Surgical Reconstruction of the Acetabulum and Pelvis in Metastatic Bone Disease

Management of a painful metastatic acetabular lesion is complex and requires the assessment of tumor size and location, remaining integrity of the acetabulum, analgesic requirements, ability to use postoperative radiation, and projected patient survival. Patients presenting with suspected periacetabular metastasis frequently have groin pain aggravated by weight bearing. After a complete physical examination, advanced imaging and a complete laboratory workup should be performed to assess the extent of local and systemic disease. If a patient has a previously identified metastatic lesion, it is beneficial to communicate with the patient's medical oncologist to gather information on responses to chemotherapeutic agents, hormonal agents, and radiation therapy. Management may be nonsurgical, interventional, or surgical. Despite the limited life expectancy of patients with periacetabular metastasis, when performed in the appropriate setting, reconstruction by using anti-protrusio cages, screws, and cemented hip arthroplasty can improve quality of life by aiding independent ambulation and decreasing pain.