Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease

Wi Faisham,Ah Nawaz,W Zulmi,Daj Muslim,Vmk Bhavaraju

doi:10.5704/moj.0905.006

Abstract

Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).

Highlights

Metastatic bone disease is common in cancer patients and causes substantial disease-related morbidity and mortality .1,2 Treatment for bone metastases is usually palliative, with goals of orthopaedic management being adequate control of pain, prevention or stabilization of pathological fractures, improvement of function and ambulation, facilitation of medical and nursing care, and improvement of psychological well-being.The proximal femur and periacetabular region are the most common sites of involvement in the appendicular skeleton . 1,2,3 This is a common site of pathological fracture because of the significant forces that pass through this region while standing
Palliative radiotherapy is a well-established treatment to control the bone pain from metastasis. When it comes to weight bearing and ambulation, surgical intervention is required to stabilize the joint 4
The pain score was reduced after surgery and most of the patient did not require regular analgesics (Table I)

Summary

Introduction

Metastatic bone disease is common in cancer patients and causes substantial disease-related morbidity and mortality .1,2 Treatment for bone metastases is usually palliative, with goals of orthopaedic management being adequate control of pain, prevention or stabilization of pathological fractures, improvement of function and ambulation, facilitation of medical and nursing care, and improvement of psychological well-being.The proximal femur and periacetabular region are the most common sites of involvement in the appendicular skeleton . 1,2,3 This is a common site of pathological fracture because of the significant forces that pass through this region while standing. Treatment for bone metastases is usually palliative, with goals of orthopaedic management being adequate control of pain, prevention or stabilization of pathological fractures, improvement of function and ambulation, facilitation of medical and nursing care, and improvement of psychological well-being. The proximal femur and periacetabular region are the most common sites of involvement in the appendicular skeleton . 1,2,3 This is a common site of pathological fracture because of the significant forces that pass through this region while standing. A fracture involving the acetabular region may cause severe pain and result in impaired mobility and function. Palliative radiotherapy is a well-established treatment to control the bone pain from metastasis. When it comes to weight bearing and ambulation, surgical intervention is required to stabilize the joint 4

Methods

Results

Conclusion