The Results of Surgical Management of Bone Metastasis Involving the Periacetabular Area: Siriraj Experience
Prasert Wangsaturaka MD*, Apichat Asavamongkolkul MD*, Saranatra Waikakul MD*, Rapin Phimolsarnti MD*
Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
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.
Materials and Methods : 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 classi-
fication, 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 56 years 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 pre-
operatively 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.
Keywords : Periacetabulum, Bone metastasis, Surgery
