Reconstruction of the Hemipelvis after the Excision of Malignant Tumours

Abstract

We treated 35 patients with primary malignant tumours of the periacetabular area by resection and prosthetic reconstruction of the defect. At a mean follow-up of 84 months, 15 patients (43%) were free from disease. The most common complications were deep infection (26%), local recurrence (24%) and recurrent dislocation of the hip (17%). The surviving patients achieved an average of 70% of their premorbid function. This method of reconstruction has a high morbidity and should be performed only at specialist centres, but the functional and oncological outcomes are satisfactory.

Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors

“…Dislocation and aseptic loosening of endoprostheses are other major postoperative complications. The rates of dislocation (16%) and aseptic loosening (8%) in the present series were also comparable to other reported series: 2.5% to 17% for dislocation [1,11,14,24,27,[36][37][38]] and 3.7% to 25% for aseptic loosening of implants [11,14,21,27,38]. Four patients sustained dislocations caused by violent falls despite the use of a constrained joint mechanism, three of whom also had concomitant deep infection.…”

“…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.…”

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

“…The 20% infection rate in our series of patients is lower than reported rates in some series [3,4,18,26,27,36,39,41,45,46] and greater or comparable to the experience reported in other studies [1,8,12,13,19,20,29,30,38] ( Table 3). The overall infection rate in many series varied from 10% to 47% after internal hemipelvectomy [1, 3, 4, 8, 10, 12, 13, 18-20, 23, 25-27, 29, 30, 34, 36, 38-41, 45, 46], whereas it ranged from 11% to 38% in patients who had resection and endoprosthetic reconstruction [1,3,12,19,20,26,27,36,45,46]. Abudu et al [3] reported a 26% infection rate in a series of 35 patients undergoing endoprosthetic reconstruction with saddle prostheses.…”

Finite element analysis of the pelvis after modular hemipelvic endoprosthesis reconstruction

“…However, hemipelvic reconstruction after sarcoma resection is critical and many methods for the approach exist, such as massive allograft [1][2][3][4], autoclaved autograft [5,6], custom-made endoprosthesis combined with hip arthroplasty [7][8][9], modular saddle prosthesis [9][10][11][12], and modular hemipelvic endoprosthesis [13,14]. The modular hemipelvic prosthesis is a new design that can be easily used in surgery and features flexible sizes.…”