Photo Dynamic Nail augmentation of periacetabular bone of patients with large pelvic defects yields durable pain relief

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-01-19T20:00:44+05:30 | Updated On 20 Jan 2023 1:44 PM IST

Pathologic acetabular defects can undermine the stability and osseointegration of a primary total hip arthroplasty (THA) acetabular component. Photodynamic nails (PDNs) has been used in a modified Harrington technique to provide space-filling stability to a primary acetabular implant without impeding local osseointegration.

Marilyn Heng et al describe their experience with PDN-augmented THAs. The article has been published in "Arthroplasty Today."

PDNs demonstrate impressive resistance to compressive forces and can be delivered via a flexible catheter, permitting anatomic reconstruction of the acetabular columns. PDNs are also radiolucent, which permits effective monitoring for disease progression without a metal artifact. Of particular benefit is the ability to pass screws through the PDN material after curing without the need for a specialized drill bit, thereby permitting the integration of the nail with an endoprosthetic construct without compromising the potential for local osseointegration.

An institutional review board-approved retrospective analysis of all patients who underwent PDN-augmented THA in the management of severe (Harrington class II or III) acetabular defects from September 1, 2020 to May 1, 2021 with at least 6 months of follow-up was performed. The primary outcome was implant survivorship. Comparisons between preoperative and 6-week postoperative visual analogue pain scores were made using the Mann-Whitney U test.

Key findings of the study were:

• Six patients were included in this case series, 5 with metastatic cancer and 1 with pelvic discontinuity and avascular necrosis following failed attempted acetabular fixation.

• The mean follow-up duration was 10.3 ± 4.3 months.

• The mean age was 75.5 ± 4.7 years, mean body mass index 27.3 ± 5.6, and 5 patients were female.

• All but 1 patient was American Society of Anesthesiologists (ASA) class III.

• Two patients required acetabular revisions, one for aseptic loosening and a second for a pathologic fracture secondary to disease progression.

• One patient passed away 90 days after the procedure.

• The mean visual analogue pain score significantly improved from 7.8 ± 1.6 to 2.0 ± 1.4 six weeks after surgery (P = .008).

The authors concluded that - "Management of the compromised hip joints of patients with large acetabular defects is a challenge. Here we described our early experience using PDNs to augment a primary THA in patients with osteoporosis or metastatic disease, with satisfactory outcomes and implant survival in a small series. Findings support the continued use of this technique although intermediate and long-term outcomes are necessary to confirm its viability."

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751