title: Reconstruction of metastatic acetabular defects using a modified Harrington procedure.
abstract: OBJECTIVE
  Metastases engaging the acetabulum result in significant disability. We investigated the outcome after curettage and reconstruction of the defect with a protrusio cage, retrograde screws, and a cemented total hip arthroplasty.
  
  
  METHODS
  We retrospectively identified 70 consecutive patients who were surgically treated for metastatic disease of the acetabulum between 1995 and 2012 using the above technique. The type of primary tumor, extent of the disease, degree of acetabular erosion, and type of implant used were identified. Patient and implant survival, complications, and functional outcome were recorded.
  
  
  RESULTS
  There were no mortalities in the perioperative period (30 days after surgery). Median overall patient survival was 12 months. Prosthesis survival was 92% at 1 year and 89% at 5 years. One third of the patients suffered a complication, the most frequent one being dislocation. The functional outcome was good. Multiple skeletal or visceral metastases and specific types of cancer were associated with poor patient survival.
  
  
  CONCLUSIONS
  Reconstruction of metastatic acetabular defects using a protrusio cage stabilized with retrograde screws and a cemented total hip arthroplasty is a safe procedure that provides efficient relief of symptoms. Patients with extensive disease, especially when diagnosed with specific types of cancer, have a very poor prognosis. The complication rate is substantial, the most frequent being dislocation. However, revision surgery is seldom required and prosthesis survival is high.
authors.affiliation: a Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute and Department of Orthopaedics, Karolinska University Hospital , Stockholm, Sweden.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsagozis
authors.affiliation: a Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute and Department of Orthopaedics, Karolinska University Hospital , Stockholm, Sweden.
authors.forename: Rikard
authors.initials: R
authors.lastname: Wedin
authors.affiliation: a Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute and Department of Orthopaedics, Karolinska University Hospital , Stockholm, Sweden.
authors.forename: Otte
authors.initials: O
authors.lastname: Brosjö
authors.affiliation: a Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute and Department of Orthopaedics, Karolinska University Hospital , Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bauer
mesh_terms: D065526:Acetabuloplasty / Q000379:methods; D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001859:Bone Neoplasms / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome