Precise single column resection and reconstruction with femoral head plus THR for malignant pelvic tumors

Abstract

Background Some malignant pelvic tumor may affect the anterior or posterior column at the acetabula area. The postoperative recurrenceand complication rate are high. Precise resection with safe surgical margin could cure the patients while saving healthier host bone for relative simple reconstruction.Questions/Purposes The purpose of this study is to evaluate the effect of precise single column resection and reconstruction with femoral head plus THR for malignant pelvic tumorswith respect to the (1) surgical safety, (2) oncological outcome and (3) prosthesis survivorship and function.Methods This is a clinical cases study. From 2007 to 2015, 19 patients with primary malignant tumors of the pelvis were enrolled in the study. The diagnosis included 16 cases of chondrosarcoma, 1 case of undifferentiated polymorphic sarcoma, 1 case of Ewing's sarcoma and 1 case of solitary plasmacytoma. All tumors were resected with safe surgical margins, which were proved by the postoperative specimen evaluation. Anterior column was involved in 17 cases and posterior column in 2 cases. Ten of 19 tumors were resected assisted by computer navigation. Femoral heads were used to reconstruct anterior or posterior column defects and fixed by screws; THR was used for the joint reconstruction. Oncologic outcome and function were evaluated by regular follow-up.Results The follow up time was more than 12 months in 14 cases with the average of 58.4 months (median 61, range 13-118) months. Surgical margins contained wide resection in 12 cases and marginal resection in 7 cases. The bony wide resection rate was 90% (9/10) in the navigation group and 77.8% (7/9) in free hand group respectively. One patient with Ewing's sarcoma died 14 months postoperative due to lung metastasis. There was only one case with chondrosarcoma was found recurrence in 61 months postoperatively, who was in the navigation group and having marginal margin resection. There was one prosthesis removed due to prosthesis infection (14 months postoperatively). There were another two patients with minor wound infection. The average MSTS function score was 24.8 (17-29).Conclusions The current treatment method is oncological safe and functional with less complications. The hardware is relatively cost effective and right on the shelf. However, this procedure is highly skill needed.