Due to the intricate anatomy of the pelvic structure and the heightened risk of surgical complications, managing metastatic disease, especially in the acetabulum, can be complex. Effective treatment often requires a multidisciplinary approach. We spoke with Christopher Johnson, DO, Orthopedic Oncology and chair of the Orthopedic Oncology and Sarcoma program at the Parkview Packnett Family Cancer Institute, and James Danias, MD, Orthopedic Surgery to learn about the latest advancements in skeletal metastases of the pelvis.
What are metastatic pelvic tumors, and what challenges do they pose for patients?
Dr. Johnson: When talking about metastatic disease, we're referring to cancer that has spread from other locations in the body to the acetabulum, which is the bony socket of the hip joint.
The cancer can destroy the bone around the socket of the hip. This is particularly problematic because if someone doesn't have a hip socket, they can't walk or function. It is very debilitating, painful, and significantly impacts quality of life. In addition it is often important to be able to ambulate and function in order to receive cancer treatment.
What new surgical techniques are improving metastatic pelvic tumor treatment?
Dr. Johnson: Historically, we treated these tumors using a technique known as the Harrington procedure. This is an open and invasive method involving multiple incisions that require placing several pins into the pelvis and combining it with hip replacement. It is a complex surgery and could require a long recovery time for the patient.
Now, we utilize percutaneous techniques, which require only three small incisions, sometimes combined with hip replacement when needed. Dr. Danias has done this for us many times. He utilizes percutaneous screws known as a ‘tripod technique’, which allows us to stabilize the pelvis without large incisions. We were the first team in the state to translate tripod technique using photodynamic stabilization with an IlluminOss® implant.
How does the IlluminOss implant work?
Dr. Johnson: The implant consists of an inflatable Dacron® balloon filled with a monomer (a small molecule that joins to form a larger one). When deployed, it fills the defect in the bone caused by cancer. Once exposed to UV light, the monomer polymerizes and hardens, allowing it to conform to unique 3D structures, such as the pelvic bone. Once hardened, the implant is five times stronger than natural bone.
Who is a good candidate for these treatment options?
Dr. Johnson: This treatment is indicated for any patient with cancer that has spread to the pelvic bone and is causing pain and dysfunction.
Of course, many different cancers can lead to this, including myeloma, lung cancer, lymphoma and kidney cancer.
What does your teamwork look like in surgical practice?
Dr. Johnson: Many orthopedic oncology surgeries are multidisciplinary to optimize patient outcomes. In this setting, Dr. Danias begins by stabilizing the pelvis by placing screws or the IlluminOss implant. Then, I open the pelvis, remove the tumor and perform a hip replacement if needed.
Dr. Danias: The ultimate goal is stabilizing the socket and getting the patient as pain-free as possible. With the percutaneous fixation, we perform hip socket stabilization under an X-ray. I place screws and a bone corridor around the socket to help support it. We're incorporating that with orthopedic oncology techniques to address the tumor, which may involve cementing or removing the lesion, followed by hip reconstruction.
How have these innovations improved patient outcomes?
Dr. Johnson: When we use techniques like percutaneous fixation, patients are getting up and moving around much quicker because it's less invasive. In cases where the patient also needs a hip replacement, we perform it with an anterior approach, which means no muscle is cut during the procedure, a significant change from where we were in the past. Anterior hip replacements also lead to improved recovery and shorter patient rehabilitation time.
Dr. Danias: Additionally, combining our two specialties significantly reduces operative time. This procedure can be relatively quick compared to what patients might experience with Harrington's.
How do your research efforts translate to better patient care?
Dr. Johnson: There aren't many other centers in the country performing this combination of techniques. We are also one of the few U.S. centers participating in the Device Global Registry for IlluminOss Bone Stabilization System study.
We're helping lead the way by being one of the first in the country to use this technology and actively studying it through a collaborative research group. We are also advancing its application by utilizing it with anterior hip replacement, further improving treatment results. Being leaders in this field means our patients in this region have access to advanced technologies and progressive cancer treatment.
Dr. Danias: A lot of these methods, like the tripod screw technique, were relatively new in the literature before we started implementing them. Being at the forefront of innovation means we can continuously refine our strategies and improve patient care.
To schedule orthopedic care in Allen County, call Ortho NorthEast at 260-484-8551 or request an appointment here, or visit this page to find orthopedic care outside of Allen County.
