J Am Acad Orthop Surg. 2026 Mar 10. doi: 10.5435/JAAOS-D-25-00569. Online ahead of print.
ABSTRACT
BACKGROUND: Periacetabular metastatic disease can cause notable morbidity, prompting potential surgical intervention. Open approaches, including the Harrington type reconstructive with a total hip replacement and cemented gap cup, have been the standard approach; however, these surgeries are invasive. Minimally invasive techniques, including screw fixation with cementation and potential ablation, aim to reduce morbidity. This study compares surgical and short-term postoperative outcomes between open reconstructive techniques and minimally invasive treatments in patients with periacetabular metastatic disease.
METHODS: Prospectively maintained institutional medical records were used to retrospectively identify patients who had undergone an open approach, who would be minimally invasive candidates, and patients who have undergone the minimally invasive procedure. Demographic, surgical data, and postoperative outcomes of patients with minimum 3-month follow-up were collected. Wilcoxon rank-sum test, chi-squared, and minimal clinically important difference (MCID) tests were used to determine statistical and clinical differences.
RESULTS: Seventeen open and 48 minimally invasive patients were identified. Minimally invasive patients had statistically significant lower rate of surgical blood loss, transfusion rates, surgical time, and length of stay (P < 0.05). Fourteen open and 32 minimally invasive patients had minimum 3-month follow-up. No notable difference was found in the need for secondary procedures, complications, death within 90 days, or Pain and Ambulatory Function Scores (P > 0.05). 57.1% of the open cohort and 43.8% of the minimally invasive cohort met the MCID threshold. Minimally invasive patients had statistically significant quicker return to adjuvant therapies (P < 0.05).
DISCUSSION: Our cohort study demonstrated that minimally invasive techniques reduced surgical morbidity while achieving similar short-term (3 month) postoperative outcomes and a faster return to potentially life-prolonging therapies. Larger patient sample will help determine patients at risk for failure of both approaches and the need for secondary procedures to further define patients who might benefit from the different techniques.
PMID:41802193 | DOI:10.5435/JAAOS-D-25-00569
