A novel limb‐salvage reconstruction strategy with a custom hemipelvic endoprosthesis and preserved femoral head following the resection of periacetabular tumors: A preliminary study

Abstract

The treatment of periacetabular malignancy frequently challenges surgeons. To simplify the surgical procedure, we performed a novel reconstruction strategy preserving the femoral head for patients with periacetabular malignancies. We retrospectively reviewed 14 patients who underwent total en bloc resection of a periacetabular tumor and reconstruction of the hip joint with an individualized hemipelvic endoprosthesis and remaining femoral head from July 2015 to January 2019 at our center. Regions of pelvic resection: region II—4 (28.6%), region I + II—5 (35.7%), region II + III—2 (14.3%) and region I + II + III—3 (21.4%). The oncological outcomes were that 13 patients survived without disease and one patient survived with lung metastasis. None of the patients experienced local recurrence (range: 20–62 months; mean: 32 months). The incidence of postoperative complications was 35.7%, including delayed wound healing and deep venous thrombosis. No prosthesis‐related complications occurred until the last follow‐up in this study (range: 20–62 months; mean: 32 months). The mean Musculoskeletal Tumor Society functional outcome score was 23.2. The mean Toronto Extremity Salvage Score of the patients was 75.7 points, with a mean limb discrepancy of 1.51 cm (range: 0.5–3.2 cm). Reconstruction with preservation of the femoral head showed acceptable early functional and oncological outcomes, and it had an acceptable complication rate.

What’s New in Musculoskeletal Tumor Surgery

“…Rizkallah et al reported on the medium-term outcomes of pelvic reconstruction utilizing the LUMiC endoprostheses (Implantcast) and demonstrated low rates of aseptic loosening, with dislo-cation and infection being the most common major complications 12 . Xie et al evaluated the utility of a custom hemipelvic endoprosthesis with preservation of the femoral head in patients with primary bone malignancies and found acceptable function and oncologic outcomes at an early follow-up 13 . Hinckley et al retrospectively reviewed patients who underwent pelvic reconstruction with a custom ilium monoflange prosthesis 14 .…”

What’s New in Musculoskeletal Tumor Surgery

“…The reconstruction of the pelvis following internal hemipelvectomy has been an area of intense clinical review. Reconstruction options that have been reported to have reasonable surgical outcomes, albeit with high complication rates, include double-barreled free vascularized fibular grafting, structural allograft, individualized hemipelvic prosthesis, an ice-cream cone prosthesis, and personalized 3-dimensional (3D) printing-based limb salvage and reconstruction implants 2,4,5,10,12,14 . A few studies have identified risk factors for poorer oncologic and surgical outcomes in pelvic tumors.…”