Management of periacetabular metastases

Abstract

Purpose of review: There are few reports on the management of periacetabular metastasis. Harrington's series of 58 patients remains the largest. From 1999 to 2006 only six original reports have been published. We review the techniques described in these reports and their outcomes. Recent findings: The approach to the patient with periacetabular metastasis involves several considerations. Most can be treated nonoperatively. When there is disabling functional pain and loss of independence in personal care, surgery is indicated. Most commonly, postcurettage defects are reconstructed by packing with bone cement and, if needed, are stabilized with two groups of Steinmann pins or screws to transfer loads superiorly into the ilium and sacro-iliac joint. A cemented total hip arthroplasty with or without reinforcement shells is then seated. Summary: In appropriately selected patients there is reasonable success in terms of pain relief, recovery of functional independence, and durability of fixation. The Saddle prosthesis yields equivalent functional results and can be applied for severe periacetabular defects. These surgical reconstructions are major undertakings with a complication rate of 15–34%, including perioperative death and adverse events such as neurovascular injury, dislocations, infections, and loosening.