Abstract
BackgroundOur purpose was to examine the outcomes of patients who underwent extensive resection of periacetabular tumors involving the sacroiliac joint and joint reconstruction with a hemipelvic endoprosthesis.MethodsThe records of 25 consecutive patients diagnosed with Enneking type I/II/IV pelvic tumors from 2010 to 2016 who received resection and hemipelvic endoprosthesis reconstruction were retrospectively reviewed.ResultsThe median follow-up period was 48 months. At the most recent follow-up, 11 patients were alive, with estimated 3- and 5-year survival rates of 45.6 and 38.0%, respectively. Fourteen patients died, with a mean survival of 20.8 months, and 8 patients had local recurrence at an average of 9.3 months after surgery. Distal metastases were detected in 11 patients at an average of 11.0 months after surgery. The total complication rate was 56.0%, and the most common complications were wound healing disturbances (28.0%) and deep infections (16.0%). The prosthesis-related complication rate was 24.0%; periprosthetic infections and aseptic loosening were most common. The estimated 1- and 3-year prosthesis survival rates were 81.2 and 63.2%, respectively. The mean Musculoskeletal Tumor Society score was 48.0%. Function and prosthesis-related complications did not differ significantly after adding an extra screw fixation to the first sacral vertebra.ConclusionsReconstruction with the hemipelvic endoprosthesis described herein provides satisfactory function with a relatively low complication rate. Adding an extra screw fixation to the first sacral vertebra was not associated with any improvement in the clinical results after short-term follow-up. Improvement and further studies of this endoprosthesis are needed.
Highlights
Our purpose was to examine the outcomes of patients who underwent extensive resection of periacetabular tumors involving the sacroiliac joint and joint reconstruction with a hemipelvic endoprosthesis
Of the 8 patients with local recurrence, the surgical margins were wide in 1 patient, marginal in 3 patients, and 4 patients had intralesional margins
Limb salvage surgery combined with chemotherapy and radiotherapy for the treatment of pelvic tumors is associated with similar survival and recurrence rates as traditional hemipelvectomy [9,10,11]
Summary
Our purpose was to examine the outcomes of patients who underwent extensive resection of periacetabular tumors involving the sacroiliac joint and joint reconstruction with a hemipelvic endoprosthesis. Malignant pelvic tumors are associated with a poor survival rate. Treatment of patients with extensive malignant tumors is challenging due to the difficulty of reconstruction of pelvic bone defects after resection of tumors with wide involvement. Treatment is difficult when the acetabulum and/or the sacroiliac joint are involved. Limb salvage surgery is performed as this is much more acceptable to patients as compared to hemipelvectomy [1,2,3,4]. When en bloc resection of the sacral wing is required fixation and stabilization of a prosthesis is challenging [5, 6].
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