International Orthopaedics

, Volume 37, Issue 10, pp 1981–1985 | Cite as

The modified Harrington procedure for metastatic peri-acetabular bone destruction

  • Ines Vielgut
  • Patrick SadoghiEmail author
  • Markus Gregori
  • Florian M. Kovar
  • Karin Pichler
  • Werner Maurer-Ertl
  • Andreas Leithner
Original Paper



We describe the outcome in a series of patients treated for metastatic peri-actetabular and iliac bone destruction using a modified technique of Harrington’s procedure.


Between 2006 and 2012, nine patients with a mean age of 62.2 years (42–75 years) were treated using a modified Harrington technique. Thereby, total hip replacement implants augmented by two to three threaded pins and cement were used to restore bony continuity of the pelvis and to achieve a stable construction allowing immediate full-weight bearing mobilisation.


Acetabular destruction was graded according to Harrington’s classification of peri-acetabular metastatic destruction, as class IV in one case, class III in six, and class II in two cases. The pre-operative ASA score ranged from II–IV. There were no intra-operative deaths or major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations at final follow-up. Eight patients achieved an improvement of their functional status postoperatively. One reconstruction required revision and four patients died due to their underlying disease ten to 36 months after surgery.


We found this technique an effective, reproducible, and long-lasting method to relieve pain and improve or restore function in patients with destructive metastatic lesions of the peri-acetabular bone and the iliac wing. Although we performed surgery even in severely ill patients with extended, generalised metastatic disease we had no intra- or postoperative death and observed no major complications.


Acetabular Component Iliac Wing Acetabular Reconstruction Periacetabular Bone Saddle Prosthesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Windhager R (2005) Surgical treatment of pelvic metastases. In: Jasmin C, Capanna R, Coia L, Coleman R, Saillant G (eds) Textbook of bone metastases. John Wiley & Sons, Ltd, pp 185–194Google Scholar
  2. 2.
    Ghert M, Alsaleh K, Farrokhyar F, Colterjohn N (2007) Outcomes of an anatomically based approach to metastatic disease of the acetabulum. Clin Ortop Res 459:122–127CrossRefGoogle Scholar
  3. 3.
    Harrington KD (1981) The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg 63-A:653Google Scholar
  4. 4.
    Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284CrossRefGoogle Scholar
  5. 5.
    Goslings JC, Gouma DJ (2008) What is a surgical complication? World J Surg 32(6):952PubMedCrossRefGoogle Scholar
  6. 6.
    Tillman RM, Myers GJC, Abudu AT, Carter SR, Grimer RJ (2008) The three pin modified “Harrington” procedure for advanced metastatic destruction of the acetabulum. J Bone Joint Surg 90-B:84–88CrossRefGoogle Scholar
  7. 7.
    Faisham WI, Muslim DAJ, Bhavaraju VMK, Nawaz AH, Zulmi W (2009) Modified Harrington procedure for acetabular insufficiency due to metastatic malignant disease. Malays Orthop J 3(1):36–41CrossRefGoogle Scholar
  8. 8.
    Han I, Lee YM, Cho HS, Oh JH, Lee SH, Kim HS (2010) Outcome after surgical treatment of pelvic sarcomas. Clin Orthop Surg 2:160–166PubMedCrossRefGoogle Scholar
  9. 9.
    Mueller PE, Dürr HR, Wegener B, Pellengahr C, Refior HJ, Jansson V (2002) Internal hemipelvectomy and reconstruction with a megaprosthesis. Int Orthop 26(2):76–79CrossRefGoogle Scholar
  10. 10.
    Natarajan MY, Bose JC, Mazhavan V, Rajagopal TS, Selvam K (2001) The Saddle prosthesis in periacetabular tumours. Int Orthop 25(2):107–109PubMedCrossRefGoogle Scholar
  11. 11.
    Nilsson J, Gustafson P, Fornander P, Ornstein E (2000) The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients. Acta Orthop Scand 71(6):591–596PubMedCrossRefGoogle Scholar
  12. 12.
    Stark A, Bauer HCF (1996) Reconstruction in metastatic destruction of the acetabulum. Acta Orthop Scand 67(5):435–438PubMedCrossRefGoogle Scholar
  13. 13.
    Aboulafia AJ, Buch R, Mathews J, Li W, Malawer M (1995) Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors. Clin Orthop 314:203–213PubMedGoogle Scholar
  14. 14.
    Renard AJS, Veth RPH, Schreuder HWS, Pruszczyuski M, Keller A, Van Hoesel Q, Bokkerink JPM (2000) The Saddle prosthesis in pelvic primary and secondary musculoskeletal tumours: functional results at several post operative intervals. Arch Orthop Trauma Surg 120:188–194PubMedCrossRefGoogle Scholar
  15. 15.
    Jansen JA, van de Sande MAJ, Dijkstra PDS (2013) Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors. Clin Orthop Relat Res 471:324–331PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson JTH (1978) Reconstruction of the pelvic ring following tumor resection. J Bone Joint Surg [Am] 60:747–751Google Scholar
  17. 17.
    Bruns J, Luessenhop SL, Dahmen G (1997) Internal hemipelvectomy and endoprosthetic pelvic replacement: long-term follow-up results. Arch Orthop Trauma Surg 116:27–31PubMedCrossRefGoogle Scholar
  18. 18.
    Wirbel RJ, Schulte M, Maier B, Mutschler WE (1999) Megaprosthetic replacement of the pelvis. Acta Orthop Scand 70:348–352PubMedCrossRefGoogle Scholar
  19. 19.
    Pilge H, Gradl G, von Eisenhart-Rothe R, Gollwitzer H (2012) Incidence and outcome after infection of megaprostheses. Hip Int 22(8):83–90CrossRefGoogle Scholar
  20. 20.
    Allan DG, Bell RS, Davis AJ, Langer F (1995) Complex acetabular reconstruction for metastatic tumor. J Arthroplasty 10:301–306PubMedCrossRefGoogle Scholar
  21. 21.
    Vena V, Hsu J, Rosier RN, O’Keefe RJ (1999) Pelvic reconstruction for severe periacetabular metastatic disease. Clin Orthop 362:171–180PubMedGoogle Scholar
  22. 22.
    Marco RA, Sheth DS, Boland BJ, Wunder JS, Siegel JA, Healey JH (2000) Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Joint Surg Am 82(5):642–651PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ines Vielgut
    • 1
  • Patrick Sadoghi
    • 1
    Email author
  • Markus Gregori
    • 2
  • Florian M. Kovar
    • 2
  • Karin Pichler
    • 1
  • Werner Maurer-Ertl
    • 1
  • Andreas Leithner
    • 1
  1. 1.Department of Orthopaedic SurgeryMedical University of GrazGrazAustria
  2. 2.Department of Trauma SurgeryMedical University of ViennaViennaAustria

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