Femur performed better than tibia in autologous transplantation during hemipelvis reconstruction

Abstract

BackgroundPelvic reconstruction after hemipelvectomy can greatly improve the weight-bearing stability of the supporting skeleton and improve patients’ quality of life. Although an autograft can be used to reconstruct pelvic defects, the most suitable choice of autograft, i.e., the use of either femur or tibia, has not been determined. We aimed to analyze the mechanical stresses of a pelvic ring reconstructed using femur or tibia after hemipelvectomy using finite element (FE) analysis.MethodsFE models of normal and reconstructed pelvis were established based on computed tomography images, and the stress distributions were analyzed under physiological loading from 0 to 500 N in both intact and restored pelvic models using femur or tibia.ResultsThe vertical displacement of the intact pelvis was less than that of reconstructed pelvis, but there was no significant difference between the two reconstructed models. In FE analysis, the stress distribution of the intact pelvic model was bilaterally symmetric and the maximum stresses were located at the sacroiliac joint, arcuate line, ischiatic ramus, and ischial tuberosity. The maximum stress in each part of the reconstructed pelvis greatly exceeded that of the intact model. The maximum von Mises stress of the femur was 13.9 MPa, and that of the tibia was 6.41 MPa. However, the stress distribution was different in the two types of reconstructed pelvises. The tibial reconstruction model induced concentrated stress on the tibia shaft making it more vulnerable to fracture. The maximum stress on the femur was concentrated on the connections between the femur and the screws.ConclusionsFrom a biomechanical point of view, the reconstruction of hemipelvic defects with femur is a better choice.

Three-dimensional-printed customized prosthesis for pubic defect: Clinical outcomes in 5 cases at a mean follow-up of 17 months

“…For the treatment of bone defects after type III hemipelvectomy, more and more surgeons tend to reconstruct defect because of the reported complications. Up to now, allograft, mesh repair and arti cial ligament repair are the main choices for reconstruction after type III hemipelvectomy (11,12,16). Recent reconstruction ways after type III resection were listed in Table 3.…”

“…Currently, some reconstruction methods have been reported after type III hemipelvectomy, including allograft, mesh and arti cial ligament (11,12). However, large amount of studies revealed various limitations of these reconstruction options.…”

Resection of rectal GIST using a novel technique: a report of two cases

“…Transvaginal excision was described for lesions higher on the anterior wall of the rectum, with the advantage of avoiding anal dysfunction [ 5 ]. Another method for the resection of these tumours was the perineal approach, which was implemented for GIST in the anterior wall of the rectum in some case reports [ 6 ].…”

Comparison of trans-anal endoscopic operation and trans-anal excision of rectal tumors

“…Gangping et al. [18] analyzed 116 patients with rectal cancer who underwent transanal excision and concluded that TAE for rectal cancer is satisfactory for T1 stage tumors, but it is not suitable for T2 stage tumors due to the high local recurrence rate in T2 lesions (6% vs. 15%, respectively).…”