Ablation-First Balloon-Assisted Acetabuloplasty for Painful Acetabular Metastases: Clinical Outcomes and Mechanical Rationale

PURPOSE: To evaluate the safety, technical feasibility, and clinical outcomes of a strict two-step protocol-CT/fluoroscopic-guided thermal ablation followed by Balloon-Assisted Acetabuloplasty (BAA)-for the treatment of painful acetabular metastases, utilized as an immediate mechanical stabilization bridge prior to radiotherapy. MATERIALS AND METHODS: A retrospective study was conducted on 16 consecutive patients treated for severe mechanical pain (VAS ≥ 6) and impaired mobility due to osteolytic acetabular metastases. The physiological rationale mandated a strict procedural sequence: (1) preliminary thermal devitalization using radiofrequency or microwave ablation to reduce tumor pressure and vascularity, followed subsequently by (2) balloon-assisted cavity compaction and polymethylmethacrylate (PMMA) cement injection. Clinical outcomes included VAS for pain and the Functional Mobility Scale (FMS) assessed before treatment and up to 6 months post-procedure. RESULTS: < 0.001), allowing independent ambulation in 87.5% of patients. CONCLUSION: The strict "ablation-first" BAA strategy is safe and highly effective. It abolishes load-bearing pain and restores biomechanical stability immediately, allowing previously immobilized patients to rapidly regain independent ambulation and seamlessly transition to necessary consolidative radiotherapy.