Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Bones

J Vasc Interv Radiol. 2020 Apr;31(4):649-658.e1. doi: 10.1016/j.jvir.2019.11.029. Epub 2020 Mar 3.

Abstract

Purpose: To assess early outcome, safety, and complications of an alternative to open surgical treatments of osteolytic lesions in periarticular load-bearing bones.

Materials and methods: A single-center, prospective clinical cohort study of 26 lesions in 23 consecutive patients with painful osteolytic skeletal lesions was performed. Patients were followed for an average of 7 mo (1-18 mo). Lesions were targeted from the most intact bone via minimally invasive percutaneous approach for stable anchorage of internal fixation screws using fluoroscopic guidance. Cannulated screws served as universal portals for ablation, balloon osteoplasty, and delivery of bone cement in addition to internal fixation for cement anchoring and prophylactic stabilization of uninvolved bone.

Results: There were 19 osteolytic lesions in the pelvis, 4 in the proximal femur, 2 in the proximal tibia, and 1 in the calcaneus. All defects were associated with severe pain or fractures. There were no conversions to open surgery and no infection or bleeding requiring transfusion, embolization, or additional procedures. There was significant improvement in visual analogue scale (VAS) pain score from 8.32 ± 1.70 to 2.36 ± 2.23, combined pain and functional ambulation score from 4.48 ± 2.84 to 7.28 ± 2.76, and Musculoskeletal Tumor Society score from 45% to 68% (P < .05).

Conclusions: Ablation, osteoplasty, reinforcement, and internal fixation is a safe and effective minimally invasive percutaneous image-guided treatment option for functional improvement or palliation of painful osteolytic lesions in the pelvis and periarticular loadbearing bones.

MeSH terms

  • Ablation Techniques*
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Cements / adverse effects
  • Bone Cements / therapeutic use*
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / physiopathology
  • Bone Neoplasms / surgery*
  • Bone Remodeling
  • Bone Screws
  • Calcaneus / diagnostic imaging
  • Calcaneus / physiopathology
  • Calcaneus / surgery*
  • Cementoplasty* / adverse effects
  • Female
  • Femoral Neoplasms / diagnostic imaging
  • Femoral Neoplasms / physiopathology
  • Femoral Neoplasms / surgery
  • Femur / diagnostic imaging
  • Femur / physiopathology
  • Femur / surgery*
  • Fracture Fixation, Internal* / adverse effects
  • Fracture Fixation, Internal* / instrumentation
  • Humans
  • Male
  • Middle Aged
  • Osteolysis / diagnostic imaging
  • Osteolysis / physiopathology
  • Osteolysis / surgery*
  • Pelvic Bones / diagnostic imaging
  • Pelvic Bones / physiopathology
  • Pelvic Bones / surgery*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Recovery of Function
  • Tibia / diagnostic imaging
  • Tibia / physiopathology
  • Tibia / surgery*
  • Time Factors
  • Treatment Outcome
  • Weight-Bearing

Substances

  • Bone Cements