Periacetabular Reconstruction Research Articles

LUMiC® endoprosthesis for pelvic reconstruction: A Canadian experience.

The LUMiC® prosthesis was introduced to reduce the mechanical complications encountered with periacetabular reconstruction after pelvic tumor resection. Few have evaluated the outcomes associated with its use. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. All patients with a LUMiC® endoprosthesis were included. Their charts were reviewed for surgical and functional outcomes. A total of 16 patients were followed for 28 months (3-60). A total of 12 patients (75%) had a LUMiC® after a resection of a primary sarcoma. Mean surgical time was 555 min. Four patients (25%) had a two-stages procedure. MSTS score was 60.3 preoperatively and 54.3 postoperatively. Patients got a dual mobility bearing and the silver coated implant was used in 7 patients (43.7%). Five patients (31.3%) underwent capsular reconstruction using a fabric. Silver-coating was not found to reduce infection risk (p = 0.61) and capsuloplasty did not prevent dislocation (p = 0.6). Five patients had peroperative complications (31.3%). Eight patients (50%) had an infection including all four with two-stages surgery. Dislocation occurred in five patients (31.3%) whereas no cases of aseptic loosening were reported. A total of 10 patients (62.5%) needed a reoperation. LUMiC® endoprosthesis provides low rates of aseptic loosening on medium-term follow-up. Infection and dislocation are common complications but we were unable to show benefits of capsuloplasty and silver-coated implants.

Porous tantalum acetabular cups for reconstructions after peri-acetabular resections of primary bone tumours.

Periacetabular reconstruction after resection of primary bone tumour is a very demanding procedure. They are frequently associated with scarce functional results and a high rate of complications. We report a series of patients with periacetabular resections for primary bone tumours and reconstruction with a porous tantalum (PT) acetabular cup (AC). 27 patients (median age 30 years) were included, being affected by primary bone tumours of the pelvis and treated with peri-acetabular resection and reconstruction with a PT AC. The diagnoses were 13 osteosarcomas, 7 chondrosarcomas and 7 Ewing sarcomas. Function was assessed with the Harris Hip Score and complications were classified according to Zeifang. The median follow-up was 70 months. 1 patient required removal of the PT AC because of implant associated infection 55 months after surgery. There was 1 hip dislocation and no case of aseptic loosening. At final follow-up, the median HHS was 81 points (range 48-92). The used PT AC had good medium-term survival rates and good functional results. This technique is a viable reconstructive option after resections of periacetabular primary bone sarcomas.

Limb-salvage reconstruction following resection of pelvic bone sarcomas involving the acetabulum.

Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J2021;103-B(4):795-803.

A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options.

Management of periacetabular lesions involves complex clinical decision making. The modified Harrington procedure with total hip arthroplasty can recreate pelvic stability with a cement rebar construct as well as a functional hip. This study analyzes the modified Harrington procedure to assess construct longevity and patient outcomes. We queried a prospectively maintained database to identify all patients at a large academic medical center from 2017 to 2019 with periacetabular metastatic disease treated with a modified Harrington. Medical records were reviewed and complications, patient outcomes, Musculoskeletal Society Tumor (MSTS) scores, and implant survival were recorded. A total of nine patients were treated with the modified Harrington between 2017 and 2019. At maximum follow- up there were zero revisions or longterm complications. The mean preoperative MSTS score was 2.2 (range, 0-18), compared to the mean postoperative MSTS score of 17.7 (range, 9-25) recorded at a mean 4 (range, 1-30) months following surgery (p<0.001). The modified Harrington technique total hip technique for reconstruction in periacetabular metastatic bone disease is a safe procedure with effective symptom relief, improvement in function, and excellent implant survivorship.

Pelvis weight-bearing ability after minimally invasive stabilizations for periacetabular lesion.

Periacetabular metastatic lesions cause debilitating weight-bearing pain and pose a risk of pelvic pathologic fracture. Minimally invasive percutaneous stabilization is an alternative palliative therapy over extensive open reconstructive surgeries. This study aimed to investigate the biomechanical behaviors of three distinct techniques of percutaneous periacetabular stabilization. A total of 20 composite hemipelves custom-made to contain Harrington type III periacetabular lesion based on a patient's computed tomograpy scans were assigned to treatment groups of cementoplasty alone using polymethyl methacrylate (Cement), screw fixation alone using ischial and posterior-to-anterior screws (Screws), cement-augmented screws (Screws&Cement), and a control group (Untreated). All hemipelves were loaded in a mechanical test configuration mimicking a single-legged stance, and failure load, failure deformation, and construct stiffness were determined. In the experiments, Screws&Cement demonstrated the highest yield strength (4711 ± 362 N) and was 12% higher than Cement (4005 ± 304 N, p = 0.019), 125% higher than Screws (2097 ± 359 N, p < 0.0001), and 184% higher than Untreated (1658 ± 254 N, p < 0.0001). No significant difference in yield strength was found between Screws and Untreated. Screws&Cement also demonstrated the highest stiffness (1013 ± 92 N/mm), followed by Cement (893 ± 49 N/mm), and both groups were significantly stiffer than Screws (543 ± 114 N/mm, p < 0.0001) and Untreated (580 ± 91 N/mm, p < 0.0001 for Screws&Cement, and p = 0.0003 for Cement). Thisstudy demonstrated that a cement-augmented periacetabular reconstruction is an effective option for percutaneous treatment of Harrington III periacetabular metastatic lesion. The addition of pelvic screws over cementoplasty significantly improved the pelvis load-bearing strength. When large periacetabular lesions are present, augmented screw fixation appears to be the superior choice of treatment.

Endoprosthetic Reconstruction of Type II Pelvic Resections.

The aim of the study was to evaluate the outcomes of pedestal cup and METS coned hemipelvis implants for periacetabular reconstruction after type II pelvic resections, including complications, failure rates, and functional outcomes. We retrospectively reviewed 25 patients, divided in two groups, who underwent internal hemipelvectomy and periacetabular reconstruction using either a pedestal cup (Group A = 13) or a METS coned hemipelvis (Group B = 12). The clinical, radiological, and oncological outcomes, as well as the complications, were assessed. There were no differences between the two groups regarding capacity for independent walking at 12 months and functional results. Mechanical and nonmechanical complication rates were also similar for the two groups. The two-year cumulative incidence of failure was 7.6% (95% CI 0.3-18.3) for group A and 8.8% (95% CI 1.7-20.1) for group B, while the four-year cumulative incidence of failure was 11% (95% CI 0.2-28.9) and 14.1% (95% CI 2.2-33.1), respectively. This study showed that both types of pelvic implants are reliable options for periacetabular reconstruction of bone defects after type II oncologic pelvic resections, having similar complication rates and functional results.

LUMiC\xae Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

LUMiC\xae Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

Functional outcome and complications following reconstruction for Harrington class II and III periacetabular metastasis.

BackgroundMetastatic bone disease involving the acetabulum is a debilitating condition causing significant pain and disability for patients. Many methods of reconstruction have been described for treating Harrington class II and III lesions with different results and complications. Our objectives were to report functional results, implant survival and complications following reconstruction for Harrington class II and III periacetabular metastases by using anti-protusio cages, screws and joint replacement.MethodsWe reviewed 22 patients undergoing acetabular reconstruction for metastatic disease. There were 5 Harrington class II and 17 class III lesions. Intralesional curettage, multiple screws and cemented total hip replacement were performed in all patients. Anti-protusio cages were used in 19 hips. No Steinmann pins were used. Sixteen patients died at a median survival time of 12 months (range, 4 to 28 months) after surgery. Six patients were alive at last follow-up at a median of 8 months (range, 3 to 15 months).ResultsPostoperatively, the average ECOG score was improved from 3.1 to 1.7 and Visual Analog Scale was improved from 8.4 to 2.2. One patient developed hip dislocation and one patient developed superficial infection. The mean Musculoskeletal Tumor Society (MSTS) functional score was 70 (range, 27 to 87). There was no prosthetic loosening or revision. Twenty patients were able to walk. Eight patients became community ambulators, twelve became household ambulators and two were bed-bound.ConclusionsGood functional outcome and better ambulation could be expected following class II and III periacetabular reconstruction using anti-protusio cages, screws and cemented hip replacement. Few complications were noted and manageable. Although most of these patients with metastatic disease had limited life expectancies, their quality of life would be improved with appropriate patient selection and surgical reconstruction.

Modified Harrington reconstruction for advanced periacetabular metastatic disease

Destructive metastatic lesions about the acetabulum result in pain and functional limitations. We assessed whether periacetabular reconstruction (PAR) improves quality of life by examining outcome measures of pain, function, and mobility. Thirty-seven patients with a mean follow-up of 23.6 months (range, 0.5-112 months) were retrospectively reviewed. All patients underwent modified Harrington reconstruction with periacetabular screws, cement, and total hip arthroplasty. The mean preoperative MSTS score of 14 (47%, 14/30) improved to 20 (67%, 20/30) after the procedure. Thirty-five patients who were alive 1 month after the procedure were reviewed for outcome. Postoperatively, patients reported a significant improvement in pain (P < 0.0001), mobility (P < 0.0385), and function (P < 0.0186). Kaplan-Meier survivorship curves showed 59% implant- and 55% patient survival at 2 years; and 49% implant- and 39% patient survival at 5 years. Complications included infection (16%, 6/37) and instability (16%, 6/37). Our experience with PAR has shown good results with improved postoperative functional scores. Implants will generally exceed life expectancy and are an option to restore quality of life.

Periacetabular Reconstruction with a New Endoprosthesis

Periacetabular Reconstruction with a New Endoprosthesis

Periacetabular Reconstruction with a New Endoprosthesis

Reconstruction of the Type II pelvic resection is challenging. Currently available reconstructive options have inherent problems including graft and implant failure, pain, poor function, and high major complication rates. The periacetabular reconstruction (PAR) endoprosthesis was designed to be secured with internal fixation and bone cement to the remaining ilium and support a reconstructed acetabulum. This construct potentially avoids the complications of graft or hardware failure, while maintaining early mobilization, comfort, limb lengths, and function. We retrospectively reviewed 25 patients who underwent Type II pelvic resection and reconstruction with the PAR endoprosthesis, analyzing function, complications, and survivorship. The minimum followup was 13 months (mean, 29.4 months; range, 13 to 108 months). We compared the PAR data with the literature for the Mark II saddle endoprosthesis. The PAR's average MSTS score was 20.8 (67%), major complications occurred in 14 (56%), and implant survivorship was 84% at 2 years and 60% at 5 years. The rate of failure at the ilium-saddle interface was lower and implant survivorship higher than those in the published literature for the Mark II saddle. We recommend use of the PAR endoprosthesis for reconstruction of large defects following Type II pelvic resection. The modified saddle design provides greater inherent stability, allowing for faster rehabilitation and improved longevity without increased complications and is an improvement over the currently available saddle prostheses. Level III, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence.

Reconstruction of type II pelvic resection with a new peri-acetabular reconstruction endoprosthesis

We report our early experience with a new peri-acetabular reconstruction endoprosthesis used for pelvic reconstruction after tumour resection. The outcome of 21 patients who underwent limb salvage following type II pelvic resection and reconstruction using the peri-acetabular reconstruction prosthesis between 2000 and 2006 was retrospectively reviewed. This prosthesis was designed to use the remaining part of the ilium to support a horizontally placed acetabular component secured with internal fixation and bone cement. Into this device a constrained acetabular liner is positioned which is articulates with a conventional femoral component to which a modular extension and modular head are attached. The mean follow-up was 20.5 months (1 to 77). The most common complications were deep infection, superficial wound infections, and dislocation. The mean musculoskeletal tumor society functional outcome score for the survivors was 20.1(11 to 27). We recommend the use of the peri-acetabular reconstruction prosthesis for reconstruction of large defects after type II pelvic resection, as this design has a greater inherent stability over other available prostheses.

Reconstruction with pasteurized autograft‐total hip prosthesis composite for periacetabular tumors

With the development of preoperative adjuvant treatment, imaging techniques, and improvement of surgical technique, limb salvage is now possible even in patients with pelvic tumors. However, reconstruction after periacetabular resection is complicated and challenging. We retrospectively evaluated the usefulness of pasteurized autograft-total hip composite in pelvic reconstruction with regard to graft survival, union, graft-related complications, and functional outcome in 14 patients with periacetabular tumor. The 5-year and 10-year survival rates of the pasteurized bones were 64.3% and 32.1%, respectively. Major complications that necessitated graft removal included infection in three, fracture in two, and loosening in three patients. The average functional score of seven long-term successful patients was 25.6 (85.2%). In spite of the high complication rate, pasteurized autograft can be considered as an option for periacetabular reconstruction in the selected patients who meet the following criteria. First, iliopectineal and ilioischial lines are radiologically intact; second, the tumor volume is small (preferably less than 100 ml).

Intrapelvic pin migration after periacetabular reconstruction and arthroplasty of the hip in metastatic pelvic disease—a case report

In January 1997, a 62-year-old man was diagnosed with a hypernephroma of the right kidney and bilat-eral pulmonary metastases. He underwent a right nephrectomy as initial surgery. Histology showed a 16-mm granular cell renal carcinoma of the lower part of the right kidney. He received chemotherapy with α-interferon for the following 11 months. In November 1999, CT showed a 4-cm osteolytic lesion from the right posterior inferior iliac spine to the roof of the acetabulum. The medial and lat-eral bony borders were partially destroyed and the lesion was therefore classified as class III accord-ing to Harrington (1981).The patient underwent local radiation therapy in December 1999, and a second course of chemo-therapy with vinblastine. Immune modulation ther-apy with α-interferon showed a partial remission of the pulmonary metastases. In addition, he received intravenous treatment with bisphosphonates. In February 2000, the patient sustained a patho-logical fracture of the right iliac wing with medial and cranial dislocation of the entire acetabulum.A second course of radiation therapy was given in August 2000. In April 2001, the patient presented with an advanced right periacetabular fracture (Figure 1). A periacetabular reconstruction and a total hip arthroplasty was performed. A reinforcement cage (Burch-Schneider, Protek, Switzerland) was com-bined with a cemented standard stem with a 28-mm metal ball head and cemented polyethylene inlay. After reduction of the fracture, structural continu-ity was achieved and reinforced with 3 Steinmann pins using the compound osteosynthesis tech-nique, i.e. the pins were entirely covered with bone cement, which filled the gap. 1 pin was inserted from the superior iliac crest to the cranial part of the acetabulum, and 2 pins through the center of the acetabulum. One of these pins was unthreaded (Figure 2). The pins were cut off flush with the iliac crest.The patient quickly regained pain-free walking using 2 crutches. At routine follow-up (6 months), he was satisfied with the functional result (Figure 3).In November 2001, the patient suffered an epi-sode of transient hematuria and was treated under the suspicion of urinary tract infection. An abdomi-nal sonography showed mild hepatic steatosis but no other abnormalities. 9 months after surgery, a routine pelvic radiograph (Figure 4) showed migration of one of the Steinmann pins. A CT scan was performed, which showed the dislocation of the pin into the pelvic cavity very close to the blad-der, the anterior side of the rectum and the prostate (Figure 5). There was no sign of any penetration of the neighbouring organs. The dislocated pin was removed under general anesthesia by a modified ilio-inguinal approach without difficulty. The his-tological findings showed no signs of local tumor

On the practical use of autography, especially for natural history publications

Background: Periacetabular reconstruction after malignant bone tumor resection to preserve limb function is extremely challenging. The optimal reconstruction method has not yet received consensus and the functional outcomes still remain unsatisfactory. Case Report: A thirteen-year-old girl who was suffering from acetabular osteosarcoma was treated with wide excision of the tumor, followed by periacetabular reconstruction with an autogenous extracorporeal irradiated osteoarticular graft combined with a vascularized fibula graft. Incorporation of the irradiated pelvic bone was achieved despite infection and limb function turned out to be acceptable. Conclusion: This is the first report on an irradiation-vascularized hybrid autograft to reconstruct massive bone loss in primary limb-sparing surgery.