Percutaneous osteoplasty proves as hip as surgery

Fluoroscopy-guided cement injections ease pain, disabling effects of tumors, arthritis on femoral head

Inspired by vertebroplasty's success, 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 for selected 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 rather than subject them to major surgery, said principal investigator Dr. Dimitrios Filippiadis. Selected patients suffered with disabling lesions of the femoral head produced by arthritis and, especially, bone-dissolving metastases.

Filippiadis and colleagues enrolled 12 consecutive patients who underwent fluoroscopy-guided percutaneous polymethylmethacrylate 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. More than two years after osteoplasty, overall mobility and pain has improved significantly in 10 patients. The two arthritic patients in the study eventually underwent surgery. 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.