Integrating techniques to optimize outcomes: durable hybrid reconstruction of a metastatic periacetabular pathologic fracture - a case report.

introductionMetastatic involvement of the periacetabular region is a rare but functionally devastating complication of advanced malignancies. Structural insufficiency fractures in this area lead to severe pain, loss of ambulation, and impaired quality of life. Surgical reconstruction is challenging due to poor bone quality, complex anatomy, and often prior radiotherapy. CASE PRESENTATION: We report the case of a 36-year-old woman with a history of metastatic breast cancer who presented with acute right hip pain and inability to walk following a fall. Imaging revealed a metastatic insufficiency fracture of the right acetabulum involving the roof and both columns. The patient had a prior history of pelvic radiotherapy. A two-stage hybrid reconstruction was planned to optimize mechanical support while minimizing postoperative complications. CLINICAL DISCUSSION: This case highlights the complexity of surgical decision-making in metastatic acetabular insufficiency. Various techniques exist, including cementoplasty, tripod fixation, Harrington reconstruction, 3D-printed implants, and pedestal prostheses. Each has unique advantages and limitations depending on lesion extent and patient factors. In our case, a staged hybrid approach (plate fixation, followed by Harrington + tripod + cemented THA) provided durable reconstruction without complications at 24 months follow-up.

conclusionHybrid reconstruction offers a viable and effective option for managing complex metastatic periacetabular insufficiency fractures, particularly in previously irradiated patients. A multidisciplinary, staged strategy can achieve excellent functional outcomes with low complication rates.