The argument for threaded pins with a Harrington pelvic reconstruction: a case report

Abstract

Metastatic bone disease is not uncommon and most orthopaedic surgeons, despite their subspecialty, will have some experience of its treatment. It is difficult to determine the incidence of metastatic bone disease; however it is estimated for all tumours at approximately 20,000 cases per year in the UK [1]. The British Orthopaedic Association have published “Metastatic Bone Disease: A Guide to Good Practice” to advise on the appropriate management of metastatic malignancy [1]. The aim of surgery in the context of metastatic disease is to palliate pain and restore function. These cases should ideally be managed within a multidisciplinary environment. Pelvic metastatic disease is not uncommon but may be managed by radiotherapy alone [1]. Peri-acetabular lesions differ, however, as they have the potential to lead to central dislocation of the hip, and therefore surgical treatment may be necessary [1]. The reconstructive options for peri-articular lesions are more involved than for other areas in the appendicular skeleton and should be discussed with the regional tumour unit and are best performed by those experienced in acetabular reconstruction. Harrington described a technique for acetabular insufficiency in 1981 which involved retrograde pins from the ilium into the acetabulumwhich were cemented with an acetabulum support with a polyethylene socket [2, 3]. Harrington described using 4.8-mm threaded Steinman pins inserted into the superior part of the ilium into healthy bone in a retrograde fashion via the same incision and in most cases across the sacroiliac joint [2]. The results of this technique have been replicated in other centres [4–7]. Tillman et al. described a modified Harrington technique using three threaded pins to provide a scaffold for the cementation of a conventional hip arthroplasty acetabular component [3]. We report a case of a modified Harrington technique using nonthreaded pins which was complicated by migration of one of the nonthreaded pins.