Acetabular Reconstruction after Periacetabular Tumor Resection: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Periacetabular oncological lesions may present in various areas of the acetabulum and be of varying size. Many types of reconstruction are available for their treatment to deal with defects after tumor resection but which technique is optimal remains controversial. Objective To evaluate different methods and approaches of acetabular metallergic reconstruction after periacetabular tumor resection as regards surgical techniques, clinical, functional, oncological outcomes and possible complications. Methods This systematic review and meta-analysis study included twenty five studies with a total of 846 cases to evaluate different methods of acetabular reconstruction after periacetabular tumor resection as regards surgical techniques, clinical, functional, oncological outcomes and possible complications. We conducted a systematic review of literature in different databases and with pre-specified eligibility criteria and according to Cochrane’s handbook of systematic review guidelines in screening, we concluded sixteen different studies to be included in our study. Data were obtained from text, tables, figures, and supplementary data. We focused on the following outcome measures: operative time, blood loss, postoperative complication, MSTS score, and implant survival rate. Risk of bias assessment was done according to GRADE guidelines to every study using Cochrane’s risk of bias tool. Results Regarding implant survival analysis, the current study detected that first year survival rate was as following; constrained-type hip tumor prosthesis was 91%, ice-cream cone prosthesis was 72% and for Iliac Stem prosthesis first year survival rate was 90%. 3-year survival rate, the present study pooled result for the odds of three year survival for hemipelvic endoprosthesis (OR = 0.78, 95%CI = [0.71, 0.88], I 2 = 59.7%, P value=0.04), three year survival rate for the rest was as following; constrained-type hip tumor prosthesis was 62%, ice-cream cone prosthesis was 58% and for Iliac Stem prosthesis first year survival rate was 70%. 5 year survival, best results were achieved by Compound osteosynthesis 93.3 % followed by LUMiC ndoprosthetic 83%. Conclusion The choice of the best method of reconstruction after periacetabular tumor resection should be tailored according to each case, depending on many factors such as, age, daily activity, general condition, tumor type and human size. However, hemipelvic endoprothesis and ice cream cone prothesis may be the treatment of choice in young active patients, while in elderly with multiple comorbidities 3D printing represent the best option according to its availability