Bony reconstruction after internal hemipelvectomy: A retrospective analysis of 44 patients undergoing femoro-pelvic pseudoarthrosis.

Abstract

e23509 Background: After acetabular resection for sarcomas, achieving a bony femoro-pelvic fusion is very difficult, and prosthetic reconstructions have very high complication rates. We reconstructed the defects with a simple polypropylene mesh between the femoral head and the remaining part of the pelvis thereby aiming at a pseudo-arthrosis and analyzed its functional outcome. Methods: Between 2013 and 2022, 44 patients having bone tumors of the pelvis underwent acetabular resections and femoro-pelvic pseudoarthrosis. Commonest Histology was chondrosarcoma (23). According to Enneking’s classification, type II (3), type I+II (9) , type II+III (24), type I+II+IV (5), and type I+II+III (3) resections were carried out. A 30 x 30 cm polypropylene mesh was tied to the remains of the capsule around the head and was then turned on itself to make a strong braided rope-like structure. It was passed through the remaining ilium/ ischium/ sacrum and was tied to itself in proper rotation with heavy ethibond suture. In 4 cases, a proximal femur megaprosthesis and in 2, a nail cement spacer was implanted in femur to reduce shortening. Functional limb results were reported according to MSTS functional scores. Results: 37/44 patients attained independent ambulation. The mean time to full weight bearing was 4.7 months (3-9 months). There were 6 flap necrosis, 3 infections, 1 nerve injury, and 1 vascular injury. Local recurrence occurred in 6 (13%) and Systemic metastasis developed in 20 patients (47% of malignant tumors). At an average follow-up of 56 months ( 24 – 127 months), 26 are alive without any signs of disease. The average MSTS score was 22 (range 13–27). The best MSTS scores were with type II or II+III IH where ilium was left to support the femur while the worst was with type I+II+III resection patients. Patients with higher BMI have poorer functional outcomes with meshplasty. Conclusions: Mesh-pseudoarthrosis is a very simple reconstruction option that has an excellent functional outcome. It reduces surgical time and eliminates uncertainties about fusion/joint replacement. This should be strongly recommended as a method of reconstruction for patients undergoing acetabular resections.