Inspired by vertebroplasty's success, Greek researchers have shown that percutaneous cement injections can also successfully stabilize arthritic and neoplastic lesions affecting the femoral head. The technique offers pain relief and an alternative to surgery in selected patients.

Hip replacement surgery has become a popular treatment for patients with painful decay of the hip joint due to congenital and chronic conditions or tumors. Besides its cost and invasiveness, this surgical procedure carries failure rates of up to 30% in young patients. Image-guided percutaneous vertebroplasty, a procedure that strengthens spinal fractures produced by osteoporosis or cancer, has a documented pain reduction rate above 90 %. This insight led musculoskeletal radiologists at the University of Athens to try a similar minimally invasive approach as a palliative alternative in some patients with disabling lesions of the femoral head produced by arthritis and, especially, bone-dissolving metastases, said principal investigator Dr. Dimitrios Filippiadis, a radiologist at the University of Athens. Filippiadis and colleagues enrolled 12 consecutive patients who underwent fluoroscopy-guided percutaneous polymethyl-methacrylate injections under general anesthesia to treat femoral head lesions resistant to pain medication. Six patients had osteolytic metastases, three suffered from sickle cell anemia, two from arthritis, and one from osteonecrosis. According to Filippiadis, about 83% of these patients show enhanced mobility and significant pain reduction more than two years after osteoplasty. He released the preliminary findings at the 2007 RSNA meeting. Researchers used a visual scale scoring system to assess pain and mobility before and after treatment. All patients showed a mean decrease of 4.2 points after a mean follow-up of 29 months. Overall mobility improved in 10 patients. The two arthritic patients in the study eventually underwent surgery. Patients have also undergone post-procedural evaluations with CT and MRI. No further complications have been recorded to date in connection to the 20-minute procedure. Cement leakage, a common complication seen in some patients who undergo vertebroplasty, was conspicuously absent in the osteoplasty patient sample, Filippiadis said. "Percutaneous injection of cement in lesions of the femoral head seems a feasible new technique for femoral head stabilization, especially in lytic metastatic lesions," he said. The study has limitations. Members of the audience grilled Filippiadis extensively about the patient selection protocol used or the likelihood of turf issues between radiologists and orthopedic surgeons. A prospective trial with a larger patient population could give more conclusive data on these preliminary findings, said study coauthor Dr. Alexis Kelekis in an interview with Diagnostic Imaging.