Pathologic acetabular fractures: new concepts in surgical management

Pathologic fracture of the pelvis and acetabulum secondary to metastases is a disabling condition for cancer patients. Management has for the most part remained nonoperative because the complexities of pelvic anatomy and reconstruction yield risks which have outweighed potential benefits. No advances in surgical reconstruction have been reported in one and a half decades. Previous reports and ideas addressing surgical reconstruction have focused on which type of total hip arthroplasty best suits the acetabular bone stock remaining following removal of the tumor. As improving medical management of metastatic cancer increases longevity, improved methods for surgical management of pathologic fractures are required. A new concept for surgically managing periacetabular fractures due to metastases is introduced whose premise is based on pelvic rather than hip pathology. Resection of tumor-infiltrated acetabular columns creates reconstructive challenges best met by the techniques and knowledge gained from trauma surgeons repairing acetabular fractures. The additional use of reinforced polymethylmethacrylate and subchondral bone cement augments fixation. These concepts have been incorporated into a new classification system and treatment strategy which is critically examined in 13 individuals. Tumor resection and pelvic-periacetabular reconstruction can satisfactorily be performed through extensile pelvic approaches without necessarily performing a hip arthroplasty. A more complete oncologic resection, superior reconstruction, and quicker rehabilitation for affected individuals can result in approximately one half of individuals.