LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

Abstract

BackgroundReconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC® prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC® prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated.Questions/purposes(1) What proportion of patients experience mechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC® after pelvic tumor resection? (2) What proportion of patients experience nonmechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC® after pelvic tumor resection? (3) What is the cumulative incidence of implant failure at 2 and 5 years and what are the mechanisms of reconstruction failure? (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society (MSTS) score at final followup?MethodsWe performed a retrospective chart review of every patient in whom a LUMiC® prosthesis was used to reconstruct a periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 2008 to June 2014 in eight centers of orthopaedic oncology with a minimum followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 years (range, 12–78 years) were included. At review, 32 patients (68%) were alive. The reverse Kaplan-Meier method was used to calculate median followup, which was equal to 3.9 years (95% confidence interval [CI], 3.4–4.3). During the period under study, our general indications for using this implant were reconstruction of periacetabular defects after pelvic tumor resections in which the medial ilium adjacent to the sacroiliac joint was preserved; alternative treatments included hip transposition and saddle or custom-made prostheses in some of the contributing centers; these were generally used when the medial ilium was involved in the tumorous process or if the LUMiC® was not yet available in the specific country at that time. Conventional chondrosarcoma was the predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used in case of a higher presumed risk of dislocation in the early period of our study; later, dual-mobility cups became the standard for the majo...

Acetabular reconstruction with an ice‐cream cone prosthesis following resection of pelvic tumors: Does computer navigation improve surgical outcome?

“…The cumulative incidence of implant failure in this study was satisfactory compared with the other reconstructions 54‐58 . Bus et al 11 reported that the cumulative incidence of implant failure of LUMiC, the other stemmed‐cone acetabular prosthesis, was 17.3% for mechanical reasons and 9.2% for infection at 5 years. We believe that implant survival of these stemmed‐cone prostheses would be further improved by the assistance of navigation.…”

“…This prosthesis (coned hemipelvis; Stanmore Implants, Elstree, UK) was developed in 2003, based on the Ring prosthesis 6 and the McMinn prosthesis, 7‐10 which would be simple to make, easy to use, and versatile to use even when there was little pelvis remaining 1 . Recently, the reconstruction with this type of prosthesis has been globally recognized as one of the most reliable procedures, which includes another stemmed‐cone acetabular prosthesis named “Pedestal Cup” or “LUMiC.” 11,12 One of the important steps for success is correct positioning and alignment of the implant stem within the ilium, because placing the stem in an incorrect position, such as through the sacroiliac joint, can be a source of postoperative pain and functional loss. Therefore, the success rate of acetabular reconstruction might be improved by the accurate insertion of the stem with the intraoperative navigation.…”

Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?

“…Most patients in group II required a shoe lift but could participate in most activities at school or home, and three patients (18%) could enjoy sports activities such as football, badminton, or swimming. been 28% to 65% in endoprosthetic reconstruction, 23,29,[33][34][35][36]49,61,62 29% to 60% in allograft reconstruction, 39,48,63,64 20% to 57% in recycled autograft reconstruction. 41,43,65 Among these major complications, deep infection is the most serious and frequent one, and is a common cause of implant failure.…”

“…[21][22][23][24][25] While selected cases involving neurovascular structures still require external hemipelvectomy, [25][26][27] limb-salvage through pelvic reconstruction achieves greater postoperative function and quality of life. 28 The reconstructive options include endoprosthetic reconstruction, 23,[29][30][31][32][33][34][35][36][37] biological reconstruction using allograft 38,39 or autograft, [40][41][42][43][44] iliofemoral arthrodesis, 24,45 or hip transposition arthroplasty. 28,46,47 The high complication rate is a major problem of these reconstructive procedures except for hip transposition arthroplasty, which includes superficial/deep infection, dislocation, neurovascular and visceral damage, mechanical and structural failure, and wound dehiscence/necrosis, 24,25,29,32,[48][49][50] and these complications are associated with poor functional outcomes.…”

Peri̇asetabular Ewi̇ng Sarkomu Olgu Sunumu: Cerrahi̇ Tekni̇k Ve Lumic Asetabular İmplant İle Rekonstrüksi̇yon

“…Hidroksiapatit kaplı sementsiz veya sementli sapları bulunurken infeksiyon riskini azalt mak için gümüş kaplı sap ve cup seçenekleri de mevcuttur. Sap kısmında bulunan testere dişlerine benzer yapıların rotasyonel stabiliteyi arttırdığı düşünülmektedir (4). Literatürde, LUM IC® in farklı dizaynı sayesinde hem Pedestal cup TM protezi ve saddle protezi hem de konvansiyonel rekonstrüksiyon yöntemlerine oranla daha az infeksiyon, daha az…”