to immediate full weight bearing with significant improvement in both function and pain at 2 years.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 73%

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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

Plummer

Passen

Alexander

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

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“…Functional outcomes have been reported in a few studies, usually in publications with small sample sizes of Harrington or modified Harrington procedure (range 19 to 51 patients) (Harrington 1992, Nilsson et al 2000, Tillman et al 2008, Shahid et al 2014, Charles et al 2017, or with nonspecific outcome measures (Tillman et al 2008, Charles et al 2017, Wegrzyn et al 2018, Rowell et al 2019. No studies have been published using PROMs.…”

Section: Discussionmentioning

confidence: 99%

Modified Harrington’s procedure for periacetabular metastases in 89 cases: a reliable method for cancer patients with good functional outcome, especially with long expected survival

et al. 2020

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Background and purpose — The pelvis is the 3rd most common site of skeletal metastases. In some cases, periacetabular lesions require palliative surgical management. We investigated functional outcome, complications, and implant and patient survival after a modified Harrington’s procedure. Patients and methods — This retrospective cohort study included 89 cases of surgically treated periacetabular metastases. All patients were treated with the modified Harrington’s procedure including a restoration ring. Lesions were classified according to Harrington. Functional outcome was assessed by Harris Hip Score (HHS) and Oxford Hip Score (OHS). Postoperative complications, and implant and patient survival are reported. Results — The overall postoperative functional outcome was good to fair (OHS 37 and HHS 76). Sex, age, survival > 6 and 12 months, and diagnosis of the primary tumor affected functional outcome. Overall implant survival was 96% (95% Cl 88–100) at 1 year, 2 years, and 5 years; only 1 acetabular implant required revision. Median patient survival was 8 months (0–125). 10/89 patients had postoperative complications: 6 major complications, leading to revision surgery, and 4 minor complications. Interpretation — Our modified Harrington’s procedure with a restoration ring to achieve stable fixation, constrained acetabular cup to prevent dislocation, and antegrade iliac screws to prevent cranial protrusion is a reliable reconstruction for periacetabular metastases and results in a good functional outcome in patients with prolonged survival. A standardized procedure and low complication rate encourage the use of this method for all Harrington class defects.

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“…Their series consisted of 131 cases, and they reported a dislocation rate of 2% with statistically significant improvements in function and pain. 21…”

Section: Ring and Cage Constructsmentioning

confidence: 99%

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

et al. 2019

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Metastatic disease to the periacetabular region of the pelvis is a complex and challenging problem to treat. Similar to the proximal femur, this area of the skeleton has a high proportion of involvement when primary tumors metastasize to bone. Surgical intervention to treat this patient population is significantly more difficult than treating lesions of the proximal femur. There tends to be higher rates of intraoperative blood loss and postoperative complications, as well as poorer prognoses. It is important for the operating surgeon to evaluate the patient's medical status using a multidisciplinary approach and fully understand their prognosis before planning and performing surgical intervention. Given the complex nature of these surgeries, they are best performed by orthopaedic oncologists or experienced revision arthroplasty specialists. The clinical evaluation, workup, and perioperative adjuncts to treatment for periacetabular metastatic disease are similar to those for disease of the proximal femur as discussed in part 1 of this article series. This review focuses on aspects specific to acetabular disease and surgical intervention in these patients.

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Total Hip Arthroplasty for Periacetabular Metastatic Disease. An Original Technique of Reconstruction According to the Harrington Classification

Cited by 35 publications

References 39 publications

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

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

Modified Harrington’s procedure for periacetabular metastases in 89 cases: a reliable method for cancer patients with good functional outcome, especially with long expected survival

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

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