Pelvic Metastatic Disease: A Novel Technique for Reconstruction of the Posterior Acetabular Column

Abstract

Abstract Background: Pelvic metastases often lead to significant morbidity due to acetabular destruction. Conventional methods may lack adequate support for the posterior acetabular column. This study evaluates a novel technique involving a retrograde ischioacetabular Schanz nail combined with the modified Harrington technique for enhancing stability in total hip arthroplasty (THA)

Surgical technique description: After intralesional resection of the acetabular metastatic lesion, we use an ischiatic counter incision to drill a Schanz pin along the posterior acetabular column. Then, we augment the osseous defect with polymethyl methacrylate and total hip arthroplasty, according to each patient compromise we add acetabular reinforcement rings or cages.

Methods: We reviewed records of 10 patients with harrington type II-IV lesions treated with this technique at Instituto Nacional de Cancerología from 2017 to 2023 at the Musculoskeletal tumors unit in Instituto Nacional de Cancerología, Bogota, Colombia. Using data acquired from medical history, we identified pain using VAS score in a follow up to 9 months. Outcomes measured included pain control (Visual Analog Scale) and functionality (Karnofsky Performance Status). Follow-up data, including radiological assessments and surgical notes, were analyzed for complications and reconstruction effectiveness

Result: Mean patient age was 59.2 years, with 70% female. Average survival was 18.9 months, with follow-up averaging 21.1 months. All patients showed improved pain control (100%), with six achieving full independence. No major complications or revisions were necessary. The longest survivor remains well at 7 years postoperatively

Discussion: The technique provides enhanced stability and reduces the need for revision, offering significant pain relief and structural support. It is effective for both short- and long-term survival patients with pelvic metastases. Conclusion: The retrograde Schanz nail in the modified Harrington technique offers a reproducible and effective method for acetabular reconstruction in pelvic metastases, providing durable support and pain relief.