Surgical treatment of peri-acetabular metastatic disease: Retrospective, multicentre study of 91 THA cases

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2020-10, Vol.106 (6), p.1025-1032
• Main Authors: Lavignac, Pierre, Prieur, Jules, Fabre, Thierry, Descamps, Jules, Niglis, Lucas, Carlier, Christophe, Bouthors, Charlie, Baron-Trocellier, Thomas, Sailhan, Fréderic, Bonnevialle, Paul
• Format: Article
• Language: English
• Subjects: Acetabular ring; Life Sciences; Pathological fracture; Peri-acetabular metastasis; Total hip arthroplasty
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2020.03.032

The occurrence of peri-acetabular metastasis (PAM) is a turning point in the progression of cancer because the disabling pain prevents the patient from walking or makes it difficult. Recent progress in controlling cancers that spread to the bone and controlling local bone destruction justify this national study. Since the data in France is incomplete or based on small studies, we analysed a multicentre retrospective cohort of patients with PAM who underwent total hip arthroplasty (THA) to evaluate 1) the clinical and radiological outcomes and 2) the factors impacting patient survival. The clinical outcomes, complication rate and survivorship are comparable to that of recent published studies. Ninety-one patients (27 men, 64 women) with a mean age of 62.7±10.5 years (extremes 38 and 88) with PAM secondary to breast cancer [42 patients (46%)] or lung cancer [20 patients (22%)] underwent THA. The metastasis was the first sign of cancer in 33 cases (36%). Concurrent visceral metastases were present in 30 patients (33%), multiple peripheral bone metastasis in 48 patients (53%) and synchronous spine metastasis in 39 patients (43%). The most common construct was a cemented stem with metal reinforcement cage and cemented dual mobility cup [71 times (78%), while 85/91 had a dual mobility cup (93%)]. Elimination or reduction of pain was reported in 81 patients (91%). Overall walking ability was deemed normal or acceptable in 74 patients (83%). Six patients died (7%) before the end of the 3rd month. There were seven general complications (8%) including five thromboembolic events. There were 22 complications related to the surgical procedure in 20 patients (22%) that required surgical revision, including 10 surgical site infections (11%) and 3 dislocations (3%) (one concerning a dual mobility cup and 2 after single mobility cup). The median survivorship all causes combined was 19.5 months; it was 23.7 months for patients with breast cancer and 8.9 months for those with lung cancer. Despite different endpoints being used, the clinical outcomes in our study are like those in other published studies, as were the incidence of surgery-related complications and the survivorship. The recommended surgical technique is the implantation of an acetabular reinforcement cage, curettage with cement filling of osteolytic areas, dual mobility cup and cemented stem followed by radiation therapy. The role of THA versus interventional radiology procedures must still be determined. IV, r