Hip replacement for lytic acetabular lesion

PIG Meeting: 29th April 2021

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


  • 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


  • 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


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


  • 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