Reconstruction Using the Saddle Prosthesis Following Excision of Primary and Metastatic Periacetabular Tumors

Aboulafia, Albert J.; Buch, R. S. R.; Mathews, John; Li, W; Malawer, Martin M.

doi:10.1097/00003086-199505000-00027

Cited by 97 publications

(126 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 79%

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

Angelini

Drago

Trovarelli

et al. 2014

Clinical Orthopaedics &Amp; Related Research

134

122

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Background Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. Questions/purposes We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. Methods From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection.Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. Results A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection.

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Section: Discussionsupporting

confidence: 79%

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

Angelini

Drago

Trovarelli

et al. 2014

Clinical Orthopaedics &Amp; Related Research

134

122

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“…As reported in the literature, the overall infection rate in several series varied from 12% to 47% after internal hemipelvectomy [1][2][3]10]. We had one major complication in the group undergoing intralesional excision whereas six of the 14 patients who underwent wide resection had major complications.…”

Section: Discussionmentioning

confidence: 65%

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

Guo

Sun

Zang

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Surgical options include the use of autogenous bone grafts, allografts, compound osteosynthesis and/or an endoprosthesis [9,10]. Especially in cases of a less extended bony destruction of the peri-acetabular region (Harrington class II), several authors have described the use of acetabular support rings in combination with THA or reconstruction using saddle prostheses following excision of primary and metastatic peri-acetabular tumours [11][12][13]. Although they have reported good results immediately after surgery or during early follow-up, reconstruction failures or degradation of the functional status have been observed in a considerable portion of the patients, especially following implantation of saddle prostheses.…”

Section: Discussionmentioning

confidence: 99%

The modified Harrington procedure for metastatic peri-acetabular bone destruction

Vielgut

Sadoghi

Gregori

et al. 2013

International Orthopaedics (SICOT)

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Purpose We describe the outcome in a series of patients treated for metastatic peri-actetabular and iliac bone destruction using a modified technique of Harrington's procedure. Methods Between 2006 and 2012, nine patients with a mean age of 62.2 years (42-75 years) were treated using a modified Harrington technique. Thereby, total hip replacement implants augmented by two to three threaded pins and cement were used to restore bony continuity of the pelvis and to achieve a stable construction allowing immediate full-weight bearing mobilisation. Results Acetabular destruction was graded according to Harrington's classification of peri-acetabular metastatic destruction, as class IV in one case, class III in six, and class II in two cases. The pre-operative ASA score ranged from II-IV. There were no intra-operative deaths or major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations at final follow-up. Eight patients achieved an improvement of their functional status postoperatively. One reconstruction required revision and four patients died due to their underlying disease ten to 36 months after surgery. Conclusion We found this technique an effective, reproducible, and long-lasting method to relieve pain and improve or restore function in patients with destructive metastatic lesions of the peri-acetabular bone and the iliac wing. Although we performed surgery even in severely ill patients with extended, generalised metastatic disease we had no intra-or postoperative death and observed no major complications.

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Reconstruction Using the Saddle Prosthesis Following Excision of Primary and Metastatic Periacetabular Tumors

Cited by 97 publications

References 0 publications

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

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

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

The modified Harrington procedure for metastatic peri-acetabular bone destruction

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