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Hirase T, Rowan C, Jacob T, Vemu SM, Aflatooni JO, Patel SS, Satcher RL, Lin PP, Moon BS, Lewis VO, Marco RAW, Bird JE. Percutaneous Cementation for Improvement of Pain and Function for Osteolytic Pelvic Metastasis: A Systematic Review. J Am Acad Orthop Surg 2024:00124635-990000000-00953. [PMID: 38709827 DOI: 10.5435/jaaos-d-23-00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/17/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Pelvic metastasis is a common presentation among patients presenting with skeletal metastasis. Image-guided percutaneous cementation of these lesions is becoming increasingly popular for the treatment of these lesions. The objective of this study was to conduct a systematic review that investigates clinical outcomes after percutaneous cementation for pelvic metastasis. METHODS A systematic review was registered with International Prospective Register of Systematic Reviews and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, SCOPUS, and Ovid MEDLINE databases. All level I to IV clinical studies published in the English language investigating the clinical outcomes after percutaneous cementation for pelvic metastasis were included. RESULTS Fourteen studies with 579 patients (278 men, 301 women) and 631 metastatic pelvic lesions were included in the study. The mean follow-up range was 0.7 to 26.4 months. Percutaneous cementation alone was performed in 441 patients (76.2%). Supplemental ablative procedures were performed in 77 patients (13.3%), and supplemental internal fixation using cannulated screws was performed in 107 patients (18.5%). Twelve studies with 430 patients (74.2%) reported pain-related and/or functional outcome scores, of which all studies reported overall clinically notable improvement at short-term follow-up. All studies reported periprocedural complications. Local cement leakage was the most common complication (162/631 lesions, 25.7%) followed by transient local pain (25/579 patients, 4.3%). There were no reported cases of major complications. Seven patients (1.2%) underwent re-intervention for persistent symptoms. CONCLUSIONS Percutaneous cementation may be an effective method for treating pain and function related to pelvic metastasis. The most common complication was cement leakage surrounding the lesion. The rates of major complications were low, and most complications appeared minor and transient. Additional prospective studies are needed to further assess the efficacy of this procedure. LEVEL OF EVIDENCE IV, systematic review of level I to IV therapeutic studies.
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Affiliation(s)
- Takashi Hirase
- From the Department of Spine Surgery, Hospital for Special Surgery, New York, NY (Hirase), Texas A&M University School of Medicine, Bryan, TX (Hirase, Rowan, Jacob), the Department of Orthopedics and Sports Medicine, Houston Methodist Hospital (Vemu, Aflatooni), the Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center (Patel, Satcher, Lin, Moon, Lewis, Bird), and the Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX (Marco)
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Çevik HB, Ruggieri P, Giannoudis PV. Management of metastatic bone disease of the pelvis: current concepts. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02382-x. [PMID: 37934294 DOI: 10.1007/s00068-023-02382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient's characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease. METHODS We comprehensively researched multiple databases and evaluated essential studies about current concepts of managing a metastatic bone disease of the pelvis, focusing on specific indications as well as on the result of treatment. RESULTS Pelvic metastases not in the periacetabular region can be managed with modification of weight-bearing, analgesics, bisphosphonates, chemotherapy and/or radiotherapy. Minimally invasive approaches include radiofrequency ablation, cryoablation, embolization, percutaneous osteoplasty, and percutaneous screw placement. Pathological or impending periacetabular fracture, excessive periacetabular bone defect, radioresistant tumor, and persistent debilitating pain despite non-surgical treatment and/or minimally invasive procedures can be managed with different surgical techniques. Overall, treatment can be divided into nonoperative, minimally invasive, and operative based on specific indications, the expectations of the patient and the lesion. CONCLUSION Different treatment modalities exist to manage metastatic pelvic bone disease. Decision-making for the most appropriate treatment should be made with a multidisciplinary approach based on a case-by-case basis.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Orthopaedics and Traumatology, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padua, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Lee L, Schutz M, Myhre SL, Tasse J, Blank AT, Brown A, Lerman DM. Minimally invasive management of pathologic fractures of the pelvis and sacrum: Tumor ablation and fracture stabilization. J Surg Oncol 2023. [PMID: 37095698 DOI: 10.1002/jso.27284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Pathologic fractures of the pelvis/sacrum due to metastatic bone disease (MBD) cause pain and dysfunction due to mechanical instability of the pelvic ring. This study presents our multi-institutional experience with percutaneous stabilization of pathologic fractures and osteolytic lesions from MBD throughout the pelvic ring. METHODS The records of patients undergoing this procedure from 2018 to 2022 were reviewed retrospectively from two institutions. Surgical data and functional outcomes were recorded. RESULTS Fifty-six patients underwent percutaneous stabilization, with a median operative duration of 119 min (interquartile range [IQR]: 92.8, 167) and median estimated blood loss of 50 mL (IQR: 20, 100). The median length of stay was 3 days (IQR: 1, 6), and 69.6% (n = 39) of patients were discharged home. Early complications included one partial lumbosacral plexus injury, three acute kidney injuries, and one case of intra-articular cement extravasation. Late complications included two infections and one revision stabilization procedure for hardware failure. Mean Eastern Cooperative Oncology Group (ECOG) scores improved from 3.02 (SD 0.8) preoperatively to 1.86 (SD 1.1) postoperatively (p < 0.001). Ambulatory status also improved (p < 0.001). CONCLUSIONS Percutaneous stabilization of pathologic fractures and osteolytic defects of the pelvis and sacrum is a procedure that improves patient function, ambulatory status and is associated with a limited complication profile.
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Affiliation(s)
- Linus Lee
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Sue Lynn Myhre
- Institute for Limb Preservation, Presbyterian/St. Luke's Medical Center, Denver, Colorado, USA
| | - Jordan Tasse
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Daniel M Lerman
- Colorado Limb Consultants, Denver, Colorado, USA
- Institute for Limb Preservation, Presbyterian/St. Luke's Medical Center, Denver, Colorado, USA
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Ibe I, Dussik CM, Callan AK, Barr J, Lee FY. Emerging Minimally Invasive Percutaneous Procedures for Periacetabular Osteolytic Metastases. J Bone Joint Surg Am 2023; 105:479-489. [PMID: 36701566 DOI: 10.2106/jbjs.22.00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
➤ Periacetabular osteolytic skeletal metastases are frequently associated with pain and impaired ambulatory function. Minimally invasive techniques allow for the restoration of ambulation without interrupting critical systemic cancer therapy. ➤ The open surgical management of massive periacetabular osteolytic lesions, such as by curettage, internal fixation, or complex total hip reconstruction, is associated with blood loss, hospitalization, rehabilitation, and complications such as infection or delayed wound-healing. ➤ Minimally invasive percutaneous procedures have become increasingly popular for the management of periacetabular osteolytic metastases by interventional oncologists and orthopaedic surgeons before complex open surgical procedures are considered. ➤ Minimally invasive procedures may include various methods of cancer ablation and reinforcement techniques. Minimally invasive procedures may entail cancer ablation, polymethylmethacrylate (PMMA) cement reinforcement, balloon osteoplasty, percutaneous screw fixation, or combinations of the aforementioned techniques (e.g., ablation-osteoplasty-reinforcement-internal fixation [AORIF]).
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Affiliation(s)
- Izuchukwu Ibe
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Alexandra K Callan
- Department of Orthopaedics, University of Texas Southwestern Medical School, Dallas, Texas
| | - Jennifer Barr
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
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Heng M, Fourman MS, Mitrevski A, Berner E, Lozano-Calderon SA. Augmenting Pathologic Acetabular Bone Loss With Photodynamic Nails to Support Primary Total Hip Arthroplasty. Arthroplast Today 2022; 18:1-6. [PMID: 36267396 PMCID: PMC9576482 DOI: 10.1016/j.artd.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/27/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background Pathologic acetabular defects can undermine the stability and osseointegration of a primary total hip arthroplasty (THA) acetabular component. Our service has used photodynamic nails (PDNs) in a modified Harrington technique to provide space-filling stability to a primary acetabular implant without impeding local osseointegration. Here we describe our experience with PDN-augmented THAs. Methods An institutional review board-approved retrospective analysis of all patients who underwent PDN-augmented THA in the management of severe (Harrington class II or III) acetabular defects from September 1, 2020 to May 1, 2021 with at least 6 months of follow-up was performed. The primary outcome was implant survivorship. Comparisons between preoperative and 6-week postoperative visual analogue pain scores were made using the Mann-Whitney U test. Results Six patients were included in this case series, 5 with metastatic cancer and 1 with pelvic discontinuity and avascular necrosis following failed attempted acetabular fixation. The mean follow-up duration was 10.3 ± 4.3 months. The mean age was 75.5 ± 4.7 years, mean body mass index 27.3 ± 5.6, and 5 patients were female. All but 1 patient was American Society of Anesthesiologists (ASA) class III. Two patients required acetabular revisions, one for aseptic loosening and a second for a pathologic fracture secondary to disease progression. One patient passed away 90 days after the procedure. The mean visual analogue pain score significantly improved from 7.8 ± 1.6 to 2.0 ± 1.4 six weeks after surgery (P = .008). Conclusions PDN augmentation of the periacetabular bone of patients with large pelvic defects yields durable pain relief and function in vulnerable hosts. PDN should be considered a part of the reconstructive surgeon’s armamentarium.
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Affiliation(s)
- Marilyn Heng
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mitchell S. Fourman
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aiden Mitrevski
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Berner
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Santiago A. Lozano-Calderon
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA,Corresponding author. Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA. Tel.: +1 617 643 3653.
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