Abstract
Multiple myeloma is a malignancy of monoclonal plasma cells (plasma cells are of B-lymphocyte lineage of the hematopoietic system). It is the second most prevalent blood malignancy after non-Hodgkin’s lymphoma. It accounts for approximately 1 % of all malignancies and 2 % of all cancer deaths. Bony involvement is very common; the incidence of pelvic and periacetabular involvement in MM is reported to be around 6 %. Lytic lesions comprise a hallmark of multiple myeloma, which may be complicated with pathologic fractures in a substantial percentage of patients. Pelvic and periacetabular bony involvement of multiple myeloma is associated with some unique characteristics regarding the biomechanics of this specific anatomical region, the morbidity, the overall survival, and prognosis, which all reflect to impairment of quality of life. In this paper, we review the special features of multiple myeloma lesions around the pelvis and acetabulum and present an algorithm of management with the use of current surgical techniques.
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References
Abe M (2011) Myeloma bone disease and RANKL signaling. Clin Calcium 21:1167–1174
Ai LS, Sun CY, Zhang L et al (2012) Inhibition of BDNF in multiple myeloma blocks osteoclastogenesis via down-regulated stroma-derived RANKL expression both in vitro and in vivo. PLoS One 7:e46287
Akhtar K, Laghari NA, Haq AU et al (2009) Multiple myeloma in younger age. J Coll Physicians Surg Pak 19:62–63
Algan SM, Horowitz SM (1996) Surgical treatment of pathologic hip lesions in patients with metastatic disease. Clin Orthop Relat Res 332:223–231
Allan DG, Bell RS, Davis A et al (1995) Complex acetabular reconstruction for metastatic tumor. J Arthroplasty 10:301–306
Alvi HM, Damron TA (2013) Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone? Clin Orthop Relat Res 471:706–714
Angtuaco EJ, Fassas AB, Walker R et al (2004) Multiple myeloma: clinical review and diagnostic imaging. Radiology 231:11–23
Balducci M, Chiesa S, Manfrida S et al (2011) Impact of radiotherapy on pain relief and recalcification in plasma cell neoplasms: long-term experience. Strahlenther Onkol 187:114–119
Barlogie B, Kyle RA, Anderson KC et al (2006) Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase III US Intergroup Trial S9321. J Clin Oncol 24:929–936
Basi S, Schulman G, Fogo AB (2005) Multiple complications in multiple myeloma. Am J Kidney Dis 45:619–623
Benevenia J, Cyran FP, Biermann JS et al (2004) Treatment of advanced metastatic lesions of the acetabulum using the saddle prosthesis. Clin Orthop Relat Res 426:23–31
Buckle CH, Neville-Webbe HL, Croucher PI et al (2010) Targeting RANK/RANKL in the treatment of solid tumours and myeloma. Curr Pharm Des 16:1272–1283
Cavo M, Rajkumar SV, Palumbo A et al (2011) International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood 117:6063–6073
Choi JH, Yoon JH, Yang SK (2007) Clinical value of new staging systems for multiple myeloma. Cancer Res Treat 39:171–174
D’Antonio JA, Capello WN, Borden LS et al (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137
Dimopoulos M, Terpos E, Comenzo RL et al (2009) International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma. Leukemia 23:1545–1556
Dispenzieri A, Kyle R, Merlini G et al (2009) International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 23:215–224
Durie BG (2006) The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system. Eur J Cancer 42:1539–1543
Enneking W, Dunham W, Gebhardt M et al (1990) A system for the classification of skeletal resections. Chir Organi Mov 75:217–240
Fisher NE, Patton JT, Grimer RJ et al (2011) Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement: early results. J Bone Joint Surg Br 93:684–688
Giuliani N, Colla S, Morandi F et al (2005) Lack of receptor activator of nuclear factor-kB ligand (RANKL) expression and functional production by human multiple myeloma cells. Haematologica 90:275–278
Goranova-Marinova V, Goranov S, Pavlov P et al (2007) Serum levels of OPG, RANKL and RANKL/OPG ratio in newly-diagnosed patients with multiple myeloma. Clinical correlations. Haematologica 92:1000–1001
Greipp PR, San Miguel J, Durie BG et al (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420
Harrington KD (1981) The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg Am 63:653–664
Harrington KD (1982) New trends in the management of lower extremity metastases. Clin Orthop Relat Res 169:53–61
Ho L, Ahlmann ER, Menendez LR (2010) Modified Harrington reconstruction for advanced periacetabular metastatic disease. J Surg Oncol 101:170–174
Hoell S, Dedy N, Gosheger G, Dieckmann R, Daniilidis K, Hardes J (2012) The Burch-Schneider cage for reconstruction after metastatic destruction of the acetabulum: outcome and complications. Arch Orthop Trauma Surg 132(3):405–410
Kastritis E, Zervas K, Symeonidis A et al (2009) Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG). Leukemia 23:1152–1157
Khan FA, Rose PS, Yanagisawa M et al (2012) Surgical technique: porous tantalum reconstruction for destructive nonprimary periacetabular tumors. Clin Orthop Relat Res 470:594–601
Kitagawa Y, Ek ET, Choong PF (2006) Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour. J Orthop Surg (Hong Kong) 14:155–162
Kotwal SY, Finn HA (2011) A 17-year follow-up of modified “Harrington” reconstruction after acetabular resection. J Arthroplasty 26(1570):e1521–e1574
Koutsikos J, Grigoraki V, Athanasoulis T et al (2006) Scintigraphy with technetium-99m methoxyisobutylisonitrile in multiple myeloma patients: correlation with the International Staging System. Hell J Nucl Med 9:177–180
Kumar SK, Lee JH, Lahuerta JJ et al (2012) Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 26:149–157
Lee WJ, Wu W (2012) Bilateral hip pain as presentation of multiple myeloma. Emerg Med J 29:181
Levy RN, Sherry HS, Siffert RS (1982) Surgical management of metastatic disease of bone at the hip. Clin Orthop Relat Res 169:62–69
Ludwig H, Durie BG, Bolejack V et al (2008) Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 111:4039–4047
Lutje S, de Rooy JW, Croockewit S et al (2009) Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma. Ann Hematol 88:1161–1168
Melton LJ 3rd, Rajkumar SV, Khosla S et al (2004) Fracture risk in monoclonal gammopathy of undetermined significance. J Bone Miner Res 19:25–30
Messiou C, Collins DJ, Morgan VA et al (2011) Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility. Eur Radiol 21:1713–1718
Mulligan M, Chirindel A, Karchevsky M (2011) Characterizing and predicting pathologic spine fractures in myeloma patients with FDG PET/CT and MR imaging. Cancer Invest 29:370–376
Palumbo A, Sezer O, Kyle R et al (2009) International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 23:1716–1730
Parikh SN, Kreder HJ (2005) Pelvic reconstruction for massive acetabular insufficiency. Clin Orthop Relat Res 2005:217–221
Ratasvuori M, Wedin R, Keller J et al (2013) Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 22:132–138
Richardson P (2006) Newer treatment options for patients in first relapse. From the Multiple Myeloma Research Foundation. Oncology (Williston Park). 20:633–638
Rudert M, Holzapfel BM, Pilge H et al (2012) Partial pelvic resection (internal hemipelvectomy) and endoprosthetic replacement in periacetabular tumors. Oper Orthop Traumatol 24:196–214
Scharschmidt TJ, Lindsey JD, Becker PS et al (2011) Multiple myeloma: diagnosis and orthopaedic implications. J Am Acad Orthop Surg 19:410–419
Sonmez M, Akagun T, Topbas M et al (2008) Effect of pathologic fractures on survival in multiple myeloma patients: a case control study. J Exp Clin Cancer Res 27:11
Stanley A, Young A (2010) Primary prevention of venous thromboembolism in medical and surgical oncology patients. Br J Cancer 102(Suppl 1):S10–S16
Sun W, Li J, Li Q et al (2011) Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors. J Arthroplasty 26:1508–1513
Terpos E, Rezvani K, Basu S et al (2005) Plasmacytoma relapses in the absence of systemic progression post-high-dose therapy for multiple myeloma. Eur J Haematol 75:376–383
Tillman RM, Myers GJ, Abudu AT et al (2008) The three-pin modified ‘Harrington’ procedure for advanced metastatic destruction of the acetabulum. J Bone Joint Surg Br 90:84–87
Utzschneider S, Schmidt H, Weber P et al (2011) Surgical therapy of skeletal complications in multiple myeloma. Int Orthop 35:1209–1213
Walker R, Barlogie B, Haessler J et al (2007) Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol 25:1121–1128
Walker RH (1993) Pelvic reconstruction/total hip arthroplasty for metastatic acetabular insufficiency. Clin Orthop Relat Res 294:170–175
Wangsaturaka P, Asavamongkolkul A, Waikakul S, Phimolsarnti R (2007) The results of surgical management of bone metastasis involving the periacetabular area: Siriraj experience. J Med Assoc Thai 90(5):1006–1013
Yaneva MP, Goranova-Marinova V, Goranov S (2006) Palliative radiotherapy in patients with multiple myeloma. J BUON 11:43–48
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Sakellariou, V.I., Mavrogenis, A.F., Savvidou, O. et al. Reconstruction of multiple myeloma lesions around the pelvis and acetabulum. Eur J Orthop Surg Traumatol 25, 643–653 (2015). https://doi.org/10.1007/s00590-014-1555-4
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DOI: https://doi.org/10.1007/s00590-014-1555-4