Stage 4 breast cancer: hip reconstruction preserves mobility

What happened, in summary

A 50-year-old woman had previously undergone lumpectomy for infiltrating ductal carcinoma of the breast 8 years before she developed severe right hip pain. She became unable to walk for 1 week, and imaging showed a destructive breast-cancer metastasis in the right acetabulum, the socket portion of the hip joint. X-rays and CT showed diffuse involvement of the ilium, complete involvement of the ischium and posterior wall, and involvement of the acetabular roof with erosion into the joint. Although she had not yet developed a catastrophic acetabular fracture, she was becoming increasingly bedbound. Because the primary breast cancer was known and imaging showed diffuse metastatic lesions, preoperative biopsy was not performed. She chose operative reconstruction after discussion of risks and benefits. Surgery was performed in 2 stages. First, surgeons placed 3 fully threaded cannulated screws percutaneously into the periacetabular region to create support. Then, through a posterior hip approach, the metastatic lesions were encountered and debrided during acetabular preparation. Because the acetabulum was structurally destroyed by cancer and debridement, the team performed cemented total hip arthroplasty, anchoring the acetabular cup around the screws with polymethyl methacrylate cement. A cemented femoral stem was also placed. Intraoperative pathology confirmed metastatic breast cancer. She began full weight-bearing physical therapy on postoperative day 1 and reported immediate pain relief. Palliative radiation to the right hip started 4 weeks after surgery, followed by chemotherapy. At 6 weeks, she had no hip pain and could walk with occasional cane use. At 6 months, she had returned to baseline function; at 2 years, hip pain had not recurred.