A Novel Tripod Percutaneous Reconstruction Technique in Periacetabular Lesions Caused by Metastatic Cancer.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
01 Apr 2020
01 Apr 2020
Historique:
pubmed:
23
2
2020
medline:
20
11
2020
entrez:
22
2
2020
Statut:
ppublish
Résumé
Metastatic lesions in the periacetabular region can cause pain and immobility. Symptomatic patients are often treated surgically with a total hip replacement using various modified Harrington methods. These open surgical procedures confer inherent risks. Prolonged recovery and potential complications may delay adjuvant radiation and systemic therapy. We describe a novel technique for acetabular reconstruction. Three large-bore cannulated screws are placed percutaneously under fluoroscopy in a tripod configuration to reinforce the mechanical axes of the acetabulum. Increased stability improves pain control and permits weight-bearing. Twenty consecutive patients with periacetabular metastases were treated using the tripod technique. Eighteen patients (90%) had Harrington class-III lesions, and 2 patients had Harrington class-II lesions. The mean surgical time was 2.3 hours. Sixteen patients (80%) were able to get out of bed on postoperative day 1. At 3 months postoperatively, there was significant improvement in pain as documented on their visual analog scale (p < 0.01) and in functionality as measured by the Eastern Cooperative Oncology Group score (p < 0.01). The mean follow-up time was 7 months (range, 0.6 to 20 months). At the most recent follow-up, only 3 among the 16 surviving patients were using opioids chronically for pain. Total hip arthroplasty was performed in 4 patients (20%) in a staged fashion using the previously placed screws as support for a cemented cup and obviating the need for a cage device. Of the 16 patients, 15 could walk either independently (6 patients) or using an ambulatory aid (9 patients). Eight patients with the primary tripod reconstruction survived >6 months postoperatively. They were found to have either new bone formation filling the defects or healing of the pathological fractures. There has been no implant loosening or failure. The tripod technique is a novel application to provide safe and effective pain relief in the context of periacetabular metastatic disease. It can be easily converted to support a cemented acetabular cup for a total hip replacement should disease progression occur. This technique provides an alternative to open surgery as currently practiced in these patients. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
Metastatic lesions in the periacetabular region can cause pain and immobility. Symptomatic patients are often treated surgically with a total hip replacement using various modified Harrington methods. These open surgical procedures confer inherent risks. Prolonged recovery and potential complications may delay adjuvant radiation and systemic therapy.
METHODS
METHODS
We describe a novel technique for acetabular reconstruction. Three large-bore cannulated screws are placed percutaneously under fluoroscopy in a tripod configuration to reinforce the mechanical axes of the acetabulum. Increased stability improves pain control and permits weight-bearing.
RESULTS
RESULTS
Twenty consecutive patients with periacetabular metastases were treated using the tripod technique. Eighteen patients (90%) had Harrington class-III lesions, and 2 patients had Harrington class-II lesions. The mean surgical time was 2.3 hours. Sixteen patients (80%) were able to get out of bed on postoperative day 1. At 3 months postoperatively, there was significant improvement in pain as documented on their visual analog scale (p < 0.01) and in functionality as measured by the Eastern Cooperative Oncology Group score (p < 0.01). The mean follow-up time was 7 months (range, 0.6 to 20 months). At the most recent follow-up, only 3 among the 16 surviving patients were using opioids chronically for pain. Total hip arthroplasty was performed in 4 patients (20%) in a staged fashion using the previously placed screws as support for a cemented cup and obviating the need for a cage device. Of the 16 patients, 15 could walk either independently (6 patients) or using an ambulatory aid (9 patients). Eight patients with the primary tripod reconstruction survived >6 months postoperatively. They were found to have either new bone formation filling the defects or healing of the pathological fractures. There has been no implant loosening or failure.
CONCLUSIONS
CONCLUSIONS
The tripod technique is a novel application to provide safe and effective pain relief in the context of periacetabular metastatic disease. It can be easily converted to support a cemented acetabular cup for a total hip replacement should disease progression occur. This technique provides an alternative to open surgery as currently practiced in these patients.
LEVEL OF EVIDENCE
METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 32079881
doi: 10.2106/JBJS.19.00936
pii: 00004623-202004010-00007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
592-599Références
Issack PS, Kotwal SY, Lane JM. Management of metastatic bone disease of the acetabulum. J Am Acid Orthop Surg. 2013 Nov;21(11):685-95.
Harrington KD. The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg Am. 1981 Apr;63(4):653-64.
Tillman RM, Myers GJ, Abudu AT, Carter SR, Grimer RJ. The three-pin modified ‘Harrington’ procedure for advanced metastatic destruction of the acetabulum. J Bone Joint Surg Br. 2008 Jan;90(1):84-7.
Lozano-Calderon SA, Kaiser CL, Osler PM, Raskin KA. Cemented total hip arthroplasty with retrograde ischioacetabular Steinmann pin reconstruction for periacetabular metastatic carcinoma. J Arthroplasty. 2016 Jul;31(7):1555-60. Epub 2016 Jan 21.
Clayer M. The survivorship of protrusio cages for metastatic disease involving the acetabulum. Clin Orthop Relat Res. 2010 Nov;468(11):2980-4.
Tsagozis P, Wedin R, Brosjö O, Bauer H. Reconstruction of metastatic acetabular defects using a modified Harrington procedure. Acta Orthop. 2015;86(6):690-4. Epub 2015 Jul 28.
Rowell P, Lowe M, Sommerville S, Dickinson I. Is an acetabular cage and cement fixation sufficiently durable for the treatment of destructive acetabular metastases? Clin Orthop Relat Res. 2019 Jun;477(6):1459-65.
Ho L, Ahlmann ER, Menendez LR. Modified Harrington reconstruction for advanced periacetabular metastatic disease. J Surg Oncol. 2010 Feb 1;101(2):170-4.
Marco RA, Sheth DS, Boland PJ, Wunder JS, Siegel JA, Healey JH. Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Joint Surg Am. 2000 May;82(5):642-51.
Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964 Dec;46:1615-46.
Starr AJ, Reinert CM, Jones AL. Percutaneous fixation of the columns of the acetabulum: a new technique. J Orthop Trauma. 1998 Jan;12(1):51-8.
Bishop JA, Routt ML Jr. Osseous fixation pathways in pelvic and acetabular fracture surgery: osteology, radiology, and clinical applications. J Trauma Acute Care Surg. 2012 Jun;72(6):1502-9.
Smith HS, Barkin RL. Painful boney metastases. Am J Ther. 2014 Mar-Apr;21(2):106-30.
Helgstrand JT, Røder MA, Klemann N, Toft BG, Lichtensztajn DY, Brooks JD, Brasso K, Vainer B, Iversen P. Trends in incidence and 5-year mortality in men with newly diagnosed, metastatic prostate cancer-a population-based analysis of 2 national cohorts. Cancer. 2018 Jul 15;124(14):2931-8. Epub 2018 May 3.
Gobbini E, Ezzalfani M, Dieras V, Bachelot T, Brain E, Debled M, Jacot W, Mouret-Reynier MA, Goncalves A, Dalenc F, Patsouris A, Ferrero JM, Levy C, Lorgis V, Vanlemmens L, Lefeuvre-Plesse C, Mathoulin-Pelissier S, Petit T, Uwer L, Jouannaud C, Leheurteur M, Lacroix-Triki M, Cleaud AL, Robain M, Courtinard C, Cailliot C, Perol D, Delaloge S. Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur J Cancer. 2018 Jun;96:17-24. Epub 2018 Apr 13.
Lou Y, Dholaria B, Soyano A, Hodge D, Cochuyt J, Manochakian R, Ko SJ, Thomas M, Johnson MM, Patel NM, Miller RC, Adjei AA, Ailawadhi S. Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers. Cancer Med. 2018 Oct;7(10):4932-42. Epub 2018 Sep 2.
Wunder JS, Ferguson PC, Griffin AM, Pressman A, Bell RS. Acetabular metastases: planning for reconstruction and review of results. Clin Orthop Relat Res. 2003 Oct;415(Suppl):S187-97.
Couraud G, André-Pierre G, Titien T, Florent E, Alexia H, Xavier-Jean C, Boussion H, Sandra G. Evaluation of short-term efficacy of extraspinal cementoplasty for bone metastasis: a monocenter study of 31 patients. J Bone Oncol. 2018 Sep 19;13:136-42.