Grzegorz Guzik1. 1. Department of Oncological Orthopaedics, Specialist Hospital in Brzozów - Podkarpacie Oncological Centre, Poland.
Abstract
INTRODUCTION: The number of patients suffering from malignant tumors with bony metastases has been increasing. Surgery makes it possible to preserve physical function and decrease pain. Safe and efficient techniques for filling cancer-related bone defects within the pelvis are still being searched for. MATERIAL AND METHODS: A total of 13 patients with cancer metastases to the acetabular ceiling area in the hip were operated on using vertebroplasty sets in the Oncological Orthopedics Department in Brzozów in the years 2010-2013. A percutaneous approach was employed in 4 patients, while in 9 the surgery was combined with acetabulofemoral joint resection and arthroplasty. Patient qualification for the treatment took into account the size and shape of the bone defect as determined per computed tomography. Pain intensity (VAS scale) and gait efficiency were evaluated before and after the treatment. RESULTS: All patients reported a distinct decrease in pain intensity. All of them started to ambulate and loading the joint did not aggravate the symptoms. No thrombo-embolic or infectious complications were observed. The mobility of the operated joints was good. CONCLUSIONS: The filling of lytic bone defects in the acetabular ceiling area determines walking efficiency and reduced pain intensity. Surgical procedures take a long time, are complicated and associated with a high risk of complications. Percutaneous administration of bone cement may be an alternative solution in patients with an intact cortical bone layer. The literature data indicate good outcomes of this approach, with a minimal number of complications. Acetabuloplasty with bone cement is a safe and effective treatment method in the case of cancer metastases to the acetabular ceiling area.
INTRODUCTION: The number of patients suffering from malignant tumors with bony metastases has been increasing. Surgery makes it possible to preserve physical function and decrease pain. Safe and efficient techniques for filling cancer-related bone defects within the pelvis are still being searched for. MATERIAL AND METHODS: A total of 13 patients with cancer metastases to the acetabular ceiling area in the hip were operated on using vertebroplasty sets in the Oncological Orthopedics Department in Brzozów in the years 2010-2013. A percutaneous approach was employed in 4 patients, while in 9 the surgery was combined with acetabulofemoral joint resection and arthroplasty. Patient qualification for the treatment took into account the size and shape of the bone defect as determined per computed tomography. Pain intensity (VAS scale) and gait efficiency were evaluated before and after the treatment. RESULTS: All patients reported a distinct decrease in pain intensity. All of them started to ambulate and loading the joint did not aggravate the symptoms. No thrombo-embolic or infectious complications were observed. The mobility of the operated joints was good. CONCLUSIONS: The filling of lytic bone defects in the acetabular ceiling area determines walking efficiency and reduced pain intensity. Surgical procedures take a long time, are complicated and associated with a high risk of complications. Percutaneous administration of bone cement may be an alternative solution in patients with an intact cortical bone layer. The literature data indicate good outcomes of this approach, with a minimal number of complications. Acetabuloplasty with bone cement is a safe and effective treatment method in the case of cancer metastases to the acetabular ceiling area.