Palliative Treatment for the Management of Advanced Pelvic Hydatid Bone Disease

Abstract

Hydatid bone disease is a zoonotic parasitic infection that is caused primarily by the tapeworm Echinococcus granulosus, and it continues to be a major public health concern in pastoral regions. The reconstruction of limb function after limb salvage surgery remains a challenge for clinicians. The purpose of this study was to determine the clinical efficacy of palliative treatment of the management of advanced pelvic hydatid bone disease. From March 2005 to December 2018, medical records and images of patients with advanced pelvic hydatid bone disease treated with surgery combined with antiparasitic chemotherapy were evaluated retrospectively. The Enneking classification was applied to determine the location of the lesion, and the Musculoskeletal Tumor Society score system was used for outcome evaluation. Fifteen patients who met the criteria were included in this study, with a mean follow-up of 4.40 ± 1.76 years. All patients received treatment with surgery combined with antiparasitic chemotherapy. The mean number of surgical interventions per patient for pelvic cystic echinococcosis was 5.3 (range, 2-9 interventions per patient). Recurrence of pelvic hydatid bone disease occurred in 5 patients and was managed successfully through repeated debridement procedures. Palliative treatment with limb salvage surgery was an effective and practical approach to the management of advanced pelvic hydatid bone disease. Standard antiparasitic chemotherapy, which included albendazole at a dose of 10 mg/kg/day administered in two daily doses for 3 to 6 months, was also considered an essential part of the overall treatment strategy.

Figure 1.

A 30-year-old man presented with progressive, painful limitation of the left hip for 6 months. (A) Preoperative anteroposterior X-ray of the pelvis showed osteolytic bone destruction in the left ilium, periacetabulum, pubic bone, ischium, and proximal femur, with interruption of cortical continuity in the left proximal femur (black arrow). (B–D) Preoperative computed tomographic scans and three-dimensional reconstruction showed multiple areas of low-density bone destruction in regions I, II, and III of the left pelvis and proximal left femur (black arrows). (E, F) Preoperative magnetic resonance images showed multiple, round, long T2 signals of different sizes in the left ilium with surrounding soft tissues, left pelvic wall, and left buttock muscle (white arrows). (G, H) Postoperative and postoperative month 3 anteroposterior X-rays of the pelvis showed good alignment of the femoral prosthesis and pelvic internal fixation.

Figure 2.

A 46-year-old man presented with right hip/groin pain, swelling, and a painful mass of the right hip. (A) Preoperative anteroposterior X-ray of the pelvis showed osteolytic bone destruction around the right ilium, sacroiliac joint, and acetabulum (black arrow). (B–D) Preoperative computed tomographic scan and magnetic resonance (MR) images showed bone destruction in regions I, II, and IV of the right pelvis and proximal right femur (black arrows and white arrow). (E) Anteroposterior X-ray of the pelvis after debridement with the bone defect filled by bone cement and fixation with a plate internal fixation (black arrow). (F, G) Computed tomographic three-dimensional reconstruction and MR image at postoperative year 2 after the first operation showed multiple areas of bone destruction around the right ilium, acetabulum, and upper femur, indicating signs of recurrence of infection (black arrow and white arrow). (H) Postoperative anteroposterior X-ray of the pelvis showed good alignment of the femoral prosthesis and pelvic prosthesis with stable pelvic reconstruction.