Abstract
BackgroundAlthough researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high. Aiming for preserving the acetabulum and reducing the risk of complications, we applied a surgery method using tumor-free autologous femoral head to reconstruct the defective acetabulum after resection of periacetabular tumors followed by performing a conventional total hip arthroplasty (THA). Moreover, we proposed a preliminary classification system for these surgery methods.MethodsWe retrospectively reviewed 6 patients treated with acetabulum reconstruction combined with autologous femoral head following peri-acetabulum resection between April 2010 and May 2018. All patients were diagnosed as periacetabular tumors including chondrosarcoma (n = 5) and chondroblastoma (n = 1). Clinical data such as age, diagnosis, complications, local recurrence or metastasis, and function (Musculoskeletal Tumor Society 1993, MSTS93) were documented. The average time of follow-up was 62.5 months (range, 17 to 106 months).ResultsA total of 5 patients survive with average MSTS93 score of 27.8 points (range, 26–30). One patient, suffering from multiple bone metastasis prior treatment, ended up dying. One who had received radiotherapy before surgery had poor incision healing. Further, a classification system was preliminary proposed in 2 patients involving the pubis (type A) and 4 patients involving ischium (type B).ConclusionsBased on the results, we preliminary proposed a classification system for reconstruction with autologous femoral head after periacetabular low malignant tumors resection. The clinical results suggested that surgery methods involving pubis (type A) and ischium (Type B) are safe and feasible. However, further researches should be conducted to verify our classification system.
Highlights
Researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high
These complications are closely related to the large number of bone defects and soft tissue injuries caused by tumor resection [18,19,20]
Region C: acetabular bearing area converging anterior column and posterior column, and acetabulum of region C is divided into C1 and C2, respectively, representing the anterior column and posterior column of acetabulum giant cell tumor, or osteoblastoma or who were expected to have a longer survival time and the surgery could significantly improve the quality of life in advanced stage; (2) periacetabular tumors that involved the Enneking II region but did not breach the articular cavity; and (3) patients who received total hip arthroplasty (THA) combined with acetabulum reconstruction and autologous femoral head grafting
Summary
Researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high. A systematic study has shown that complications of these surgical procedures, including deep infection, dislocation, nonunion of bone graft, and fracture, have a total incidence of up to 50%, among which deep infection and dislocation are the most common [17]. These complications are closely related to the large number of bone defects and soft tissue injuries caused by tumor resection [18,19,20]
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