Reconstruction of Type I-II Internal Hemipelvectomy in a Patient With Pelvic Myxoid Chondrosarcoma: A Case Report

Abstract

Pelvic chondrosarcomas are a major clinical challenge since the only therapeutic approach available is surgical resection. Reconstruction after partial resection of the pelvis including the acetabulum or the hip joint is a laborious and rigorous surgical procedure. Numerous complications are associated with different reparative methods. Moreover, due to the anatomical complexities of the area, adequate surgical margins are difficult to achieve in many cases, which are closely related to the advent of local recurrence of the tumor. Several techniques for hip function restoration and skeletal reconstruction have been reported. The purpose of this report is to describe a novel pelvic reconstruction technique for PI-II resection that required a custom-designed implant. We present the case of a 61-year-old female patient with chronic pain in the gluteal region. The pelvis's magnetic resonance imaging (MRI) showed an osteolytic tumor in the right iliac wing that compromises the acetabular roof. The diagnosis was a grade 2 central chondrosarcoma. Surgery included the reconstruction of the acetabulum by inserting two Schanz pins coated with hydroxyapatite, one in the iliopubic corridor and the other in the ischium. A supporting "pyramid" was built, unitizing both Schanz with cement, onto which an acetabular cage was inserted. The procedure was completed with a conventional total hip prosthesis. The patient presented an acute prosthesis infection, which positively responded to prompt surgical lavage and antibiotic treatment. After 10 months of follow-up, the patient remains free of infection, with weight-bearing as tolerated, without pain, and with excellent hip motion. No tumor recurrence has occurred. Medialization of the construct has occurred as expected, with no evidence of implant loosening. The technique used in this patient is novel, could be considered cost-effective, and has allowed the reconstruction of a functional hip. For resections of the acetabular area and preservation of the ischium and pelvic zones, this technique may be an acceptable option.

Grade III chondrosarcoma of the left iliopubic branch: A case report

“…This results in the development of large, painful, extra-skeletal masses, often devoid of other discernible symptoms. Clinical presentation varies, and symptoms manifest when the disease has advanced due to direct tumor infiltration or extrinsic compression [ 2 , 3 ]. In this particular case, there was superior displacement of the bladder, sigmoid colon, rectum and anal canal, with extrinsic compression of the right ureter.…”

“…Complexity increases when dealing with tumors in the pelvic region, particularly around the acetabulum, due to the intricate local anatomy, extensive surgical approaches required, and the biomechanical implications of substantial bone resection [ 2 , 7 ]. Historically, hindquarter amputation was the standard procedure for malignant pelvic tumors [ 11 ].…”

“…Historically, hindquarter amputation was the standard procedure for malignant pelvic tumors [ 11 ]. However, limb-sparing surgery, such as internal hemipelvectomy, has gained traction [ 2 , 5 , 11 ]. This procedure aims to achieve local and systemic disease control while preserving the limb and the patient's ability to walk [ 7 ].…”

“…Chondrosarcomas encompasses neoplasms derived from mesenchymal lineage cells and are characterized by the production of a cartilaginous matrix that may arise de novo or develop as a sequel to pre-existing benign cartilaginous neoplasms [ 1 , 2 ]. While its prevalence is eclipsed by myeloma and osteosarcoma, it ranks as the third most common primary malignant bone tumor [ [2] , [3] , [4] ]. Its incidence is notably variable, with European rates approximating 1–4 cases per 100,000 individuals [ 3 ].…”

“…The therapeutic cornerstone for chondrosarcomas is surgical resection, a modality of choice due to the inherent resistance of these tumors to conventional radiotherapy and chemotherapy [ 1 , 2 , 4 , 6 , 8 ]. This requires comprehensive surgical procedures, including hindquarter amputation or internal hemipelvectomy, aimed at ensuring complete extirpation with wide surgical margins, thereby mitigating the risk of recurrence [ 4 ].…”