[The surgical treatment of metastatic periacetabular tumors]

To retrospectively review the experience with different surgical procedures for periacetabular metastasis.

The data of 43 patients with periacetabular metastasis between July 2000 and July 2007 was reviewed. There were 21 patients with primary malignant tumors at the beginning, and 10 patients diagnosed metastasis by preoperative biopsy. The other 12 patients presented skeletal involved as initial manifestations of metastasis prior to the pathological diagnosis of the primary tumor. Twelve patients had solitary metastasis, and the others had multiple bone metastasis. The surgical procedure included curettage (35 cases) and en-blot excision (8 cases). The techniques of reconstruction of acetabular defect included total hip replacement (THR) with cemented components or titanium acetabular reconstruction cup (12 cases), THR with partial pelvis replacement with Candal Hook (16 cases), THR with Steinmann pins and cement augmented or titanium cup reconstruction (7 cases), and modular hemipelvic prosthesis reconstruction (8 cases).

All the patients received successful operations. The average score for preoperative pain of 7.2 was assessed. Forty-one patients (95.4%) were evaluated for relief of pain and resumption of walking, and the pain score improved to 3.5 after surgery. The average functional score was 24.5 postoperatively. Six of 32 patients had local recurrence. Fourteen patients died of diseases. The average blood loss during the operation was 1600 ml in 43 patients and the bleeding exceeded 3000 ml was in 3 patients with renal carcinomas. Major complications included two superficial wound infections, one multiple organ failure and two dislocations.

Although surgery will not typically cure patients of their metastatic disease, surgery that is well planned and well executed can help many people by relieving their suffering and improving their quality of life.