The use of hook acetabular cage after intralesional surgery in secondary bone tumors of the acetabulum: indications and results at medium term.

Abstract

Introduction: The acetabulum is a common site for metastatic lesions. When lytic lesions involve this region, the surgical approach often consists of intralesional treatment and reconstruction to restore stability and ambulation. Reconstruction using a hook acetabular cage represents a viable reconstructive option. The aim of this study was to evaluate the reliability of the hook acetabular cage for reconstruction after curettage of secondary tumors of the acetabulum.

Materials and methods: Patients undergoing intralesional surgery for acetabular roof metastases between 2006 and 2022 at two referral centers were included; surviving patients were required to have at least 1 year of follow-up. Staging involved whole-body CT or FDG-PET; local extension was assessed with radiographs, CT, and MRI. All cases were evaluated by a multidisciplinary tumor board. Statistical analysis included descriptive data, implant survival, and overall survival (OS) using the Kaplan-Meier method.

Results: Twenty patients (10 men and 10 women), with a mean age of 61.6 ± 15.5 years, were included. Seventeen patients had acetabular metastases from solid tumors, whereas three had acetabular involvement from multiple myeloma. During a mean follow-up of 34.2 ± 29.1 months, six patients (30%) experienced complications, including three infections and three dislocations. Eleven patients (55%) died during follow-up, including five from causes unrelated to the underlying malignancy. At 36 months, implant survival was 74.4% (95% CI, 48.9-88.5%) and overall survival was 65.1% (95% CI, 37.7-82.8%). Median overall survival was 61 months.

Conclusions: Hook acetabular cage reconstruction may provide reliable of the acetabulum after tumor surgery, restoring joint stability and function. The reconstruction system used demonstrated sufficient durability to cover the average survival of the patients. Implant mid-term survival supports their use in selected metastatic cases. Further comparative studies are needed to establish their efficacy relative to alternative devices.