Hip replacement for lytic acetabular lesion

PIG Meeting: 29th April 2021

57-year-old man with metastatic intraductal parotid cancer for Prophylactic THR

Background

  • WLE + parotidectomy + temporal bone/mastoid tip resection/neck dissection
  • Adjuvant concurrent chemo/radiotherapy
  • Multiple post-operative and post-radiotherapy lesions including facial drop and poor mouth opening.
  • current smoker

Issues

  • New cerebellar and temporal lobe lesions
  • No neurological symptoms
  • Awaiting neurosurgical review, unlikely to occur pre operatively
  • Multiple bony lytic lesions including acetabulum and ischial tuberosity
  • Uncertain if having acetabular component to surgery
  • Potential difficult airway

Discussion

1. Anaesthetic plan

  • GA vs Spinal discussed
  • Concern expressed regarding spinal placement with large and expanding cerebellar lesions
  • Radiotherapy to face and jaw, airway may be challenging
  • Surgery sounds like it could be complex and lengthy, likely in lateral position
  • GA and secure airway would be preferred plan

2. Neurosurgical review

  • Asymptomatic
  • Large lesions, increased in size between scans
  • Consensus Neurosurgical team should review scans and/or patient preoperatively

Plan

  • Neurosurgical review preoperatively – has occurred – aim to proceed to THR for tissue diagnosis of metastatic disease.
  • Clarify with surgeon regarding surgical procedure
  • Plan for GA and potential difficult airway

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s