Clin Orthop Surg.  2017 Sep;9(3):374-385. 10.4055/cios.2017.9.3.374.

Comparison of Pasteurized Autograft-Prosthesis Composite Reconstruction and Resection Hip Arthroplasty for Periacetabular Tumors

• Lee SY
• Jeon DG
• Cho WH
• Song WS
• Kong CB

• KMID: 2412275
• DOI: http://doi.org/10.4055/cios.2017.9.3.374

Abstract

BACKGROUND
Because of the high complication rate of anatomical reconstruction after periacetabular resection, the strategy of resection alone has been revisited. However, in terms of complications and functional outcome, whether resection hip arthroplasty (RHA) shows a superior result to that of pelvic ring reconstruction remains controversial.
METHODS
We compared 24 RHAs and 16 pasteurized autograft-prosthesis composite (PPC) reconstructions regarding the complication rates, operative time, blood loss, and functional outcome.
RESULTS
Compared to 16 PPC hips, 24 RHA hips showed lower major and minor complication rates (p < 0.001), shorter surgical time (p < 0.001), and superior Musculoskeletal Tumor Society scores (p < 0.001). Of the 24 RHA hips, bony neo-acetabulum was identified in 7 on computed tomography and partial neo-acetabulum in 9; the remaining 8 had no bony acetabular structure. The average time to bony neo-acetabulum formation was 7 months (range, 4 to 13 months).
CONCLUSIONS
RHA for periacetabular tumors can be an excellent alternative to anatomical reconstruction. It offers short surgical time, low complication rates, and functional results comparable to those of other reconstruction methods. However, this procedure is indicated for patients who can accept some limb shortening, and a tumor should be confined to the periacetabular area.

Keyword

Acetabulum; Reconstructive surgery; Treatment outcome

MeSH Terms

Acetabulum/*surgery
Adolescent
Adult
Aged
Arthroplasty, Replacement, Hip/*methods
Autografts
Bone Neoplasms/*surgery
Disinfection/methods
Female
Humans
Male
Middle Aged
Prostheses and Implants
Reconstructive Surgical Procedures/*methods
Young Adult

Figure

• 

  Fig. 1 (A) The axial pelvic computed tomography (CT) shows complete bony neo-acetabulum formation 9 months postoperatively. (B) The axial CT shows partial bony neo-acetabulum formation (less than 1/2 of the femoral head circumference).

• 

  Fig. 2 (A) The preoperative plain radiograph shows a mixed osteolytic and sclerotic lesion in the right ilium and acetabulum in a 34-year-old male patient with chondrosarcoma (case 8). (B) The postoperative plain radiograph shows Enneking type II + I (partial) resection and repositioning of the previously detached iliac bone block-muscle complex with wire. (C) The follow-up plain radiograph shows complete neo-hip joint formation; the patient is fully active with shortening by 3 cm.

• 

  Fig. 3 (A) The plain radiograph shows an osteolytic lesion in the right acetabulum in a 41-year-old patient with chondrosarcoma (case 21). (B) The postoperative radiograph demonstrates Enneking type I (partial) + II + III (partial) resection and the femoral head fixed to the remaining iliac wing with a single wire. (C) At 6 months postoperatively, because of the high iliac osteotomy level, only partial bony neo-acetabulum had formed. The patient had no pain and could walk with one cane.

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