A novel surgical approach for complex destructive acetabular malignancies

Abstract

Current treatment of acetabular defects created by metastatic disease involve extensile approaches removing the abductors from the greater trochanter or greater trochanteric osteotomy. We have developed a technique which does not involve removal of the muscle from the greater trochanter or trochanteric osteotomy. We remove the gluteus medius muscle from its anterior origin along several inches of the anterior iliac wing and the gluteus maximus from its insertion (the conjoined tendon) along the posterior proximal femur. The entire hip joint capsule is removed from anterior and posterior to the gluteus medius and minimus taking care to leave the insertion of these muscles intact. We have performed this approach in 13 patients with known metastatic disease and our preliminary results indicate that their limp and immediate weight bearing are improvements from the current standard of care involving removal of either the insertion of the gluteus medius and minimus from the greater trochanter or greater trochanteric osteotomy.