Clinical and functional outcomes of the saddle prosthesis

Abstract

BackgroundThe implantation of a saddle prosthesis after resection of a pelvic tumor has been proposed as a simple method of reconstruction that provides good stability and reduces the surgical time, thus limits the onset of intraoperative complications. There are no studies in the literature of patients evaluated using gait analysis after being implanted with a saddle prosthesis. The present study is a retrospective case review aimed at illustrating long-term clinical and functional findings in tumor patients reconstructed with a saddle prosthesis.Materials and MethodsA series of 15 patients who recieved pelvic reconstruction with a saddle prosthesis were retrospectively reviewed in terms of clinical, radiographic, and functional evaluations. Two patients were additionally assessed by gait analysis.ResultsLong-term functional follow-up was achieved in only 6 patients, and ranged from 97 to 167 months. Function was found to be rather impaired, as a mean of only 57 % of normal activity was restored. Gait analysis demonstrated that the implant had poor biomechanics, as characterized by very limited hip motion.ConclusionsThough the saddle prosthesis was proposed as advance in tumor-related pelvic surgery, the present study indicates that it yields unsatisfactory clinical and functional results due to both clinical complications and the poor biomechanics of the device. The use of a saddle prosthesis in tumor surgery did not provide satisfactory results in long-term follow-up. It is no longer implanted at our institute, and is currently considered a “salvage technique.”Level of evidenceLevel IV.

The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection

“…29 High complication rates have been reported with the use of various types of endoprosthetic reconstruction because of difficulty in achieving adequate initial fixation and reliable bone ingrowth. 13,14,[30][31][32] This precludes the use of these implants in patients needing a P1/2 resection. Menendez et al 11 reported a 56% incidence of major complications and 60% five-year implant survivorship with the use of the periacetabular reconstruction (PAR) endoprosthesis.…”

“…Menendez et al 11 reported a 56% incidence of major complications and 60% five-year implant survivorship with the use of the periacetabular reconstruction (PAR) endoprosthesis. There have been several reports on the outcome of the use of the saddle prosthesis in periacetabular tumours: the major reported complications were infection (16.7% to 26.7%), periprosthetic fracture (13.3% to 22.2%), and dislocation (18.8% to 22.2%), 1,30,31,33,34 with the patients having a mean MSTS functional score of 50.8% to 57%. However, the implant survivorship was poor being 33.3% at five years.…”

Types of extended organ-sparing and reconstructive surgical interventions for tumor involvement of the cotyloid cavity

“…Все они характеризуются достаточно высокой частотой развития осложнений и неоднозначными функ-циональными результатами после операции. По мнению большинства специалистов, занимающихся реконструк-тивной онкохирургией тазового кольца, универсальной методики реконструкции параацетабулярной области при опухолевом поражении в настоящее время не существует [1,15,18,21,34,35,[47][48][49]. Анализ данных литературы свидетельствует об актуальности обсуждаемой проблемы и перспективности совершенствования имеющихся и разработки новых методик органосохраняющего лечения этих пациентов.…”

“…Однако, несмотря на объективные успехи развития реконструктивной хирургии в онкологической ортопедии, эти операции до сих пор остаются трудоем-кими и сложными оперативными вмешательствами, ха-рактеризующимися значительной продолжительностью, выраженной кровопотерей, длительной послеоперацион-ной реабилитацией и высокой частотой послеоперацион-ных осложнений [15,16]. При этом большинство специ-алистов тазовой онкохирургии считают, что нарушение непрерывности тазового кольца после удаления опухоли в области вертлужной впадины, подвздошных костей и крестцово-подвздошного сочленения требует выполне-ния реконструкции.…”

Outcomes following periacetabular tumor resection: A 25‐year institutional experience

“…Limb salvage following periacetabular resection has evolved over recent years due to the growing availability of reconstructive options. Numerous studies have investigated the types of reconstruction, with options including hip transposition, [1][2][3][4] allografts, [5][6][7][8][9][10] saddle prostheses, [11][12][13][14][15][16][17] modular and custom prostheses, 11,[18][19][20][21][22] as well resection without reconstruction (resection arthroplasty), 2,[23][24][25][26][27] and amputation. 1,3,14,23,28 Resection arthroplasty on is associated with low complication and recurrence rates.…”