Abstract
Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods. Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure. Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure. Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was 1738.6 ± 200.3 Nmm−1 compared to the intact pelvis, which was 911.4 ± 172.7 Nmm−1 (P value = 0.01). The mean load to failure for the standard acetabular cup construct was 3297.3 ± 117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8 ± 7.0 N. Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.
Highlights
Primary sarcomas of the pelvis account for 10% to 15% of primary bone tumours and pelvis is considered the third most common site for metastasis
We have devised our own method of reconstruction for the acetabular defect using commercially available acetabular reconstruction cage, threaded rods, and cemented flanged acetabular cup
We believe that our method of reconstruction for periacetabular tumours might offer a cheaper and available alternative compared to other forms of endoprosthesis reconstruction
Summary
Primary sarcomas of the pelvis account for 10% to 15% of primary bone tumours and pelvis is considered the third most common site for metastasis. Periacetabular resections are associated with a high incidence of complications, mainly infection and reconstruction failure [2,3,4]. This is usually due to the difficulty of reconstruction of the acetabulum cup and the local forces acting on this anatomical region. There are various custom-made endoprosthesis available but these are expensive and their long term results are not encouraging They are associated with high rate of morbidity, infection, and failures [11]. The mean load to failure for the standard acetabular cup construct was 3297.3 ± 117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8 ± 7.0 N. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option
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