High complication rates with pelvic allografts: Experience of 22 sarcoma resections

Abstract

We performed 22 reconstructions by allografts in patients with pelvic sarcoma: 14 Ewing's sarcomas, 7 chondrosarcomas, and 1 osteosarcoma. All patients with Ewing's sarcoma and osteosarcoma received chemotherapy. No patients with chondrosarcoma had adjuvant treatment. 12 reconstructions were iliosacral arthrodesis after resection of an ilium tumor, 1 was iliofemoral arthrodesis and 9 were pelvic reconstructions with total hip prosthesis after resection of an acetabulum tumor. In the surviving patients, the mean length of follow-up was 4 (2-6) years. 2 allografts fractured and 8 allografts developed an infection. The infection was commoner in patients who had chondrosarcomas, large tumors, and a long operation time. Neither chemotherapy nor radiotherapy increased the infection rate. All infected allografts had to be removed.

Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors

“…hemipelvic prostheses [1,18,27,36,37], 11% to 24% in modular-type hemipelvic prostheses [11,14,24,38], and 8% to 60% in allograft reconstruction [2,22,23,26,39]. To reduce the risk of postoperative deep infection, we need to adopt intraoperative repeated and meticulous ultrasonic irrigation, routine use of antibiotic-loading bone cement, application of muscle/or musculocutaneous flap, and twostaged reconstruction after tumor resection followed by a ''Reconstruction cup'' (C-THA) endoprosthesis 55% (30%-80%) 32%…”

“…However, limb-salvage reconstruction of malignant pelvic tumors, especially in the periacetabular region, remains challenging because of the complex anatomy, the difficulty achieving wide surgical margins, and large bone and soft tissue defects after tumor resection. The reconstructive options include resection arthroplasty [7,30,33], iliofemoral or ischiofemoral arthrodesis [9,12], hip transposition method (pseudarthrosis) [3,12,32], free-vascularized fibular graft for pelvic ring reconstruction [29], allograft [2,22,23,26,39], recycled autologous bone graft [16,20], and endoprosthetic replacement [1,4,11,14,18,21,24,25,27,28,34,[36][37][38]. However, no standard reconstructive procedure exists after internal hemipelvectomy for malignant periacetabular tumors.…”

What Are the Functional Results and Complications From Allograft Reconstruction After Partial Hemipelvectomy of the Pubis?

“…The infection rate, for instance, in a previously published series of patients at our institution who underwent allograft reconstruction after internal hemipelvectomy for malignant pelvic bone tumors was 20% [11], although reported rates of infection with pelvic allografts have ranged from one in 13 to five in 13 [1,3,7,10]. Rates of pelvic allograft fracture have been reported ranging from zero of 16 to three of 14 with nonunion reported in one series as three of 16 [3,6,10,13,18].…”

Two-staged revision with custom made prosthesis in septic failure of massive allograft reconstruction after type II-III pelvic resection

“…[1][2][3][4] However, high complication rates are associated with allograft reconstruction after pelvic resections. [4][5][6] Infection is one of the most frequent and disastrous complications. Late-onset infection occurred in our patient at four-year follow-up.…”