Navigated METS coned hemi-pelvis endoprosthesis (Stanmore) with Avantage dual mobility acetabulum (Zimmer Biomet) and modular proximal femoral endoprosthetic replacement with trochanteric reattachment Surgical Technique
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Computer navigated tumour surgery is regarded as one of the major developments in the field of orthopaedic oncology of the past decade. Navigation permits pre-operative three-dimensional resection and implant planning to be combined with intra-operative imaging. These advantages have resulted in its growing incorporation into routine practice since its first application in 2004. In this case I describe the use of navigation to aid endoprosthetic reconstruction of the pelvis and acetabulum using the Stanmore coned semi-pelvis (‘ice cream cone’) endoprosthesis (http://www.stanmoreimplants.com/downloadpdfs/06.METS%20Coned%20Hemi-Pelvis%20Information%20and%20Surgical%20Procedures%20(File%20Size%20-%201MB).pdf).
This implant is ‘off the shelf’ and utilised in orthopaedic oncology to reconstruct the peri-acetabulum. Pelvic anchoring is provided by a fixed hydroxyapatite stem which can augmented with bone cement and reinforced with screws to achieve a stable acetabular reconstruction. Having created the acetabulum, a suitable acetabular cup is cemented into the cone for use with a total hip replacement. Recent evidence has confirmed that dual-mobility articulations reduce the risk of dislocation with hemi-pelvic endoprostheses, so this case describes the use of a cemented dual-mobility acetabular cup and bearing.
Metastatic bone disease commonly presents to the orthopaedic surgeon. Bone is the most common site of metastasis. For example approximately 60% to 70% of patients with breast cancer develop bone metastases during the course of their disease. Skeletal related events (SREs: pathological or impending fracture, hypercalcaemia, spinal cord compression, severe pain) may require surgery and/or radiotherapy to palliate pain and to maintain both the capacity to walk and quality of life.
Author : Mr Jonathan Stevenson FRCS (Tr & Orth)
Institution: The Royal Orthopaedic hospital, Birmingham, UK.