Pain relief with percutaneous trochanteroplasty in a patient with bilateral trochanteric myelomatous lytic lesions.

Abstract

Multiple myeloma is a hematologic malignancy associated with destructive bone loss. Lytic lesions, a hallmark of this cancer, can result in significant morbidity because of associated pain and structural osseous compromise. Osteoplasty has demonstrated efficacy in the treatment of myelomatous pain within the axial skeleton; however, there is limited evidence supporting the utility of osteoplasty to treat extra-spinal lesions. We describe a 67 year-old woman with stable IgA lambda multiple myeloma with sentinel bilateral greater trochanteric lytic lesions that was referred to our interventional pain management clinic for evaluation of bilateral lateral hip pain. Conservative treatment options including physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), oral opiates, and local corticosteroid injections to bilateral trochanteric bursae failed to offer pain relief. The patient underwent minimally invasive percutaneous trochanteroplasty with concomitant core biopsy of her bilateral trochanteric lytic lesions. The intended goals of this novel procedure were to determine the cause of the suspected lytic lesions, provide pain relief, and offer structural stability by safely implanting bone cement as part of a fracture prevention strategy. At 12 month follow-up, the patient's pain improved by 70% and she no longer required the use of pain medication. The patient also displayed a significant improvement in her day-to-day functioning and quality of life.