Outcomes of Patients Treated with Porous Tantalum Acetabular Reconstruction for Pathologic Acetabular Fractures.

Abstract

The periacetabular region is a common location for secondary malignancies. The purpose of this study was to assess outcomes following acetabular reconstruction in patients sustaining periacetabular pathologic fractures. This retrospective study examined 62 patients (28 men and 35 women) who received an acetabular implant for management of a pathologic fracture between 2010 and 2022. The mean age and body mass index were 63 years (range, 28.8 to 86.9) and 29.1 (range, 17.2 to 48.9), respectively. The most common diagnosis was metastatic disease (n = 44). There were 48 patients who underwent radiation therapy for the management of their disease before sustaining a pathologic fracture. Medical records and radiographs were reviewed. The mean follow-up of surviving patients was 5.4 years (range, 1.2 to 13.8). There were 41 patients who received a tantalum cup-cage construct for acetabular reconstruction, while 21 patients received a tantalum cup alone. At the time of surgery, 24 patients demonstrated pelvic discontinuity (22 cup-cage and two cup alone). There were seven patients who demonstrated radiographic evidence of implant loosening. Overall revision rate was 11.3 and 1.6% for aseptic loosening. At the most recent follow-up, there were 33 patients who were deceased. There were no differences in revision rate between reconstructive methods (P = 0.69). After reconstruction, Harris Hip scores increased from 36.2 to 76.9 postoperatively (P < 0.01). The cumulative incidence of death was higher than that of revision at all evaluated timepoints. Arthroplasty following pathologic acetabular fractures resulted in satisfactory outcomes in patients who had and did not have a pelvic discontinuity. Tantalum cup only and cup-cage constructs provide durable results with satisfactory revision rates when applied selectively based on the severity of the acetabular fracture.