How does iliosacral bone tumor resection without reconstruction affect the ipsilateral hip joint?

Abstract

BackgroundWhether reconstruction is more beneficial after iliosacral bone tumor resection remains controversial. Because of high rates of complications and recurrence, few patients benefit from reconstruction. The aim of this study is to assess functional outcomes and to reveal changes in the ipsilateral hip joint after partial iliosacral resection.MethodsFrom 1998 to 2016, 21 patients aged 20–66 years underwent iliosacral resection, 18 without reconstruction (group 1) and 3 with reconstruction (group 2). Function was evaluated using the Musculoskeletal Tumor Society 1993 rating scale (MSTS 1993), and disability was measured using the Toronto Extremity Salvage Score (TESS). I-A distance was defined as the distance from the iliosacral joint to the upper line of the acetabulum along the curved line. Group 1 were subdivided into two groups: group 1A included the patients with a defect less than one-third of the I-A distance and group 1B the remainder. Acetabulum-head index (AHI) and center-edge angle (CE angle) were measured. The relationship between defect length and femoral head coverage was analyzed.ResultsThe mean follow-up was 67.3 months. Eighteen patients were included in group 1 and three in group 2. Preoperative data of the 3 groups were statistically equivalent. In addition, no difference of postoperative functional outcome has been highlighted. The final average MSTS 1993 score was 93.6% in group 1 and 93.3% in group 2. The mean TESS was 98 in group 1 and 98.5 in group 2. AHI and CE angle between groups 1 and 2 were not different. The AHI was 80 ± 5.4% in group 1A and 67 ± 9.0% in group 1B (t = − 3.740, P = 0.002), while the CE angle was 29 ± 5.9° in group 1A and 20 ± 6.3° in group 1B (t = − 3.172, P = 0.006) at the last follow-up. Regarding the limb-length discrepancy, group 1 and 2 were similar whereas group 1A and 1B were statistically different (group 1A: 0.7 ± 0.7 cm; group 2: 2.6 ± 1.0 cm; t = − 4.324, P = 0.001).ConclusionsIlio-sacral resection without reconstruction removing more than one- third of the I-A distance leads to an impairement of the limb-length discrepancy and an increase of the defect of the acetabular coverage without altering the functional outcome. Nevertheless, iliosacral resection without reconstruction could serve as a viable treatment option for pelvic type I-IV tumors.

Iliectomy with limb preservation for a dog with ilial osteosarcoma: Surgical description and case report

“…12 Good functional outcome has been noted in man without reconstruction postresection, 19 although limb length discrepancy and decreased acetabular coverage was reported in all patients. 14,19 Given the biomechanical differences between man and dog, caution should be exercised in extrapolating from human research regarding the requirement for stabilization.…”

“…Reconstruction to improve ambulation after resection of the wing of the ilium may include bone grafts, plates, and prostheses; however, some authors do not recommend reconstruction when the acetabulum is not resected . Good functional outcome has been noted in man without reconstruction postresection, although limb length discrepancy and decreased acetabular coverage was reported in all patients . Given the biomechanical differences between man and dog, caution should be exercised in extrapolating from human research regarding the requirement for stabilization.…”

En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint

“…When no reconstruction is done, medialization of the hip joint closer to the center of gravity means the moment produced by the body weight is smaller because it acts over a shorter lever arm, which results in improved single‐leg stance for the patient. Niu et al . performed resection of sacroiliac joint tumors in 21 patients, 18 of whom were not reconstructed, and three of whom were reconstructed.…”

“…It is more difficult to reconstruct pelvic ring integrity after resection of tumors. Beadel and Niu advocated that the pelvic ring should not be reconstructed after resection of iliosacral joint tumors. More and more literature reported different methods of pelvic ring reconstruction, which can be divided into two types: one is screw rod internal fixation combined with bone grafting, the other is titanium plate and screw internal fixation combined with bone grafting.…”

Transarticular Invasion of Primary Bone Tumors and Tumor-Like Lesions Near the Sacroiliac Joint: an MRI Study in 128 Patients

“…Due to the deep location of a primary bone tumor near the sacroiliac joint, the tumor may invade the sacroiliac joint or even cross it at the time of diagnosis. Preoperative definite diagnosis of transarticular invasion of the sacral or iliac tumor may have guiding significance in the determination of the surgical regimen [1,2]. Imaging studies of pelvic bone tumors invading the sacroiliac joint or across the sacroiliac joint have been rarely reported in the literature [3][4][5][6].…”