Cementoplasty of pelvic bone metastases: systematic assessment of lesion filling and other factors that could affect the clinical outcomes

  • Thomas P. MoserEmail author
  • Marta Onate
  • Katia Achour
  • Véronique Freire
Scientific Article



To evaluate lesion filling and other factors that could affect the clinical outcomes of cementoplasty for pelvic bone metastases.


We retrospectively reviewed the files of 40 patients treated for 44 pelvic bone metastases, collected the parameters related to patients (pain relief evaluated on a visual analog scale, subsequent fractures, and need for surgery), lesions (size, cortical breach score, fracture, soft-tissue extension), and cementoplasty procedures (number of needles, volume of cement, percentage of lesion filling, cement leaks, residual acetabular roof defect), and performed a statistical analysis.


The lesions were on average 43.2 mm in diameter and the mean cortical breach score was 2.5 out of 6, with a pathological fracture in 14 lesions. The number of needles inserted was one in 32 out of 44, two in 10 out of 44, and three in 2 out of 44. On average, the volume of cement injected per lesion was 10.3 ml and the filling was 54.8%. Mild or moderate asymptomatic cement leakage occurred in 20 lesions (45.5%). The mean pain score was 84.2 mm before the procedure (with no correlation with lesion size, cortical breach score or fracture) and 45.6 mm at follow-up. The pain relief of 38.6 mm was statistically significant (p < 0.001) and did not correlate with the filling percentage. There were no fractures of the treated lesions at a mean follow-up of 355 days.


Cementoplasty of pelvic bone metastases appears effective for providing pain relief and may prevent subsequent fractures. We were unable to demonstrate a correlation between the lesion filling and the degree of pain relief.


Pelvic bone Metastasis Cementoplasty Pain relief 



The authors wish to thank Sepideh Babaei, MD, for the editorial assistance provided during the preparation of this manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Cotten A, Duquesnoy B. Cimentoplastie percutanée des ostéolyses malignes du cotyle. Presse Med. 1995;24:1308–10.PubMedGoogle Scholar
  2. 2.
    Weill A, Kobaiter H, Chiras J. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement. Eur Radiol. 1998;8:123–9.CrossRefGoogle Scholar
  3. 3.
    Cotten A, Deprez X, Migaud H, Chabanne B, Duquesnoy B, Chastanet P. Malignant acetabular osteolyses: percutaneous injection of acrylic bone cement. Radiology. 1995;197:307–10.CrossRefGoogle Scholar
  4. 4.
    Papagelopoulos PJ, Mavrogenis AF, Soucacos PN. Evaluation and treatment of pelvic metastases. Injury. 2007;38:509–20.CrossRefGoogle Scholar
  5. 5.
    Coleman RE. Management of bone metastases. Oncologist. 2000;5:463–70.CrossRefGoogle Scholar
  6. 6.
    Harrington KD. The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Joint Surg Am. 1981;63:653–64.CrossRefGoogle Scholar
  7. 7.
    Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D. Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol. 2008;31:1165–73.CrossRefGoogle Scholar
  8. 8.
    Basile A, Giuliano G, Scuderi V, et al. Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med. 2008;113:1018–28.CrossRefGoogle Scholar
  9. 9.
    Botton E, Edeline J, Rolland Y, et al. Cementoplasty for painful bone metastases: a series of 42 cases. Med Oncol. 2012;29:1378–83.CrossRefGoogle Scholar
  10. 10.
    Iannessi A, Amoretti N, Marcy PY, Sedat J. Percutaneous cementoplasty for the treatment of extraspinal painful bone lesion, a prospective study. Diagn Interv Imaging. 2012;93:859–70.CrossRefGoogle Scholar
  11. 11.
    Marcy PY, Palussiere J, Descamps B, et al. Percutaneous cementoplasty for pelvic bone metastasis. Support Care Cancer. 2000;8:500–3.CrossRefGoogle Scholar
  12. 12.
    Hierholzer J, Anselmetti G, Fuchs H, Depriester C, Koch K, Pappert D. Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur. J Vasc Interv Radiol. 2003;14:773–7.CrossRefGoogle Scholar
  13. 13.
    Maccauro G, Liuzza F, Scaramuzzo L, et al. Percutaneous acetabuloplasty for metastatic acetabular lesions. BMC Musculoskelet Disord. 2008;9:66.CrossRefGoogle Scholar
  14. 14.
    Scaramuzzo L, Maccauro G, Rossi B, Messuti L, Maffulli N, Logroscino CA. Quality of life in patients following percutaneous PMMA acetabuloplasty for acetabular metastasis due to carcinoma. Acta Orthop Belg. 2009;75:484–9.PubMedGoogle Scholar
  15. 15.
    Gupta AC, Hirsch JA, Chaudhry ZA, et al. Evaluating the safety and effectiveness of percutaneous acetabuloplasty. J Neurointerv Surg. 2012;4:134–8.CrossRefGoogle Scholar
  16. 16.
    Choi ES, Kim YI, Kang HG, Kim JH, Kim HS, Lin PP. Percutaneous cementoplasty for acetabulum in patients with bone metastasis. Acta Orthop Belg. 2017;83:480–7.PubMedGoogle Scholar
  17. 17.
    Cotten A, Demondion X, Boutry N, et al. Therapeutic percutaneous injections in the treatment of malignant acetabular osteolyses. Radiographics. 1999;19:647–53.CrossRefGoogle Scholar
  18. 18.
    Moser T, Cohen-Solal J, Breville P, Buy X, Gangi A. Pain assessment and interventional spine radiology. J Radiol. 2008;89:1901–6.CrossRefGoogle Scholar
  19. 19.
    Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10:1128–30.CrossRefGoogle Scholar
  20. 20.
    Colman MW, Karim SM, Hirsch JA, et al. Percutaneous acetabuloplasty compared with open reconstruction for extensive periacetabular carcinoma metastases. J Arthroplast. 2015;30:1586–91.CrossRefGoogle Scholar
  21. 21.
    Onate Miranda M, Moser TP. A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty). Insights Imaging. 2018;9:275–85.CrossRefGoogle Scholar
  22. 22.
    Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200:525–30.CrossRefGoogle Scholar
  23. 23.
    Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976). 2001;26:1537–41.CrossRefGoogle Scholar
  24. 24.
    Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976). 2001;26:1547–54.CrossRefGoogle Scholar
  25. 25.
    Kwon HM, Lee SP, Baek JW, Kim SH. Appropriate cement volume in vertebroplasty: a multivariate analysis with short-term follow-up. Korean J Neurotrauma. 2016;12:128–34.CrossRefGoogle Scholar
  26. 26.
    Sun HB, Jing XS, Liu YZ, Qi M, Wang XK, Hai Y. The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief, cement dispersion, and cement leakage: a prospective cohort study of 130 patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra. World Neurosurg. 2018;114:e677–88.CrossRefGoogle Scholar
  27. 27.
    Dalstra M, Huiskes R. Load transfer across the pelvic bone. J Biomech. 1995;28:715–24.CrossRefGoogle Scholar
  28. 28.
    Deschamps F, de Baere T, Hakime A, et al. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol. 2016;26:1631–9.CrossRefGoogle Scholar
  29. 29.
    Pusceddu C, Fancellu A, Ballicu N, Fele RM, Sotgia B, Melis L. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol. 2017;46:539–45.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  • Thomas P. Moser
    • 1
    • 2
    Email author
  • Marta Onate
    • 1
  • Katia Achour
    • 1
  • Véronique Freire
    • 1
    • 2
  1. 1.Department of RadiologyCentre Hospitalier de l’Université de Montréal (CHUM)MontrealCanada
  2. 2.Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM)MontrealCanada

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