Abstract
Introduction Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision. Reconstruction using custom-made implants represents the treatment of choice. This study was conducted to analyze treatment outcomes of custom-made implants in a single orthopaedic tumor center. Patients and Methods Twenty patients with a histologically verified periacetabular malignancy and a median follow up time of 5 (1–17) years were included. Results The median number of revision surgeries per patient was 1.5 (0–7). Complications were dislocations in 3 patients, aseptic loosening in 4 patients, deep infections in 9 patients, thromboembolic events in 5 patients and sciatic nerve lesions in 4 patients. Overall survival was 77% after one year, 69% after two years and 46% after five years. Median Harris Hip Score was 81 (37–92) points at last follow up. Conclusion Although internal hemipelvectomy and reconstruction using custom-made implants is linked with a high risk of postoperative complications, good functional outcomes can be regularly achieved. This information may help treating surgeons to find adequate indications, as eligible patients need to be critically selected and integrated into the decision-making process.
Highlights
Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision
Several methods have been applied for reconstruction of the acetabulum, such as iliofemoral arthrodesis or pseudarthrosis, allograft reconstruction, irradiated, autoclaved or frozen autografts, femoral neck autografts and allograft-prosthetic composites, all of them being associated with a higher complication rate than simple excision arthroplasty or transposition of the hip [2,5,6,7]
3D models have been produced with the help of CAD techniques by milling or laser printing of raisin which served as templates to produce the endoprosthesis, 3D printing of metal allows to speed up the manufacturing process and enables the creation of rough surfaces at the bone interface for rapid and long-lasting osseointegration
Summary
Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision. Limb sparing surgery of primary malignant pelvic tumors has become the treatment of choice over the last decade, mainly due to improvement in surgical technique, imaging and perioperative management [1,2]. [11] Another significant improvement was the introduction of patient specific jigs to exactly define resection planes, which is a prerequisite for a perfect match between osteotomy and custom implant [12]. This technique of thorough planning made the procedure more straight forward and reduced surgery time
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