Percutaneous cementoplasty of acetabular bony metastasis

Abstract

The development of malignant lesions in the acetabulum can lead to painful and disabling bone destruction. Lytic metastases of the acetabulum are frequent, causing pathologic fractures, pain and disability. The literature is sparse in relation to the exact indications and technique for this procedure. Percutaneous injection of methylmethacrylate or ethanol may provide marked pain relief or bone strengthening in patients, with malignant acetabular destruction, who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when the weight-bearing part of the acetabulum is involved. The goals of treatment are pain relief and mechanical strengthening of the acetabulum. Radiography and computed tomography must be performed prior to therapeutic percutaneous injection to assess the location and extent of the lytic process, the presence of cortical destruction or fracture, and the presence of soft-tissue involvement. We report a case of a 39-year-old woman with a secondary acetabular lesion, which was treated successfully with percutaneous acetabular cementoplasty. We describe a novel technique used to inject cement into the lesion, allowing for greater cement volume and pressurisation within the lesion.