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Semin intervent Radiol 2024; 41(02): 154-169
DOI: 10.1055/s-0044-1787165
Review Article

Recent Advances in Minimally Invasive Management of Osteolytic Periacetabular Skeletal Metastases

Will Jiang
1   Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
,
Sangmin Lee
2   Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
,
Dennis Caruana
1   Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
,
Kun Da Zhuang
3   Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
,
Roberto Cazzato
4   Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
,
Igor Latich
2   Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
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Abstract

Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.

Keywords

periacetabular - metastases - percutaneous - ablation - cement


Publication History

Article published online:
10 July 2024

© 2024. Thieme. All rights reserved.

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