Surgical treatment for pelvic bone metastases.

The pelvis is the second most common site of bone metastases after the spine. Pain, bone destruction causing mechanical instability and pathological fractures are the most common manifestations. Traditional treatments for pelvic bone metastases include surgery and external beam radiation therapy. If bone destruction is limited, analgesics, radiation therapy, hormonal therapy, chemotherapy, embolization, bisphosphonates and minimally invasive techniques such as radiofrequency ablation, osteoplasty and cryosurgery can be considered [6]. Lesions of the hemipelvis not directly involving the hip joint, pathological fractures sustained through an area of the pelvis other than the acetabulum and avulsion fractures of the anterior superior/inferior iliac spines, iliac crest and pubic rami seldom require surgical stabilization and reconstruction because pelvic stability is maintained. By contrast, diffuse involvement of the pelvis, impending or existing pelvic discontinuity and bony destruction of the periacetabular area warrants surgical treatment [4,7–10]. The use of poly(methyl methacrylate) to bridge large defects and suspend an acetabular component, conventional total hip replacement, massive allograft or saddle megaprosthetic reconstruction are likely to fail because of the deficient bone and the progressive osteolytic disease [1].