Selective arterial embolization as neoadjuvant treatment in hip pseudotumors
Mehmet Ali Tokgöz1, Andrea Sambri2, Giuseppe Rossi3, Giuseppe Bianchi2, Davide Maria Donati2
1Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
2Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
3Department of Radiology and Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
Keywords: Pseudotumor of hip, selective arterial embolization, total hip arthroplasty.
Objectives: This study aims to investigate the significance of selective arterial embolization (SAE) as neoadjuvant for the treatment of pseudotumor (PT) associated with hip arthroplasty and present our case series including all the known bearing techniques.
Patients and methods: This retrospective study included 16 patients (9 males, 7 females; mean age 75.5 years; range, 55 to 87 years) affected by hip PT. Seven patients were treated only surgically without any adjuvant treatment (group A), while nine patients were performed preoperative SAE (group B). Pseudotumors were grouped according to magnetic resonance imaging and computed tomography (CT) classifications. Durations of all operations and number of blood units given intra- and postoperatively were recorded.
Results: Although embolization did not change the amount of intraoperative bleeding (p=0.619), a common vascular network leading to PT was observed in all patients in angiography. Group A’s mean duration of operation was shorter than group B (p=0.03); however, this condition was attributed to larger and more complex lesions of patients who underwent embolization. According to CT classification, blood loss was more and duration of operation was longer in severe stages (p=0.046 and p=0.035, respectively).
Conclusion: Successful demonstration of vascular network in patients with PT strengthens the idea that SAE technique may be used particularly in severe cases according to CT classification. Our findings suggest that PT may develop in all commonly used bearings.