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Hirase T, Rowan C, Jacob T, Vemu SM, Aflatooni JO, Patel SS, Satcher RL, Lin PP, Moon BS, Lewis VO, Marco RAW, Bird JE. Percutaneous Cementation for Improvement of Pain and Function for Osteolytic Pelvic Metastasis: A Systematic Review. J Am Acad Orthop Surg 2024; 32:e726-e736. [PMID: 38709827 DOI: 10.5435/jaaos-d-23-00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/17/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Pelvic metastasis is a common presentation among patients presenting with skeletal metastasis. Image-guided percutaneous cementation of these lesions is becoming increasingly popular for the treatment of these lesions. The objective of this study was to conduct a systematic review that investigates clinical outcomes after percutaneous cementation for pelvic metastasis. METHODS A systematic review was registered with International Prospective Register of Systematic Reviews and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, SCOPUS, and Ovid MEDLINE databases. All level I to IV clinical studies published in the English language investigating the clinical outcomes after percutaneous cementation for pelvic metastasis were included. RESULTS Fourteen studies with 579 patients (278 men, 301 women) and 631 metastatic pelvic lesions were included in the study. The mean follow-up range was 0.7 to 26.4 months. Percutaneous cementation alone was performed in 441 patients (76.2%). Supplemental ablative procedures were performed in 77 patients (13.3%), and supplemental internal fixation using cannulated screws was performed in 107 patients (18.5%). Twelve studies with 430 patients (74.2%) reported pain-related and/or functional outcome scores, of which all studies reported overall clinically notable improvement at short-term follow-up. All studies reported periprocedural complications. Local cement leakage was the most common complication (162/631 lesions, 25.7%) followed by transient local pain (25/579 patients, 4.3%). There were no reported cases of major complications. Seven patients (1.2%) underwent re-intervention for persistent symptoms. CONCLUSIONS Percutaneous cementation may be an effective method for treating pain and function related to pelvic metastasis. The most common complication was cement leakage surrounding the lesion. The rates of major complications were low, and most complications appeared minor and transient. Additional prospective studies are needed to further assess the efficacy of this procedure. LEVEL OF EVIDENCE IV, systematic review of level I to IV therapeutic studies.
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Affiliation(s)
- Takashi Hirase
- From the Department of Spine Surgery, Hospital for Special Surgery, New York, NY (Hirase), Texas A&M University School of Medicine, Bryan, TX (Hirase, Rowan, Jacob), the Department of Orthopedics and Sports Medicine, Houston Methodist Hospital (Vemu, Aflatooni), the Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center (Patel, Satcher, Lin, Moon, Lewis, Bird), and the Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX (Marco)
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Bauones S, Garnon J, Cazzato RL. Commentary on: (Percutaneous Fixation with Internal Cemented Screws for Iliac Lytic Bone Metastases: Assessment of Pain and Quality of Life on Long Term Follow-up). Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03793-y. [PMID: 38926165 DOI: 10.1007/s00270-024-03793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Salem Bauones
- Interventional Radiology Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de L'hopital, 67000, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de L'hopital, 67000, Strasbourg, France
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Letty Q, Grange R, Bertholon S, Thomas T, Beneton A, Morisson S, Boutet C, Grange S. Percutaneous Fixation with Internal Cemented Screws for Iliac Lytic Bone Metastases: Assessment of Pain and Quality of Life on Long Term Follow-up. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03746-5. [PMID: 38782766 DOI: 10.1007/s00270-024-03746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To assess effectiveness on pain, quality of life and late adverse events of percutaneous fixation with internal cemented screw (FICS) among patients with iliac lytic bone metastases with or without pathological fractures. MATERIALS AND METHODS This retrospective exploratory study analyzed FICS procedures on iliac osteolytic bone lesions with and without pathological fracture performed from July 2019 to January 2022 in one tertiary level university hospital. The procedure were performed under general anesthesia, and were CT and fluoroscopically guided. Numerical Pain Rate Score (NPRS), mean EuroQol visual analogue scale (EQ VAS), morphine consumption, walking ability, walking perimeter and presence of walking aids and the appearance of complications were evaluated. RESULTS Nineteen procedures among 18 patients were carried out with a mean follow up time of 243.3 ± 243.2 days. The mean of the maximum NPRS decreased from 8.4 ± 1.3 to 2.2 ± 3.1 at 1 month (p < 0.01) and remained between 1.3 and 4.1 during a follow-up consultation period of 3-24 months. The mean EQ VAS rose from 42.0 ± 12.5 to 57.3 ± 13.9 at 1 month (p < 0.01) follow-up and remained between 55.8 and 62.5 thereafter. No patient scores returned to pre-procedure levels during follow-up. Mean morphine use decreased from 111.1 ± 118.1 to 57.8 ± 70.3 mg/d at 1 month (p > 0.05) follow-up. No late adverse events were reported. CONCLUSION Percutaneous FICS is a safe procedure with fast and long-standing effect on pain, mobility and quality of life. It can be used as a complement to the known analgesic therapeutic arsenal for bone metastases.
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Affiliation(s)
- Quentin Letty
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Rémi Grange
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Sylvain Bertholon
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Thierry Thomas
- Department of Rhumatology, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Aurelie Beneton
- Department of Supportive Care in Oncology, Lucien Neuwirth Cancer Institute, 5 Rue Charles de Gaulle, 42055, Saint-Etienne Cedex 2, France
| | - Stéphanie Morisson
- Department of Supportive Care in Oncology, Lucien Neuwirth Cancer Institute, 5 Rue Charles de Gaulle, 42055, Saint-Etienne Cedex 2, France
| | - Claire Boutet
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France
| | - Sylvain Grange
- Department of Radiology, Hôpital Nord, University Hospital of Saint Etienne, Avenue Albert Raymond, 42055, Saint-Etienne Cedex 2, France.
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Deschamps F. When the interventional radiologist competes with the orthopaedic surgeon. Eur Radiol 2024; 34:2738-2739. [PMID: 37673962 DOI: 10.1007/s00330-023-10216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Frédéric Deschamps
- Interventional Radiology Department, Gustave Roussy, 115 rue Edouard Vaillant, 94805, Villejuif, France.
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Çevik HB, Ruggieri P, Giannoudis PV. Management of metastatic bone disease of the pelvis: current concepts. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02382-x. [PMID: 37934294 DOI: 10.1007/s00068-023-02382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient's characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease. METHODS We comprehensively researched multiple databases and evaluated essential studies about current concepts of managing a metastatic bone disease of the pelvis, focusing on specific indications as well as on the result of treatment. RESULTS Pelvic metastases not in the periacetabular region can be managed with modification of weight-bearing, analgesics, bisphosphonates, chemotherapy and/or radiotherapy. Minimally invasive approaches include radiofrequency ablation, cryoablation, embolization, percutaneous osteoplasty, and percutaneous screw placement. Pathological or impending periacetabular fracture, excessive periacetabular bone defect, radioresistant tumor, and persistent debilitating pain despite non-surgical treatment and/or minimally invasive procedures can be managed with different surgical techniques. Overall, treatment can be divided into nonoperative, minimally invasive, and operative based on specific indications, the expectations of the patient and the lesion. CONCLUSION Different treatment modalities exist to manage metastatic pelvic bone disease. Decision-making for the most appropriate treatment should be made with a multidisciplinary approach based on a case-by-case basis.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Orthopaedics and Traumatology, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padua, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
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Jiang W, Caruana DL, Dussik CM, Conway D, Latich I, Chapiro J, Lindskog DM, Friedlaender GE, Lee FY. Bone Mass Changes Following Percutaneous Radiofrequency Ablation, Osteoplasty, Reinforcement, and Internal Fixation of Periacetabular Osteolytic Metastases. J Clin Med 2023; 12:4613. [PMID: 37510728 PMCID: PMC10380351 DOI: 10.3390/jcm12144613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The success of orthopedic interventions for periacetabular osteolytic metastases depends on the progression or regression of cancer-induced bone loss. PURPOSE To characterize relative bone mass changes following percutaneous radiofrequency ablation, osteoplasty, cement reinforcement, and internal screw fixation (AORIF). METHODS Of 70 patients who underwent AORIF at a single institution, 21 patients (22 periacetabular sites; average follow-up of 18.5 ± 12.3 months) had high-resolution pelvic bone CT scans, with at least one scan within 3 months following their operation (baseline) and a comparative scan at least 6 months post-operatively. In total, 73 CT scans were measured for bone mass changes using Hounsfield Units (HU). A region of interest was defined for the periacetabular area in the coronal, axial, and sagittal reformation planes for all CT scans. For 6-month and 1-year scans, the coronal and sagittal HU were combined to create a weight-bearing HU (wbHU). Three-dimensional volumetric analysis was performed on the baseline and longest available CT scans. Cohort survival was compared to predicted PathFx 3.0 survival. RESULTS HU increased from baseline post-operative (1.2 ± 1.1 months) to most recent follow-up (20.2 ± 12.1 months) on coronal (124.0 ± 112.3), axial (140.3 ± 153.0), and sagittal (151.9 ± 162.4), p < 0.05. Grayscale volumetric measurements increased by 173.4 ± 166.4 (p < 0.05). AORIF median survival was 27.7 months (6.0 months PathFx3.0 predicted; p < 0.05). At 12 months, patients with >10% increase in wbHU demonstrated superior median survival of 36.5 months (vs. 26.4 months, p < 0.05). CONCLUSION Percutaneous stabilization leads to improvements in bone mass and may allow for delays in extensive open reconstruction procedures.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Dennis L. Caruana
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Christopher M. Dussik
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Devin Conway
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, P.O. Box 208042, New Haven, CT 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, P.O. Box 208042, New Haven, CT 06520, USA
| | - Dieter M. Lindskog
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Gary E. Friedlaender
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Francis Y. Lee
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
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Ibe I, Dussik CM, Callan AK, Barr J, Lee FY. Emerging Minimally Invasive Percutaneous Procedures for Periacetabular Osteolytic Metastases. J Bone Joint Surg Am 2023; 105:479-489. [PMID: 36701566 DOI: 10.2106/jbjs.22.00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
➤ Periacetabular osteolytic skeletal metastases are frequently associated with pain and impaired ambulatory function. Minimally invasive techniques allow for the restoration of ambulation without interrupting critical systemic cancer therapy. ➤ The open surgical management of massive periacetabular osteolytic lesions, such as by curettage, internal fixation, or complex total hip reconstruction, is associated with blood loss, hospitalization, rehabilitation, and complications such as infection or delayed wound-healing. ➤ Minimally invasive percutaneous procedures have become increasingly popular for the management of periacetabular osteolytic metastases by interventional oncologists and orthopaedic surgeons before complex open surgical procedures are considered. ➤ Minimally invasive procedures may include various methods of cancer ablation and reinforcement techniques. Minimally invasive procedures may entail cancer ablation, polymethylmethacrylate (PMMA) cement reinforcement, balloon osteoplasty, percutaneous screw fixation, or combinations of the aforementioned techniques (e.g., ablation-osteoplasty-reinforcement-internal fixation [AORIF]).
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Affiliation(s)
- Izuchukwu Ibe
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Alexandra K Callan
- Department of Orthopaedics, University of Texas Southwestern Medical School, Dallas, Texas
| | - Jennifer Barr
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
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Tomasian A, Filippiadis DK, Tutton S, Deschamps F, Cazzato RL, Prologo JD, Kelekis A, Levy J, Gangi A, Garnon J, Jennings JW. Comprehensive Palliative Musculoskeletal Interventional Radiology Care for Patients with Cancer. Radiographics 2022; 42:1654-1669. [DOI: 10.1148/rg.220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Koirala N, Joshi J, Duffy SF, McLennan G. Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions. J Clin Med 2022; 11:jcm11195572. [PMID: 36233434 PMCID: PMC9571370 DOI: 10.3390/jcm11195572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Percutaneous-reinforced osteoplasty is currently being investigated as a possible therapeutic procedure for fracture stabilization in high-risk patients, primarily in patients with bone metastases or osteoporosis. For these patients, a percutaneous approach, if structurally sound, can provide a viable method for treating bone fractures without the physiologic stress of anesthesia and open surgery. However, the low strength of fixation is a common limitation that requires further refinement in scaffold design and selection of materials, and may potentially benefit from tissue-engineering-based regenerative approaches. Scaffolds that have tissue regenerative properties and low inflammatory response promote rapid healing at the fracture site and are ideal for percutaneous applications. On the other hand, preclinical mechanical tests of fracture-repaired specimens provide key information on restoration strength and long-term stability and enable further design optimization. This review presents an overview of percutaneous-reinforced osteoplasty, emerging treatment strategies for bone repair, and basic concepts of in vitro mechanical characterization.
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Affiliation(s)
- Nischal Koirala
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jyotsna Joshi
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Stephen F. Duffy
- Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Gordon McLennan
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
- Correspondence:
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Avoiding complications in percutaneous osteoplasty. Tech Vasc Interv Radiol 2022; 25:100799. [DOI: 10.1016/j.tvir.2022.100799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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