An acetabular-preserving procedure for pelvic giant cell tumor involving partial acetabulum

Abstract

BackgroundThe management of pelvic giant cell tumors (GCTs) involving the acetabulum remains a challenge for surgeons on how to balance the relative benefits of minimizing recurrence and maintaining postoperative hip function. The present study was to present and evaluate the clinical indications, operative technique, and outcomes of pelvic GCTs involving partial acetabulum treated with multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless total hip arthroplasty (THA).MethodsWe retrospectively reviewed seven patients with pelvic GCTs involving partial acetabulum who underwent multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA from January 2010 to October 2014. We assess the outcome including the bone graft healing, nonunion, hardware failure, infection, tumor recurrence, and metastasis. And the functional outcome was evaluated by the Musculoskeletal Tumor Society (MSTS)93 score.ResultsAll patients were followed up for a mean of 38.1 months (range 26–61 months). All bone grafts are union. No failure of acetabular components, wound healing problem, or deep infection was suspected. No patient experienced metastasis. Recurrence was observed in one out of seven patients, treated by extended resection and implanting iodine ions in the surgical area. The mean MSTS93 score was 29.4 (range 28–30). All patients were disease-free and resumed activities of daily living at the most recent follow-up.ConclusionsAs long as one of the two columns is retained and the resulting defect does not exceed the supra-acetabular line, multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA is a viable strategy for the treatment of pelvic GCTs involving partial acetabulum. However, a large-scale prospective clinical study is still needed to verify these procedures.

RETRACTED ARTICLE: Preliminary proposal: a classification system for reconstruction with autologous femoral head after periacetabular tumors resection

“…However, our results and some relevant research showed that reconstruction with autologous femoral head grafting is feasible, and we still need more cases for verification. Although those classifications are great guides to the reconstruction of bone defects in THA revision, it does not seem to be widely used for the bone defects in periacetabular tumors resection [ 24 , 36 , 37 ].…”

“…This surgical principle is to make a corner osteotomy around the bone tumor to achieve a limited and extensive resection, so as to maximize the preservation of normal bone and soft tissue around the tumor. Some studies had applied this principle in clinical practice and achieved satisfied prognosis [ 22 – 24 ]. Inspired by those studies, we considered whether the treatment of periacetabular bone tumors could follow the principle of multiplanar osteotomy, in order to retain the patient’s bone mass, especially the part of the acetabulum [ 21 ].…”

Treatment of massive iliac chondrosarcoma with personalized three-dimensional printed tantalum implant: a case report and literature review

“…In patients with a long disease history, the tumor is always massive, and wide margin resection to avoid recurrence along with reconstruction with a sufficient biomechanical stress load can be even more challenging because of the large bone defect. 11 – 13 …”

“…In patients with a long disease history, the tumor is always massive, and wide margin resection to avoid recurrence along with reconstruction with a sufficient biomechanical stress load can be even more challenging because of the large bone defect. [11][12][13] With the developments in tissue engineering material technology, medical imaging, and 3D imaging techniques, computer-aided design of 3D orthopedic surgical implants is being more frequently used by surgeons. 14,15 In the present case, we obtained the CT data from the PACS, used Mimics 17.0 software for reconstruction, and used a 3D printing system to print out the implant.…”

Intra-articular Partial Acetabular Resection and Allograft Reconstruction for Synovial Sarcoma

“…Total hip arthroplasty was carried out primarily in these cases. Xiao et al [ 12 ] described seven patients of giant cell tumor involving acetabulum. Partial excision of the acetabulum was carried out along with reconstruction using the autologous femoral head.…”