Abstract
The pelvis is a common site of metastatic bone disease. Peri-acetabular lesions are particularly challenging and can cause severe pain, disability and pathologic fractures. Surgical management of these lesions has historically consisted of cementoplasty for contained lesions and Harrington reconstructions for larger, more destructive lesions. Due to the limitations of these procedures, a number of novel procedures have been developed to manage this challenging problem. Percutaneous techniques—including acetabular screw fixation and cementoplasty augmented with screws—have been developed to minimize surgical morbidity. Recent literature has demonstrated a reliable reduction in pain and improvement in function in appropriately selected patients. Several adjuncts to the Harrington procedure have been utilized in recent years to reduce complication rates. The use of constrained liners and dual mobility bearings have reduced the historically high dislocation rates. Cage constructs and porous tantalum implants are becoming increasingly common in the management of large bony defects and destructive lesions. With novel and evolving surgical techniques, surgeons are presented with a variety of surgical options to manage this challenging condition. Physicians must take into account the patients’ overall health status, oncologic prognosis and anatomic location and extent of disease when developing an appropriate surgical plan.
Highlights
With advances in systematic therapies alongside an aging population, the number of patients living with metastatic cancer is increasing [1]
Bone is the third most common site of metastasis after the lung and liver with the incidence varying based on primary tumor type [5,6]
Kurup et al employed cementoplasty augmentation balloons traditionally used in kyphoplasty to maximize cement filling and minimize cement spillage in peri-acetabular lesions [28]
Summary
With advances in systematic therapies alongside an aging population, the number of patients living with metastatic cancer is increasing [1]. Metastatic bone disease (MBD) is a major contributor to morbidity in cancer patients and can lead to pain, reduced quality of life, pathologic fractures, hypercalcemia and anemia [5]. Pelvic metastases represent the third most common site of MBD, accounting for 10–20% of metastatic bone lesions [7,8,9]. Due to their anatomic location supporting the hip joint, peri-acetabular lesions are challenging and can cause severe pain, disability and pathologic fractures [10]. The Harrington classification is the most commonly used classification system when describing peri-acetabular metastatic lesions [11]. Tpaabtlieon1.oHf aarrciunrget.on classification describing peri-acetabular metastatic bone disease
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