A Comprehensive Analysis of Percutaneous Screw Fixation for Metastatic Lesion of the Pelvis

Background: Minimally invasive techniques such as percutaneous screw fixation have previously been shown to be mostly successful for pain relief and functional improvement in patients with pelvic metastases. In this study, we retrospectively reviewed the largest single-center cohort to date to further characterize the impact of this treatment on pain palliation, ambulation, and function; the predictors of suboptimal outcomes; and complications. Methods: Electronic medical records were reviewed. The primary outcome measures were pain, as assessed with use of the visual analog scale (VAS) score; functional status, as assessed with use of the Eastern Cooperative Oncology Group (ECOG) score; and ambulation, as assessed with use of the Combined Pain and Ambulatory Function Score (CPAFS), including preoperatively and postoperatively. Secondary outcome measures included radiographic evidence of fracture healing and the need for narcotics. Results: The study included 103 consecutive patients (42 men, 61 women) with a mean age of 64.1 years (range, 34 to 93 years) and a median follow-up of 14.4 months (range, 3 to 64 months) who underwent 107 procedures (bilateral in 4 patients). Sixty-nine had periacetabular lesions, whereas 38 had non-periacetabular lesions. VAS, ECOG, and CPAFS values improved from preoperatively at all time points (p < 0.001). Fifty-seven (85.1%) of the 67 patients presenting with a pathologic fracture demonstrated radiographic healing. A lack of radiographic healing was associated with a prolonged need for narcotics (p < 0.001). Six hips were converted to total hip arthroplasties, and 1 underwent a Girdlestone procedure. Complications were observed in 3 cases (2.8%). Conclusions: Percutaneous screw fixation provided sustained benefits of pain relief and functional improvement in the treatment of metastatic pelvic lesions, with a low rate of complications. Bone healing after fixation was common. The risk of prolonged narcotic usage was higher in patients without evidence of bone healing. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.