Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors.
Department of Orthopaedic Surgery, Hôpital Cochin, Paris, France. Journal of Surgical Oncology
(Impact Factor: 3.24).
Seventeen saddle prostheses were inserted between 1988 and 1997 after resection of periacetabular tumors. The tumors involved the zones II and III of Enneking classification in 13 patients, the zones I and II in 2 patients, and the zone II in 2 patients. The tumors included 11 chondrosarcomas, 3 Ewing sarcomas, 2 giant cells tumors, and 1 metastasis of renal carcinoma. The tumoral resection was wide "en bloc" in 14 cases, marginal in 2 cases, and intratumoral in 1 case. The mean follow-up period of the patients is 42 months ranging from 8 to 84 months. Local recurrences occurred in five cases and metastases in four cases. Five patients died of tumoral disease and one of intercurrent disease. Complications were observed in 11 cases (65%) including nerve damages (3 cases), deep infections (3 cases), upward migrations of the saddle (4 cases), saddle dislocations (3 cases), sacroiliac subluxations (2 cases), and mechanical failures (2 cases). The modified Musculoskeletal Tumor Society Score (MSTS) and the Toronto Extremity Salvage Score (TESS) were used for functional analysis. Functional results were available for only nine patients of the series with a mean MSTS of 17 points ranging from 11 to 23 points and a mean TESS of 58 points ranging from 39 to 95 points. The saddle prosthesis provided in all cases of this series an early painfree weight-bearing reconstruction with minimal limb shortening, but the functional results remained fair in most patients due to a limited range of motion and a poor abductor strength.
Available from: Nicolas Reina
- "Enneking and Dunham , Erikson and Hjelmstedt  and then Steel  were the first to describe conservative procedures after resection of acetabular tumours. Later on, hemipelvic prostheses  , saddle prostheses  , structural pelvic allografts   and even sterilized autografts   were used to reconstruct the pelvis while preserving hip mobility; others preferred iliofemoral or ischiofemoral fusion  sometimes in combination with a vascularized autograft . Hip transposition techniques  have also been described. "
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ABSTRACT: Bone reconstruction, after periacetabular tumour removal, is a complex procedure that carries a high morbidity rate and can result in poor clinical outcomes. Among the available options, the Puget pelvic resection-reconstruction procedure uses an autograft from the ipsilateral proximal femur to restore the anatomical and mechanical continuity of the pelvic ring before inserting an acetabular implant. HYPOTHESIS AND GOALS: This reconstruction technique satisfactorily restores the pelvic anatomy such that functional results and morbidity are comparable to alternative reconstruction techniques.
This was a retrospective study of 10 patients with an average age of 38.2 years (range 19 to 75) at the surgical procedure (performed between 1986 and 2007). There were five chondrosarcomas, three Ewing tumours, one plasmacytoma and one giant cell tumour. The position of the hip centre of rotation after reconstruction and autograft integration were evaluated on radiographs. Functional results were evaluated through the Musculoskeletal Tumor Society (MSTS) score and the Postel and Merle d'Aubigné (PMA) score.
At the time of review, one patient was lost to follow-up and four had died. On radiographs, the hip centre of rotation after reconstruction was higher by a median value of 15 mm (range 5 to 35) and more lateral by a median value of 6mm (range -5 to 15). Upon evaluation of radiographs at a median time of 40 months (range 6 to 252 months), the autograft was completely integrated in five patients and partially integrated in three patients (two patients had a local recurrence). There were no cases of autograft fracture or non-union at the junctions of the graft. The median MSTS score was 25 out of 30 (range 20 to 29), or 83% (range 67 to 97%) at the median clinical follow-up of 82 months (range 49 to 264). The median PMA score was 13 out of 18 (range 12 to 18). All living patients were walking without assistance. Five patients required nine surgical revisions. Seven were attributed directly or indirectly to local recurrence; one revision was performed because of instability and one because of early acetabular loosening at 9 months.
This challenging procedure provides satisfactory mechanical and anatomical results, while restoring hip anatomy and function. The primary cause of failure in this series was local recurrence of the tumour, which highlights the need to carefully select the indications and optimize the surgical tumour resection.
Available from: vghtpe.gov.tw
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ABSTRACT: Giant cell tumors of the acetabulum are uncommon lesions. Their diagnosis is often delayed due to their slow progression, late onset symptoms and easily been obscured by bowel gas in plain pelvic radiographs. The tumor size is always very large at the time of diagnosis, with major nerve and joint involvement. Management of such tumor remains challenging to orthopedic surgeons. Between 1992 and 1999, 3 acetabular giant cell tumors were diagnosed and managed at our institution. The treatment modality was intralesional tumor excision with structural allograft reconstruction. The margin of tumor was routinely managed with high-speed burring and phenol application. All 3 patients were free of local recurrence at a mean follow-up of 89 months. Postoperative palsy of sciatic nerve occurred in 1 patient, but no complications such as wound infection or fracture were seen. The nerve palsy recovered completely 1 year later. The final functional outcome of the 3 patients was excellent. The result appears that intralesional excision with adjuvant therapy is feasible in the management of giant cell tumor of the acetabulum and is able to obtain a satisfactory outcome.
Available from: mcgill.ca
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ABSTRACT: We retrospectively reviewed 27 patients who had saddle prosthetic reconstruction for pelvic sarcoma from 1991 to 2001 with a mean followup of 45 months. Functional outcome was assessed with Musculoskeletal Tumor Society Scores of 1987 and 1993 and the Toronto Extremity Salvage score. Survival, recurrences, and complications were recorded. Seven (26%) patients had Type II (periacetabular) pelvic resection and 20 had Types II and III (periacetabular and pubis) pelvic resection. Eleven patients had chemotherapy treatment. None received radiation therapy. At final followup 14 patients were free of disease, 11 patients died, and two patients were alive with disease. The survival rate was 60%. Twenty-two percent had local recurrence, and 22% had metastasis. The mean Musculoskeletal Tumor Society Score 93 score in 17 patients was 50.8% +/- 21.7%, the mean Musculoskeletal Tumor Society Score 87 score was 15.3 +/- 6.1, and the mean Toronto Extremity Salvage score was 64.4% +/- 17.2%. Infection occurred in 10 patients; six were deep infections. There were five nerve palsies. Heterotopic ossification occurred in 10 patients, fracture occurred in six patients, and dislocation occurred in six patients. Limb shortening was progressive until it stabilized at 12 months, and ultimately ranged between 1 and 6 cm. Five patients were retired, five had full-time employment, and six were disabled. Reconstruction with the saddle prosthesis after resection for pelvic sarcoma is associated with substantial morbidity. However, the functional results seem to confer an advantage when compared with the considerable disability incurred after hemipelvectomy. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series without control group). See the Guidelines for Authors for a complete description of levels of evidence.
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