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Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease

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Abstract

Management of periacetabular metastatic bone disease (MBD) is challenging, specifically if associated with bone loss or fracture. The aim of this study was to evaluate the complications and outcomes after undergoing peri-acetabular reconstruction using an ‘ice-cream cone’ pedestal cup endoprostheses for the most severe cases of (impending) pathological acetabular fractures. Fifty cases with severe periacetabular disease were identified. Acetabular defects were classified using the Metastatic Acetabular Classification (MAC). Pre- and post-operative mobility was assessed using the Eastern Cooperative Oncology Group (ECOG) Performance Status. Pain levels were assessed using a verbal rating scale. Surgical complications and patient survival were analysed; the Prognostic Immune Nutritional Index (PINI) was applied retrospectively to survival. There were 32 females and 18 males with a median age of 65 (41–88). Median post-operative follow-up was 16 months (IQR 5.5–28.5 months). Thirty-nine had complete, and 11, impending pathological fractures. The observed five-year survival was 19%, with a median survival of 16 months (IQR 5.8–42.5 months). Significantly worse survival was observed with PINI scores < 3.0 (p = 0.003). Excluding three perioperative deaths, 13 complications occurred in 12 patients: Implant failure in six patients (four aseptic loosening, one dislocation and one infection). At the final follow-up, mobility and pain levels were improved in 85% and 100%, respectively. Reconstruction of significant pelvic MBD with the ‘ice-cream cone’ reduces pain and improves mobility. Whilst the mortality rate is high, it remains a reasonable option for bed-bound, immobile patients. We advocate the use of an ‘ice-cream cone’ prosthesis for selected patients balancing the reported risks with the observed benefits.

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Data Availability

Anonymised data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK

    J. Macdonald, C. Baird, L. Jeys, M. Parry & J. Stevenson

  2. School of Life Sciences, Aston University, Birmingham, UK

    L. Jeys

  3. Medical School, Aston University, Birmingham, UK

    M. Parry & J. Stevenson

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  1. J. Macdonald
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  2. C. Baird
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  3. L. Jeys
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  4. M. Parry
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  5. J. Stevenson
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Correspondence to J. Macdonald.

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Macdonald, J., Baird, C., Jeys, L. et al. Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease. Indian J Surg Oncol 15, 428–436 (2024). https://doi.org/10.1007/s13193-024-01917-x

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