The results of surgical management of bone metastasis involving the periacetabular area: Siriraj experience.

ABSTRACT

BACKGROUND: Periacetabular metastasis is a common site of bone metastasis and can cause major disability to the patients. Non-operative treatment including medication or radiation therapy is the first treatment modality. The operative treatment is indicated in patients with failed non-operative treatment or pathologic fracture. OBJECTIVE: To assess the functional results, quality of life, and complications after reconstruction of the periacetabular metastasis. MATERIAL AND METHOD: Fourteen patients underwent 16 intralesional excisions of tumor and cemented total hip arthroplasty reconstruction from 2002 to 2006. The primary tumors were breast carcinoma in five patients, thyroid carcinoma in three, kidney carcinoma in two, and one each of cervix carcinoma, urinary bladder carcinoma, lung carcinoma, and multiple myeloma. Type of periacetabular metastases by Harrington 's classification, age of patients, blood loss, unit of blood transfusion, and postoperative complication were reviewed. Pre- and Postoperative pain by the visual analogue scale was evaluated. RESULTS: The mean age of patients was 56years with a mean follow up time of 389 days (range 30-1,275 days). The mean time from diagnosis of primary tumor to periacetabular metastatic surgery was 32.5 months (range 0-84 months). By Harrington 's classification, seven patients were classified in class I, four patients were class II, and three patients were class III. The visual analogue scale was improved from more than 8/10 preoperatively to 2/10 postoperatively. All patients could ambulate and walk independently and two patients could walk without gait support. Four patients died of disease progression and 10 patients are still alive. Two patients had complications from postoperative hip dislocation and acetabular loosening which successfully treated by closed reduction and revision of the prosthesis respectively. CONCLUSION: With promising results, low rate of complication and improvement of quality of life could be achieved after total hip arthroplasty reconstruction in the appropriately selected patient with a periacetabular metastasis. Additional surgery may be required in the patient with longer survival or progression of the disease.