# A novel screw-and-cement pile technique for Harrington II/III periacetabular lesions: technical note and short-term outcomes

## TL;DR

A new surgical technique using screws and cement improves hip function and reduces pain in patients with advanced periacetabular tumors.

## Contribution

A simplified screw-and-cement pile technique for Harrington II/III lesions using standard implants and a single approach.

## Key findings

- VAS scores improved significantly from 7.3 preoperatively to 1.0 at 1 month.
- Harris Hip Scores increased from 30.7 preoperatively to 86.2 at final follow-up.
- No postoperative complications occurred in six patients with a mean follow-up of 13.3 months.

## Abstract

Periacetabular metastases, particularly Harrington type II/III lesions, frequently lead to acetabular insufficiency, femoral head migration, and severe pain. We developed a simplified screw-and-cement pile technique using readily available screws, left partially proud, to interlock with polymethylmethacrylate (PMMA), supporting a standard polyethylene cup through a single conventional approach to reconstruct the damaged acetabular structure.

We performed a retrospective, two-center case series involving six consecutive patients, three with Harrington type II lesions and three with Harrington type III lesions. Surgical procedures included curettage, screw placement toward the acetabular dome, with additional screws to the pubic and ischial rami as needed, PMMA embedding, and implantation of a standard polyethylene cup via a posterolateral approach. Outcomes assessed included surgical invasiveness, pain (VAS), limb function, complications, and oncologic outcomes.

The mean age of the patients was 65.8 ± 6.1 years, with a mean follow-up of 13.3 ± 7.9 months. The mean operative time was 148.3 ± 27.9 minutes, and average blood loss was 650.0 ± 367.4 mL. VAS scores improved from 7.3 ± 0.5 preoperatively to 1.0 ± 0.6 at 1 month (p < 0.001). The Harris Hip Score (HHS) increased from 30.7 ± 5.6 preoperatively to 81.7 ± 1.9 at 1 month and 86.2 ± 2.7 at final follow-up (both p < 0.001). The MSTS-93 score averaged 20.7 ± 1.0 at 1 month and 22.3 ± 0.8 at final follow-up. No postoperative complications occurred. All patients were alive at the last follow-up, with no evidence of local progression, and all received disease-specific systemic therapy.

In short-term follow-up, the screw-and-cement pile technique for Harrington II/III acetabular defects provided rapid pain relief and functional improvement without early complications. Featuring a simple approach and low-cost implants, it is a viable palliative option for achieving immediate stability and symptom control. Longer-term studies are warranted to evaluate its durability.