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: 2.77). 09/2007; 461(461):180-8. DOI: 10.1097/BLO.0b013e31806165d5
Source: PubMed


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.

Download full-text


Available from: Tao Ji
  • Source
    • "Enneking and Dunham [1], Erikson and Hjelmstedt [2] and then Steel [3] were the first to describe conservative procedures after resection of acetabular tumours. Later on, hemipelvic prostheses [4] [5], saddle prostheses [6] [7], structural pelvic allografts [8] [9] and even sterilized autografts [10] [11] were used to reconstruct the pelvis while preserving hip mobility; others preferred iliofemoral or ischiofemoral fusion [12] sometimes in combination with a vascularized autograft [13]. Hip transposition techniques [14] have also been described. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2012 · Orthopaedics & Traumatology Surgery & Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: By incorporating skewness in surface elevation into a standard Kirchhoff surface scattering model, it is shown that additional terms are generated which can account for the difference in the backscattering coefficient due to a change in the sense of the direction of observation. For the sea surface this offers an explanation for the difference between the upwind and downwind observations. Major changes in the backscattering coefficient due to change in direction appear through the directional surface spectrum while a change in the sense of the direction is reflected through the skewness function of the surface.
    No preview · Article · Jul 1988
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this article is to review the literature on limb reconstruction published in the last year and present the status of low cost limb reconstruction in a developing country like India. Recent findings Modular and customized tumour endoprostheses have been the mainstay of limb salvage surgery for bone tumours in the west, providing good longevity and excellent function. Special expandable prostheses for children maintain limb length during growth. Hemi-pelvic prostheses and allografts are now showing much better results than in the past. Socio-economic factors in the developing world, however, force the surgeons to use low cost alternatives like amputation, rotationplasty, extracorporeal irradiation and reimplantation or arthrodesis. Autoclaving or pasteurization and reimplantation can be a useful low cost alternative. Indigenous tumour prostheses, indigenously procured and processed allografts and a dedicated orthopaedic oncology service have now made limb salvage surgery a standard of care. Though lower in cost, the functional and oncological results have been similar to those reported in literature. Summary Limb salvage surgery has become the standard of care in India with the availability of high quality and low cost prostheses, affordable chemotherapy, indigenous allografts and dedicated orthopaedic oncology service. Procedures like rotationplasty and allograft-live fibula composites can be functionally effective low cost substitutes to expensive megaprostheses.
    Full-text · Article · Nov 2007 · Current Opinion in Orthopaedics
Show more