Comparison of Percutaneous Techniques for Stabilization of Osteolytic Lesions of the Periacetabular Region Due to Metastatic Bone Disease.

Abstract

Minimally invasive techniques for metastatic disease treatment in the periacetabular region of the pelvis have grown increasingly popular. Open surgical management of osteolytic lesions in the pelvis are associated with high perioperative complication rates that approach 30-36% and often require suspension of systemic treatment. Conservative measures, such as radiation treatment, can improve functional status in select patients while avoiding the morbidity of open surgical intervention; however, conservative measures do not address the problem of mechanical instability that can lead to pathologic fracture or loss of independence. Percutaneous techniques without fixation, including cementoplasty and ablation, can be performed by themselves or in combination with other modalities. When performed in combination, screw fixation and cement and/or ablation can provide an immediately stable, durable construct that can be used as a 'bridge' procedure to hip arthroplasty if desired. The newer technique of photodynamic balloon stabilization also offers immediate stability and allows for conversion to total hip arthroplasty, but lacks the long-term follow-up data of other modalities. Percutaneous techniques addressing periacetabular defects are less invasive and morbid than open treatment, have a variety of applications in select patients, and provide excellent functional results.