The Saddle prosthesis in periacetabular tumours

Abstract

The Saddle endoprosthesis provides a means of establishing a stable and mobile articulation between the femur and a partially resected pelvis. Six patients with malignant or aggressive benign bone tumours underwent resection and replacement with custom-made Saddle endoprosthesis. Wide margin was achieved in four cases and marginal margin in two. Follow-up ranged from 24 to 41 months. All the six patients were then alive, five being disease-free. One patient developed deep infection and local recurrence necessitating removal of the prosthesis. The functional results were either excellent or good in five patients.Résumé L'endoprothèse Saddle offre la possibilité d'installer une articulation mobile et stable entre le fémur et le bassin partiellement resequé. Six patients souffrant de tumeurs osseuses malignes et agressives ont subi une opération de re-section et de remplacement avec une telle prothèse faite sur mesure. Une résection large marge a été obtenue dans quatre cas et une résection marginale dans deux cas. Le suivi s'est effectué pendant 24 à 41 mois. Les six patients sont vivants, cinq indemnes de maladie. Un patient a développé une infection profonde avec réci-dive locale et la prothèse a été retirée. Les résultats fonctionnels étaient soit excellents soit bons dans cinq cas.

Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors

“…The major complication rate in the present and other series is summarized (Table 3). Among the postoperative complications, deep infection was the most serious and frequent complication also in the present series (32%), similar to other reconstructive procedures; the rates of deep infection have been reported as 18% to 33% in saddle prostheses [4,21,25,28], 25% to 30% in custom-made * Thirteen patients were excluded from MSTS/ISOLS functional evaluation because they died of disease at 4-34 months postoperatively, and another one patient was excluded as a result of hindquarter amputation performed for local recurrence of iliac chondrosarcoma after C-THA; MSTS/ISOLS = Musculoskeletal Tumor Society/International Society of Limb Salvage; F = female; M = male; P-F = proximal femur; MFH = malignant fibrous histiocytoma; GCT = giant cell tumor. * Case series with a mean followup period over 60 months are only listed in Table 2; 15 of 17 patients were primarily treated with an allograft-THA prosthesis composite; à primary malignant bone and soft tissue tumors in 82 patients, solitary metastatic bone tumors in seven, plasmacytoma/myeloma in six, and benign bone tumors in three (fibrous dysplasia two, chondroblastoma one); § the cumulative implant survival rate of C-THA was 67% at 5 and 10 years postoperatively, when patients' death was interpreted as censored to calculate cumulative survival rate.…”

“…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.…”

The modified Harrington procedure for metastatic peri-acetabular bone destruction

“…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].…”

Extracapsular wide resection of a femoral neck osteosarcoma and its reconstruction using a pasteurized autograft-prosthesis composite: A case report

“…Although several methods for reconstruction following resection have been reported, including pelvic prosthesis arthroplasty (19–21), allograft reconstruction (with or without a total hip prosthesis) (22–25), arthrodesis and pseudarthrosis, a ‘gold standard’ has yet to be established due to poor post-operative function and high complication rates. Regardless of the methods that are used, infection and dislocation are common post-operative complications.…”

“…Regardless of the methods that are used, infection and dislocation are common post-operative complications. Infection rates range from 18–33% in saddle prosthesis arthroplasty (19–21) and 8–60% in allograft reconstruction (with or without a total hip prosthesis) (22–25). …”