J Korean Orthop Assoc.  2007 Jun;42(3):298-304. 10.4055/jkoa.2007.42.3.298.

Clinical Results following Reconstructive Methods in Pelvic Tumor

• Song WS
• Cho WH
• Park JH
• Lee SY
• Lee SJ
• Jeon DG

• KMID: 2186552
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.298

Abstract

PURPOSE: This study evaluated the results of periacetabular resections in patients with pelvic tumors according to the reconstructive methods.
MATERIALS AND METHODS
Twenty-seven patients, who underwent a periacetabular resection with a minimum one year follow up were eligible for this study. There were 20 primary malignant bone tumors, three benign aggressive tumors, three metastatic tumors and one soft tissue sarcoma. According to Enneking's criteria, a type I+II resection was performed in seven patients, type II+III in 17, and type I+II+III in three. The type of reconstructions used were heat treated autogenous bone-THA composite (APC) in 15, a saddle prosthesis in 6, arthrodesis in 2, and a flail hip in 4 patients. The MSTS functional scores and complications according to the type of reconstruction were evaluated.
RESULTS
Eleven (46%) of the 27 patients were in the disease free state and 7 (26%) patients showed local recurrences. Eleven (73%) out of 15 patients with APC and 2 (33%) out of 6 patients with a saddle prosthesis had complications including infections, dislocations and loosening. The final average MSTS score was 19.6 (65%) and all reconstructive methods produced similar functional results.
CONCLUSION
Reconstructions of the acetabulum with a prosthesis after a periacetabular resection had a relatively high rate of complications. A flail hip might be one suitable reconstructive options after a periacetabular resection.

Keyword

Pelvic tumor; Periacetabulum; Reconstructive method

MeSH Terms

Acetabulum
Arthrodesis
Dislocations
Follow-Up Studies
Hip
Hot Temperature
Humans
Prostheses and Implants
Recurrence
Sarcoma

Figure

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  Fig. 1 (A) Plain radiograph shows a huge calcified mass of the pubic ramus extending to the adductor area. (B) A Type II+III resection was performed and reconstructed with heat treated autogenous bone-THA composite. (C) Four months later, all the implants and pasteurized bone were removed and the reconstruction was changed to a flail hip as a result of an infection.

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  Fig. 2 (A, B) Preoperative radiograph and MRI show a huge calcified mass of the pubis invading the inferior wall of the acetabulum. (C) A Type II+III resection was done and a limited arthrodesis was performed by wiring between the ilium and femoral head.

• 

  Fig. 3 (A, B) Plain radiograph and MRI show a diffuse lesion involving ilium and acetabulum. (C) Flail hip reconstruction after a type I+II resection was performed and proximal migration of the femoral head is observed.

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  Fig. 4 The Kaplan-Meier survival analysis shows 11% implant survival at 135 months when using heat treated autogenous bone-THA composite or a saddle prosthesis.

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