title: The three-pin modified 'Harrington' procedure for advanced metastatic destruction of the acetabulum.
abstract: Pathological fractures due to metastasis with destruction of the acetabulum and central dislocation of the hip present a difficult surgical challenge. We describe a series using a single technique in which a stable and long-lasting reconstruction was obtained using standard primary hip replacement implants augmented by strong, fully-threaded steel rods with cement and steel mesh, where required. Between 1997 and 2006, 19 patients with a mean age of 66 years (48 to 83) were treated using a modified Harrington technique. Acetabular destruction was graded as Harrington class II in six cases and class III in 13. Reconstruction was achieved using three 6.5 mm rods inserted through a separate incision in the iliac crest followed by augmentation with cement and a conventional cemented Charnley or Exeter primary hip replacement. There were no peri-operative deaths. At the final follow-up (mean 25 months (5 to 110)) one rod had fractured and one construct required revision. Of the 18 patients who did not require revision, 13 had died. The mean time to death was 16 months (5 to 55). The mean follow-up of the five survivors was 31 months (18 to 47). There were no cases of dislocation, deep infection or injury to a nerve, the blood vessels or the bladder.
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK. Roger.Tillman@roh.nhs.uk
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.forename: G J C
authors.initials: GJ
authors.lastname: Myers
authors.forename: A T
authors.initials: AT
authors.lastname: Abudu
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000556:secondary; D002484:Cementation; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007085:Ilium / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000556:secondary; D019637:Orthopedic Procedures / Q000379:methods*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology; D016896:Treatment Outcome