Reconstruction with modular hemipelvic prostheses for periacetabular tumor

Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 09/2007; 461(461):180-8. DOI: 10.1097/BLO.0b013e31806165d5
Source: PubMed

ABSTRACT Periacetabular resections for primary bone sarcoma and metastatic disease require reconstruction to restore weight-bearing along anatomic axes. We designed a modular hemipelvic prosthetic system to reconstruct the pelvis and evaluated the early clinical outcome of the prosthesis using 3-year survival rate, local recurrence rate, Musculoskeletal Tumor Society (MSTS) 93 function score, and complications. We retrospectively reviewed 28 patients who had pelvic tumor resections and reconstructions using the new hemipelvic prostheses between 2001 and 2005. Sixteen (57.1%) patients had Types II and III (periacetabular and pubis) pelvic resections, seven had Types I and II (periacetabular and ilium) pelvic resections, and five had Type II (periacetabular) pelvic resection. Six patients with osteosarcoma had chemotherapy. None received radiation therapy. Patient survival status, function, and complications were evaluated at a mean followup of 30 months (range, 10-59 months). Fifteen patients were free of disease, eight patients died of disease, and five patients were alive with disease. The overall survival rate was 67.1% at 3 years. Twenty-five percent had local recurrence and 21% had metastasis. The mean MSTS 93 score was 60. Deep infection occurred in four patients; dislocation occurred in one patient. The results are encouraging because of the acceptable complication rate and satisfactory functional outcome.

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    ABSTRACT: Peri-acetabular tumour resections and their subsequent reconstruction are among the most challenging procedures in orthopaedic oncology. Despite the fact that a number of different pelvic endoprostheses have been introduced, rates of complication remain high and long-term results are mostly lacking. In this retrospective study, we aimed to evaluate the outcome of reconstructing a peri-acetabular defect with a pedestal cup endoprosthesis after a type 2 or type 2/3 internal hemipelvectomy. A total of 19 patients (11M:8F) with a mean age of 48 years (14 to 72) were included, most of whom had been treated for a primary bone tumour (n = 16) between 2003 and 2009. After a mean follow-up of 39 months (28 days to 8.7 years) seven patients had died. After a mean follow-up of 7.9 years (4.3 to 10.5), 12 patients were alive, of whom 11 were disease-free. Complications occurred in 15 patients. Three had recurrent dislocations and three experienced aseptic loosening. There were no mechanical failures. Infection occurred in nine patients, six of whom required removal of the prosthesis. Two patients underwent hindquarter amputation for local recurrence. The implant survival rate at five years was 50% for all reasons, and 61% for non-oncological reasons. The mean Musculoskeletal Tumor Society score at final follow-up was 49% (13 to 87). Based on these poor results, we advise caution if using the pedestal cup for reconstruction of a peri-acetabular tumour resection. Cite this article: Bone Joint J 2014;96-B:1706-12.
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    ABSTRACT: We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect. From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1-22.5, standard deviation ± 5.3). Kaplan-Meier analysis was used to estimate survival rates. Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %). The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes.
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    ABSTRACT: The modular hemipelvic prosthesis has been used in patient of Type I-IV pelvic tumor with good outcomes, but how to keep the stability between the prosthesis and the residual sacrum is a problem. An additional screw-rod system seems to solve it, but its biomechanical characters are still not well understood, which need experimental evaluation.

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