Modified Harrington’s procedure for periacetabular metastases in 89 cases: a reliable method for cancer patients with good functional outcome, especially with long expected survival

Figures & data

Table 1. Patient characteristics. Values are number of cases unless otherwise specified

Characteristics	n
Eligible cases	89
Sex
Female	50
Male	39
Mean/median follow-up months (range)	18/8 (0–125)
Mean age at surgery years (range)	67 (27–94)
Age
	62
≤ 60	27
Metastatic load
Multiple bone	43
Solitary bone	18
Bone, lung, and other	17
Bone and lung	11
ASA
2	14
3	41
4	26
Data missing	8
Radiotherapy
Preoperative	31
Postoperative	37
Pre- and postoperative	2
None	19
Primary malignant tumor
Breast	28
Prostate	13
Renal cell	11
Myeloma	10
Lung	7
Other	20
Last status
Dead due to cancer	55
Dead due to treatment	3
Dead due to other cause	1
Dead due to unknown reason	10
Alive	20

Table 2. Perioperative characteristics of the 89 patients. Values are number of cases unless otherwise specified

Characteristics	n
Operation
Primary only	83
Revision	6
Mean lesion size (cm) (range)	8.9 (4–25)
Harrington’s classification
Class I	36
Class II	41
Class III	12
Class IV	–
Preoperative embolization
Yes	15
No	69
Data missing	5
Mean operation blood loss (L) (range)	1.6 (0.1–5.7)
Impending fracture	33
Pathologic fracture	56
Mean operation time (hr) (range)	2.8 (2.2–7.2)
Type of prothesis
Cemented regular	70
Uncemented regular	2
Cemented long-stem	7
Uncemented long-stem	3
Tumor prothesis	7
Acetabulum component
Constrained	56
Normal	33
Antegrade acetabular pins (n)
2	3
3	68
4	11
5	7
Head size (mm)
22	2
28	11
30	1
32	18
36	57

Table 3. Functional outcome scores

	OHS score			HHS score
Characteristics	n	mean	p-value	n	mean	p-value
Eligible cases	18	37		51	76
Sex			0.6			0.01
Female	8	38		26	82
Male	10	36		25	69
Age over 60 years			0.5			0.001
Yes	15	36		36	71
No	3	41		15	87
Metastatic load			1.0			1.0
Multiple bone	10	37		27	76
Solitary bone	6	37		10	76
Bone and other	2	37		14	76
ASA			0.2			0.1
2	3	46		9	86
3	5	32		24	74
4	4	38		12	70
Radiotherapy			0.5			0.8
Preoperative	5	34		16	76
Postoperative	8	40		27	76
Pre- and post.	0	–		1	94
None	5	36		7	73
Harrington’s classification			0.9			0.3
Class I	4	36		17	79
Class II	10	37		24	72
Class III	4	38		10	80
Primary malignant tumor			1.0			0.04
Breast	6	37		19	85
Prostate	3	40		9	72
Renal cell	2	33		6	55
Myeloma	3	35		8	75
Lung	6	37		19	85
Other	1	43		4	81
Survival over 6 months			0.4			0.03
Yes	16	36		38	79
No	2	42		13	67
Survival over 12 months			0.7			0.01
Yes	15	37		30	81
No	3	35		21	68
Operation						0.7
Primary only	18	37		48	75
Revision	–	–		3	80
Acetabulum component			0.3			0.8
Constrained	14	36		38	76
Normal	4	41		13	75

Table 4. Complications of the Harrington’s procedure cases

Complications	Mechanical failure	Hip joint dislocation	Local tumor progression	Infection	Decubitus
Major	1	2	0	2	1
Minor	0	2	1	2	0
Overall	1	4	1	4	1

51 year old woman with primary tumor of sigma carcinoma with bone, lung, and liver metastasis. Harrington classification 2 (A). The modified Harrington’s procedure for periacetabular metastases (B). 3 cannulated screws are directed to the roof of the acetabulum and the periacetabular defect is supported by a restoration reinforcement ring. A cemented acetabular cup is implanted. The bone cement is used to augment the bone defects, reinforcement ring, and antegrade inserted screws.