Functional outcome and complications following reconstruction for Harrington class II and III periacetabular metastasis

BACKGROUND: Metastatic bone disease involving the acetabulum is a debilitating condition causing significant pain and disability for patients. Many methods of reconstruction have been described for treating Harrington class II and III lesions with different results and complications. Our objectives were to report functional results, implant survival and complications following reconstruction for Harrington class II and III periacetabular metastases by using anti-protusio cages, screws and joint replacement. METHODS: We reviewed 22 patients undergoing acetabular reconstruction for metastatic disease. There were 5 Harrington class II and 17 class III lesions. Intralesional curettage, multiple screws and cemented total hip replacement were performed in all patients. Anti-protusio cages were used in 19 hips. No Steinmann pins were used. Sixteen patients died at a median survival time of 12 months (range, 4 to 28 months) after surgery. Six patients were alive at last follow-up at a median of 8 months (range, 3 to 15 months). RESULTS: Postoperatively, the average ECOG score was improved from 3.1 to 1.7 and Visual Analog Scale was improved from 8.4 to 2.2. One patient developed hip dislocation and one patient developed superficial infection. The mean Musculoskeletal Tumor Society (MSTS) functional score was 70 (range, 27 to 87). There was no prosthetic loosening or revision. Twenty patients were able to walk. Eight patients became community ambulators, twelve became household ambulators and two were bed-bound. CONCLUSIONS: Good functional outcome and better ambulation could be expected following class II and III periacetabular reconstruction using anti-protusio cages, screws and cemented hip replacement. Few complications were noted and manageable. Although most of these patients with metastatic disease had limited life expectancies, their quality of life would be improved with appropriate patient selection and surgical reconstruction.