Flail hip joint following periacetabular tumor resection of the pelvis using upper surface of the femoral neck as a saddle: A case report

Takami, Masatsugu; Ieguchi, Makoto; Aono, Masanari; Hoshi, Manabu; Takada, Jun; Oebisu, Naoto; Iwai, Tadashi

doi:10.3892/ol.2015.3756

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…Z operačních možností pak přichází v úvahu buď prostá resekce s "flail-hip" (14,24) což je spíše historická metoda s funkčními výsledky na úrovni konzervativní léčby.…”

Section: Diskuseunclassified

Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum

LESENSKÝ,

BLECHA,

VČELÁK

2023

ACHOT

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PURPOSE OF THE STUDYThe increasing prevalance of patients with metastatic bone cancer and their improved survival puts more emphasis on the quality of treatment of bone metastases. Although most pelvic lesions are treated non-operatively, extensive destruction of the acetabular segment poses a therapeutic challenge. A potential treatment option may be the modified Harrington procedure. MATERIAL AND METHODSAt our department, this surgical procedure has been opted for in 14 patients (5 men and 9 women) since 2018. The mean age at the time of surgery was 59 years (range 42 to 73). Twelve patients suffered from metastatic cancer, one patient had a fibrosarcoma metastasis and one female patient presented with aggressive pseudotumor. Radiological and clinical followup of the patients was performed. Pain was assessed using the Visual Analogue Scale, and the Harris Hip Score and the MSTS score were used to evaluate the functional outcome. The paired samples Wilcoxon test was used to analyze the statistical significance of the difference. RESULTSThe mean follow-up period was 25 months. At the time of assessment, ten patients were alive with the mean follow-up of 29 months (range 2 to 54 months) and four patients had died of cancer progression, with the mean follow-up being 16 months. No perioperative death or mechanical failure were reported. One female patient developed a hematogenous infection during febrile neutropenia, which was successfully managed with early revision and implant preservation. Statistically, a significant improvement in the MSTS (median 23) and HHS (median 86) functional scores compared to the preoperative values (MSTS median 2, p<0.01, r-effect size = 0.6; HHS preop median 0, p<0.005, r-effect size = -0.7) was observed. There was also a statistically significant reduction in pain (VAS postoperative median 1, VAS preoperative median 8, p<0.01, r-effect size = -0.6). All patients were capable of independent ambulation after the surgery, nine patients walked without support. DISCUSSIONThere are not many alternatives to this surgical procedure. Apart from non-operative palliative treatment, the options include ice cream cone prostheses or customized 3D implants which are, impractical in terms of time and cost. Our results are comparable to other studies, confirming the reproducibility and reliability of the method. CONCLUSIONSThe Harrington procedure is an efective method for management of large acetabular tumor defects with good functional outcomes, an acceptable perioperative risk and a low risk of failure in the medium term, thus suitable also for patients with good cancer prognosis.

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“…Z operačních možností pak přichází v úvahu buď prostá resekce s "flail-hip" (14,24) což je spíše historická metoda s funkčními výsledky na úrovni konzervativní léčby.…”

Section: Diskuseunclassified

Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum

LESENSKÝ,

BLECHA,

VČELÁK

2023

ACHOT

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“…Different reconstructive techniques have been proposed over the years: Harrington reconstruction, iliofemoral coaptation or pseudoarthrosis, ischiofemoral arthrodesis, saddle prosthesis, alloprosthetics composite and 3D custom made prostheses [ 3 , 7 , 8 ]. When reconstruction is not a suitable option, flail hip can be performed [ 9 ]. Among all these techniques, alloprosthetics composite reconstruction consists of a bone allograft customized on the operative table to restore pelvic bone defect combined with a total hip arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters

Bruschi

Cevolani

Spazzoli

et al. 2022

JCM

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Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores.

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“…Case reports indicated acceptable functional outcomes after resection of a pelvic tumor with no reconstruction thus leaving a flail hip [5, 6]. However, hemi-pelvic resection and allograft prosthetic composites have recently grown in popularity and area commonly used surgical techniques for the treatment of acetabulum involved pelvic malignant cases especially for younger patients [7–10].…”

Section: Introductionmentioning

confidence: 99%

Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors

Sun¹,

Zan

Ma³

et al. 2019

BMC Cancer

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Background The aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. Methods From January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed. Results Thirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor. Conclusion The precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.

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Flail hip joint following periacetabular tumor resection of the pelvis using upper surface of the femoral neck as a saddle: A case report

Cited by 8 publications

References 15 publications

Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum

Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum

Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters

Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors

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