Tripod technique may provide effective pain relief for periacetabular metastatic disease
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Patients with periacetabular metastatic disease may experience safe and effective pain relief when treated with the Tripod technique, according to published results.
Rui Yang, MD, and colleagues treated 20 patients with periacetabular metastases using the Tripod technique, a novel technique that includes percutaneous placement of three large-bore cannulated screws under fluoroscopy in a tripod configuration to reinforce the mechanical axes of the acetabulum. Researchers collected patient demographic characteristics and outcomes including survival, functionality, Eastern Cooperative Oncology Group score and VAS for pain.
Among the 20 patients, researchers found 90% had Harrington class 3 lesions and two patients had Harrington class 2 lesions. On postoperatively day 1, 80% of patients were able to get out of bed, according to results.
Results showed significant pain relief and improvement functionality as measured by VAS and the Eastern Cooperative Oncology Group scores, respectively, at 3 months postoperatively. Researchers found opioids were used chronically for pain among three of the 16 surviving patients at the latest follow-up. According to results, 20% of patients underwent total hip arthroplasty in a staged fashion using the previously placed screws as support for a cemented cup and obviating the need for a cage device. Researchers noted 15 of the 16 patients could walk either independently or using an ambulatory aid.
Survival at more than 6 months postoperatively occurred among eight patients with the primary tripod reconstruction, and researchers found either new bone formation filling the defects or healing the pathological fractures. No implant loosening or failure were reported, according to results.
“For patients with periacetabular metastatic disease, the Tripod technique offers a minimally invasive approach for pain control and functionality improvements as compared to the modified total hip replacement as currently commonly practiced. It is safe and effective, as shown in our pilot study,” Yang told Healio Orthopedics. “Most surprising to us, we found these lesions healed in many patients after the Tripod procedure, when they survived their primary cancer for more than 6 months. This is contrary to the conventional belief that those lesions need to be removed and filled in with cement via open surgeries.”
Perspective
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Felasfa Wodajo, MD
The “tripod” surgical technique described by Yang and colleagues is a new and welcome option for patients [with] painful pelvic bone metastases.
The authors described their manuscript as a pilot study and were clear about its limitations, the primary one being the absence of a control group. This is common in much oncology literature due to the relative rarity of the conditions. The stated indication for the procedure was “[one] or more symptomatic metastatic lesions involving the periacetabular area.” Sixteen of their 20 patients had “fracture of complete cortical defect.” We would expect internal fixation of an unstable fracture to reduce pain, but we also know that radiation is highly effective in reducing pain from bone metastases. Thus, the question that remains is which patients would have improved without surgical intervention. Likely over time, the authors will be able to answer this question. In the meantime, they should be congratulated for devising an innovative and safe intervention to benefit this challenging patient population.
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