The management of acetabular insufficiency secondary to metastatic malignant disease
Harrington, K.D.
Journal of Bone and Joint Surgery. American Volume 63(4): 653-664
1981
ISSN/ISBN: 0021-9355 PMID: 6163784 Document Number: 181432
Between July 1972 and July 1979, 58 patients were treated by hip replacement arthroplasty for pathological fractures and fracture-dislocations of the acetabulum secondary to metastatic malignant disease. Only 11 patients had retained sufficient periacetabular bone for total hip replacement to be performed in the conventional manner. Nineteen patients had destruction of the medial part of the acetabular wall and required fixation of the acetabular prosthetic component in a manner designed to transmit weight-bearing forces into the intact superior part of the acetabular wall. Patients (25) had destruction of both the medial and the superior areas of the acetabular wall and required techniques for fixation of the acetabular prosthetic component that allowed transmission of the weight-bearing forces into the intact bone of the superior part of the ilium and the sacrum. Three patients had metastatic lesions that warranted an attempt at resection for cure. The affected periacetabular bone was resected with wide margins and a prosthetic hip arthroplasty was then performed. All patients were evaluated postoperatively for relief of pain, resumption of walking, solidity of fixation of the prosthetic components and survival without recurrence at the operative site. Patients (37, 67%) had excellent or good pain relief 6 mo. postoperatively and 24 (43%) were rated excellent or good 2 yr postoperatively. Patients (45, 80%) were ambulatory for 6 mo. postoperatively and 26 (45%) could still walk at 2 yr. Five patients had loosening of the acetabular prosthetic component secondary to local tumor recurrence in spite of adequate radiotherapy. There were no other instances of prosthetic component loosening. There were 2 operative deaths. The mean survival time was 19 mo., but 27 of the 58 patients still were alive at the time of writing.