609 - Custom Pelvis and Hip Arthroplasty Secondary to Metastatic Papillary Thyroid Cancer to the Acetabulum

Case Diagnosis: Papillary Thyroid Cancer with Metastasis to the Spine and Acetabulum Treated with Custom Pelvis and Hip Arthroplasty

Case Description: A 72-year-old female with a history of gastroesophageal reflux disease, irritable bowel syndrome, osteoporosis, vertigo, L1-L4 decompression, hypothyroidism, and papillary thyroid cancer with metastasis to spine and acetabulum, which was treated with a custom pelvis and right total hip arthroplasty. Postoperative course was complicated by acute blood loss anemia treated with two units of packed red blood cells. She also required straight catheterization and bethanechol for urinary retention. Prior to surgery, she was unable to stand without assistance, and she was not able to ambulate secondary to pain. Postoperatively, on admission to inpatient rehabilitation, the patient was able to walk 15 feet three times with two rest breaks using a rolling walker and with the assistance of two people. After one week of inpatient rehabilitation, the patient was discharged with the ability to walk 200 feet independently with the use of a rolling walker.

Discussions: Bone represents the second most common site of distant metastases in differentiated thyroid cancer (DTC). Bone metastases from DTC are generally osteolytic lesions with secondary bone formation in response to bone destruction and soft tissue involvement. MRI is essential to assess neurological function and stage metastases. Metastatic bone disease confers increased morbidity risk and impaired quality of life. Recent data suggests that early surgical interventions for acetabular metastases may improve pain, function, and quality of life. Early physiatric care after custom pelvis and total hip arthroplasty may promote functional recovery in patients with metastatic bone disease.

Conclusions: Custom pelvis and total hip arthroplasty is a rare surgical procedure for the management of acetabular metastases. Prophylactic surgical fixation with a custom pelvis and hip arthroplasty prevents further morbidity. Early post-surgical rehabilitation care facilitates functional recovery outcomes and improves survival rates.