Alloprosthetic Composite is a Suitable Reconstruction After Periacetabular Tumor Resection

Donati, Davide María; Bella, Claudia Di; Frisoni, Tommaso; Cevolani, Luca; DeGroot, Henry

doi:10.1007/s11999-011-1799-9

Cited by 54 publications

(73 citation statements)

References 17 publications

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“…In another study, after treatment of deep infection of a hemipelvic prosthesis with implant removal and its substitution with an antibiotic-impregnated bead and spacer, two of three patients achieved healing, however, the third patient underwent an external hemipelvectomy because of persistent infection [36]. In a previous study from our institute concerning pelvic reconstruction with massive allograft, implants were removed in six of eight patients with deep infections [14]. Two of these infections were related to contaminated allografts, which raises the question regarding whether irradiation of the allograft might reduce the risk of infection, even if it might imply an increase of failure risk [34].…”

Section: Discussionmentioning

confidence: 98%

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

Angelini

Drago

Trovarelli

et al. 2014

Clinical Orthopaedics &Amp; Related Research

130

122

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Background Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. Questions/purposes We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. Methods From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection.Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. Results A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection.

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Section: Discussionmentioning

confidence: 98%

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

Angelini

Drago

Trovarelli

et al. 2014

Clinical Orthopaedics &Amp; Related Research

130

122

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“…This implant is composed of a revision-type prosthesis inserted inside a bone allograft to which the residual abductors and the iliopsoas muscle tendons are biologically reinserted, which should reduce the risk of postoperative dislocation and give better function (Gitelis et al 1988, Zehr et al 1996, Giurea et al 1998, Anract et al 2000, Langlais et al 2003, Farid et al 2006, Biau et al 2008, Donati et al 2008, 2011). In a comparative study on MP and APC, however, Zehr et al (1996) found no differences in function and survival.…”

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confidence: 99%

Comparison of allograft-prosthetic composite reconstruction and modular prosthetic replacement in proximal femur bone tumors

Benedetti¹,

Bonatti²,

Malfitano³

et al. 2013

Acta Orthopaedica

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Background and purpose The methods of reconstruction for proximal femur bone tumors that are used most often include modular prosthetic replacement and allograft-prosthesis composite reconstruction. In modular prostheses, the abductors are detached from the insertion and then reinserted into the implant, and the iliopsoas is detached and left free. In the allograft-prosthesis composite, the detached tendons are fixated to the graft. We assessed whether the latter procedure provides functional advantages regarding gait.Patients and methods We studied 2 groups of 10 patients, each with prosthetic reconstruction of the proximal femur either with modular prosthetic replacement or with allograft-prosthesis composite. Functional performance was analyzed by gait analysis 2.5–10 years after surgery. At that time, all the patients had good function according to the Musculoskeletal Society score.Results Walking speed was reduced in all patients, and especially in patients with modular prosthetic replacement. Different hip extension patterns during late stance were found in the 2 groups. Surface EMG showed a typical prolonged muscle co-contraction pattern during gait, which was more evident in modular prosthetic patients.Interpretation Although both procedures provided good functional outcome in the long-term follow-up, gait analysis revealed mechanical changes during gait that were probably related to the muscle reinsertion procedure. Direct fixation of the muscles to the bone graft appeared to result in a more efficient muscular recovery.

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“…The main advantages of massive allograft reconstruction are restoration of the pelvic bony architecture, a durable fixation with bony union providing normal biology, and good function in concomitance with a total hip prosthesis. [1][2][3][4] However, high complication rates are associated with allograft reconstruction after pelvic resections. [4][5][6] Infection is one of the most frequent and disastrous complications.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] However, high complication rates are associated with allograft reconstruction after pelvic resections. [4][5][6] Infection is one of the most frequent and disastrous complications. Late-onset infection occurred in our patient at four-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Two-staged revision with custom made prosthesis in septic failure of massive allograft reconstruction after type II-III pelvic resection

Bekmez

Ayvaz

Mermerkaya

et al. 2014

Eklem Hastalik Cerrahisi

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Alloprosthetic Composite is a Suitable Reconstruction After Periacetabular Tumor Resection

Abstract: An allograft-prosthetic composite provides a versatile substitution of the pelvis and hip, with functional scores approximately 75% of normal.

Cited by 54 publications

References 17 publications

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

Comparison of allograft-prosthetic composite reconstruction and modular prosthetic replacement in proximal femur bone tumors

Two-staged revision with custom made prosthesis in septic failure of massive allograft reconstruction after type II-III pelvic resection

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