Percutaneous acetabuloplasty for metastatic acetabular lesions

Giulio Maccauro¹ , Francesco Liuzza² , Laura Scaramuzzo¹ , Alessandro Milani³ , Francesco Muratori⁴ , Barbara Rossi¹ , Victor Waide⁵ , Giandomenico Logroscino¹ , Carlo A Logroscino¹ and Nicola Maffulli⁶

¹Department of Orthopaedics and Traumatology Catholic University. Agostino Gemelli Hospital – Rome, Italy

²Department of Orthopaedic and Traumatology Aurelia Hospital – Rome, Italy

³Institute of "Patologia Medica" Catholic University. Agostino Gemelli Hospital – Rome, Italy

⁴San Pietro Fatebenefratelli Hospital – Rome, Italy

⁵Manager Stryker, Italy

⁶Department of Orthopaedics and Traumatology Keele University School of Medicine – Staffordshire, UK

author email corresponding author email

BMC Musculoskeletal Disorders 2008, 9:66doi:10.1186/1471-2474-9-66


Published:	5 May 2008

Abstract

Background

Osteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective.

Methods

We report a retrospective study in 25 such patients (30 acetabuli) who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC), Eastern Cooperative Oncology Group (ECOG). The results obtained were analysed using the χ²Test and Fisher's exact test. Significance was sent at P < 0.05.

Results

Marked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition.

Complete pain relief was achieved in 15 of our 25 (59%) of patients, and pain reduction was achieved in the remaining 10 (41%) patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12%) between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences.

Conclusion

Percutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.