Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 594–601

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

  • Fazel A. Khan
  • Peter S. Rose
  • Michiro Yanagisawa
  • David G. Lewallen
  • Franklin H. Sim
Clinical Research

Abstract

Background

Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail.

Description of Technique

After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium.

Patients and Methods

We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22–80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26–85 months).

Results

Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation.

Conclusion

Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Allan DG, Bell RS, Davis A, Langer F. Complex acetabular reconstruction for metastatic tumor. J Arthroplasty. 1995;10:301–306.PubMedCrossRefGoogle Scholar
  2. 2.
    Boscainos PJ, Kellett CF, Maury AC, Backstein D, Gross AE. Management of periacetabular bone loss in revision hip arthroplasty. Clin Orthop Relat Res. 2007;465:159–165.PubMedGoogle Scholar
  3. 3.
    Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr. Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982: a two to five-year follow-up. J Bone Joint Surg Am. 1985;67:1074–1085.PubMedGoogle Scholar
  4. 4.
    D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–137.PubMedGoogle Scholar
  5. 5.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  6. 6.
    Dorr LD, Wan Z. Ten years of experience with porous acetabular components for revision surgery. Clin Orthop Relat Res. 1995;319:191–200.PubMedGoogle Scholar
  7. 7.
    Forsberg JA, Eberhardt J, Boland PJ, Wedin R, Healey JH. Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. PLoS One. 2011;6:e19956.PubMedCrossRefGoogle Scholar
  8. 8.
    Harrington KD. The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg Am. 1981;63:653–664.PubMedGoogle Scholar
  9. 9.
    Harris K, Pugash R, David E, Yee A, Sinclair E, Myers J, Chow E; Bone Metastases Site Group. Percutaneous cementoplasty of lytic metastasis in left acetabulum. Current Oncol. 2007;14:4–8.CrossRefGoogle Scholar
  10. 10.
    Harty JA, Brennan D, Eustace S, O’Byrne J. Percutaneous cementoplasty of acetabular bony metastasis. Surgeon. 2003;1:48–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Ilchmann T. Radiographic assessment of cup migration and wear after hip replacement. Acta Orthop Scand Suppl. 1997;276:1–26.PubMedGoogle Scholar
  12. 12.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  13. 13.
    Kunisada T, Choong PF. Major reconstruction for periacetabular metastasis: early complications and outcome following surgical treatment in 40 hips. Acta Orthop Scand. 2000;71:585–590.PubMedCrossRefGoogle Scholar
  14. 14.
    Levine B, Della Valle CJ, Jacobs JJ. Applications of porous tantalum in total hip arthroplasty. J Am Acad Orthop Surg. 2006;14:646–655.PubMedGoogle Scholar
  15. 15.
    Levine BR, Sporer S, Poggie RA, Della Valle CJ, Jacobs JJ. Experimental and clinical performance of porous tantalum in orthopedic surgery. Biomaterials. 2006;27:4671–4681.PubMedCrossRefGoogle Scholar
  16. 16.
    Marco RA, Sheth DS, Boland PJ, Wunder JS, Siegel JA, Healey JH. Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Joint Surg Am. 2000;82:642–651.PubMedGoogle Scholar
  17. 17.
    Nathan SS, Healey JH, Mellano D, Hoang B, Lewis I, Morris CD, Athanasian EA, Boland PJ. Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. J Clin Oncol. 2005;23:6072–6082.PubMedCrossRefGoogle Scholar
  18. 18.
    Nehme A, Lewallen DG, Hanssen AD. Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res. 2004;429:201–208.PubMedCrossRefGoogle Scholar
  19. 19.
    Nilsson J, Gustafson P, Fornander P, Ornstein E. The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients. Acta Orthop Scand. 2000;71:591–596.PubMedCrossRefGoogle Scholar
  20. 20.
    Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011;364:1046–1060.PubMedCrossRefGoogle Scholar
  21. 21.
    Papagelopoulos PJ, Savvidou OD, Galanis EC, Mavrogenis AF, Jacofsky DJ, Frassica FJ, Sim FH. Advances and challenges in diagnosis and management of skeletal metastases. Orthopedics. 2006;7:609–620; quiz 621–622.Google Scholar
  22. 22.
    Rose PS, Halasy M, Trousdale RT, Hanssen AD, Sim FH, Berry DJ, Lewallen DG. Preliminary results of tantalum acetabular components for THA after pelvic radiation. Clin Orthop Relat Res. 2006;453:195–198.PubMedCrossRefGoogle Scholar
  23. 23.
    Schneiderbauer MM, von Knoch M, Schleck CD, Harmsen WS, Sim FH, Scully SP. Patient survival after hip arthroplasty for metastatic disease of the hip. J Bone Joint Surg Am. 2004;86:1684–1689.PubMedGoogle Scholar
  24. 24.
    Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS. Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res. 2009;467:199–205.PubMedCrossRefGoogle Scholar
  25. 25.
    Vena VE, Hsu J, Rosier RN, O’Keefe RJ. Pelvic reconstruction for severe periacetabular metastatic disease. Clin Orthop Relat Res. 1999;362:171–180.PubMedCrossRefGoogle Scholar
  26. 26.
    Walker RH. Pelvic reconstruction/total hip arthroplasty for metastatic acetabular insufficiency. Clin Orthop Relat Res. 1993;294:170–175.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Fazel A. Khan
    • 1
  • Peter S. Rose
    • 1
  • Michiro Yanagisawa
    • 2
  • David G. Lewallen
    • 1
  • Franklin H. Sim
    • 1
  1. 1.Department of Orthopedic SurgeryMayo ClinicRochesterUSA
  2. 2.Department of OrthopedicsHirosaki National HospitalAomoriJapan

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