Korean J Radiol.  2009 Dec;10(6):641-644. 10.3348/kjr.2009.10.6.641.

Percutaneous Osteoplasty for the Management of a Femoral Head Metastasis: a Case Report

• Wang WG
• Wu CG
• Gu YF
• Li MH

• KMID: 1102569
• DOI: http://doi.org/10.3348/kjr.2009.10.6.641

Abstract

Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty (PVP) has been used to treat malignant disease that affects the skeletal system. POP has demonstrated good outcome for pain relief and functional improvement. Few studies have reported on the efficiency of POP to treat malignancies located in the femoral head. We designed a pilot study with the use of POP to treat intractable pain caused by a femoral head metastatic tumor in a 43-year-old man. During the follow-up period, the patient experienced sustained pain relief and improvement of quality of life that persisted for more than three months.

Keyword

Percutaneous vertebroplasty; Percutaneous osteoplasty; Femoral head; Metastatic tumor

MeSH Terms

Adult
Diagnosis, Differential
Femoral Neoplasms/*diagnosis/secondary/*therapy
Humans
Lung Neoplasms/pathology
Magnetic Resonance Imaging
Male
Tomography, Emission-Computed
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Procedure of percutaneous osteoplasty. A, B. Osteolytic lesion in right femoral head is depicted on coronal and axial CT images. C, D. Radiographs obtained during osteoplasty with patient in prone position. Homogenous and sufficient distribution of bone cement in lesion is shown. No evidence of polymethyl methacrylate extravasation was observed. E. Axial CT image was obtained at three-month follow-up examination. Homogenous distribution of bone cement can be observed. No tumor regeneration is observed.

Reference

1. Cotten A, Deprez X, Migaud H, Chabanne B, Duquesnoy B, Chastanet P. Malignant acetabular osteolyses: percutaneous injection of acrylic bone cement. Radiology. 1995. 197:307–310.

2. Weill A, Kobaiter H, Chiras J. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement. Eur Radiol. 1998. 8:123–129.

3. Pommersheim W, Huang-Hellinger F, Baker M, Morris P. Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 2003. 24:1003–1007.

4. Zhang J, Wu CG, Gu YF, Li MH. Percutaneous sacroplasty for sacral metastatic tumors under fluoroscopic guidance only. Korean J Radiol. 2008. 9:572–576.

5. Kelekis A, Lovblad KO, Mehdizade A, Somon T, Yilmaz H, Wetzel SG, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol. 2005. 16:81–88.

6. Hierholzer J, Anselmetti G, Fuchs H, Depriester C, Koch K, Pappert D. Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur. J Vasc Interv Radiol. 2003. 14:773–777.

7. Kawai N, Sato M, Iwamoto T, Tanihata H, Minamiguti H, Nakata K. Percutaneous osteoplasty with use of a cement-filled catheter for a pathologic fracture of the humerus. J Vasc Interv Radiol. 2007. 18:805–809.

8. Yamada K, Matsumoto Y, Kita M, Yamamoto K, Kohda W, Kobayashi T, et al. Clinical outcome of percutaneous osteoplasty for pain caused by metastatic bone tumors in the pelvis and femur. J Anesth. 2007. 21:277–281.

9. Chapman CR, Syrjala KL. Bonica JJ, editor. Measurement of pain. The management of pain. 1990. Philadelphia: Lea and Febiger;580–594.

10. Baroud G, Samara M, Steffen T. Influence of mixing method on the cement temperature-mixing time history and doughing time of three acrylic cements for vertebroplasty. J Biomed Mater Res B Appl Biomater. 2004. 68:112–116.

11. Belkoff SM, Molloy S. Temperature measurement during polymerization of polymethymethacrylate cement used for vertebroplasty. Spine (Phila Pa 1976). 2003. 28:1555–1559.