Abstract
We report the early results of nine patients with periacetabular malignancies treated with Enneking and Dunham type 2 resection and reconstruction using extracorporeally irradiated (ECI) tumour bone combined with total hip arthroplasty (THA). Diagnosis was chondrosarcoma in six patients, osteosarcoma in two patients, and metastatic renal cell carcinoma in one patient. All patients underwent surgical resection and the resected specimen was irradiated with 50 Gy in a single fraction before being prepared for reimplantation as a composite autograft. The mean follow-up was 21 months (range, 3–59). All patients were alive at latest follow-up. No local recurrence was observed. One patient serially developed three pulmonary metastases, all of which were resected. One experienced hip dislocation due to incorrect seating of an acetabular liner. This was successfully treated with revision of the liner with no further episodes of instability. There were no cases of deep infection or loss of graft. The average Musculoskeletal Tumor Society (MSTS) score was 75% (range, 57–87%). Type 2 pelvic reconstruction with ECI and THA has shown excellent early oncological and functional results in our series. Preservation of the gluteus maximus and hip abductors is important for joint stability and prevention of infection.
Highlights
Operations for pelvic sarcomas are among the most technically challenging procedures facing orthopaedic oncology surgeons
We have been selectively employing extracorporeally irradiated (ECI) as a reconstructive strategy since 2010. In this series we report our early results in a homogenous group of Enneking and Dunham type 2 pelvic resections [13] treated with the same reconstructive strategy of extracorporeal irradiation and reimplantation with composite total hip arthroplasty (THA)
One patient with osteosarcoma developed a single pulmonary metastasis at 12 months after surgery, which was treated with pulmonary metastasectomy
Summary
Operations for pelvic sarcomas are among the most technically challenging procedures facing orthopaedic oncology surgeons. Limited function and a high rate of complications including infection, dislocation, prosthetic loosening, and failure of limb salvage are typical For this reason some authors advocate iliofemoral fusion or resection without formal reconstruction preferring to tolerate limb shortening for a lower risk of complication [7, 8]. Pelvic sarcoma surgery is resource intensive with high potential morbidity For this reason, identifying the group of patients that are most likely to benefit from a particular surgical strategy is of great importance. We have been selectively employing ECI as a reconstructive strategy since 2010 In this series we report our early results in a homogenous group of Enneking and Dunham type 2 pelvic resections [13] treated with the same reconstructive strategy of extracorporeal irradiation and reimplantation with composite total hip arthroplasty (THA)
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