Percutaneous acetabuloplasty for metastatic acetabular lesions

Abstract

BackgroundOsteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective.MethodsWe report a retrospective study in 25 such patients (30 acetabuli) who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC), Eastern Cooperative Oncology Group (ECOG). The results obtained were analysed using the χ2 Test and Fisher's exact test. Significance was sent at P < 0.05.ResultsMarked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition.Complete pain relief was achieved in 15 of our 25 (59%) of patients, and pain reduction was achieved in the remaining 10 (41%) patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12%) between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences.ConclusionPercutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

Percutaneous Acetabuloplasty Compared With Open Reconstruction for Extensive Periacetabular Carcinoma Metastases

“…The largest series to date describes this procedure in 25 patients and measures functional outcome using an array of measures such as the Harris Hip Score, Western Ontario and McMaster Arthritis Index (WOMAC), ECOG performance status, and VAS for pain [9]. As in our study, the authors report strong therapeutic benefit across all of these instruments at the three month time interval, but unlike in our series, the durability of benefit is in question.…”

“…Cement acetabuloplasty has been reported to be a safe and successful procedure for periacetabular carcinoma metastases [6][7][8][9][10][11][12]14]. The largest series to date describes this procedure in 25 patients and measures functional outcome using an array of measures such as the Harris Hip Score, Western Ontario and McMaster Arthritis Index (WOMAC), ECOG performance status, and VAS for pain [9].…”

“…An example is cement acetabuloplasty [4]. Derived from the technique of vertebral augmentation using injected polymethyl-methacrylate (PMMA) [5], this technique has received enthusiasm for its effectiveness and minimally-invasive nature [4,[6][7][8][9][10][11]. In theory, percutaneously injected cement not only provides structural buttressing even with subtotal lesional filling [12], but also provides some adjuvant effect due to thermal tumor necrosis.…”

Evaluating the safety and effectiveness of percutaneous acetabuloplasty

“…Our findings confirm previous anecdotal reports of pain improvement following acetabuloplasty,7 11–13 and are in agreement with a recent study demonstrating statistically significant improvements in pain and hip function following cement placement 14. All patients in that study experienced pain reduction, with complete pain relief in 59%.…”

“…Previously reported complications include transient local pain, venous cement injection and cement extravasation into the joint space and the soft tissues 14. Cement leakage into the joint space is of foremost concern, especially when the articular cortex is compromised.…”