Mid-term outcomes of hemipelvic allograft reconstruction after pelvic bone tumor resections

Abstract

This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection.Patients and methods: Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8±14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients̓ age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revelaed and analyzed in 10 years period.Results: According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results. Conclusion:Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.

Combination of frozen autograft produced with liquid nitrogen and total hip replacement as a bone recycle reconstruction in pelvic osteosarcoma resection type 2: A case report

“…This procedure may give better functional results and maintaning limb length, but there is no potential for ingrowth of the acetabular component into the allograft bone, thus limiting its durability. A study reported that massive pelvic allografts was associated with high rates of wound complications, infections, and need for revision [ 5 , 16 ]. Previous study reported up to 46 % complication rate with allografts, all of whom needed an operation.…”

“…Due to the resistance of chemotherapy, the mainstay of treatment for pelvic osteosarcoma is wide resection. Following resection of the hemi pelvic, there are various alternative reconstruction procedures such as pseudoarthrosis, arthrodesis, mega prostheses, massive allograft, and cryosurgery [ [1] , [2] , [3] , [4] , [5] ]. However, the results were still dissatisfying with numerous complications.…”