Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Abstract

Background Primary malignant tumors located near the acetabulum are usually managed by resection of the tumor with wide margins that include the acetabulum. These resections are deemed P2 resections by the Enneking and Dunham classification. There are various methods to perform the subsequent hip reconstruction. Unfortunately, there is no consensus as to the best management. In general, patients undergoing resection at this level will have substantial levels of pain and disability as measured by the Musculoskeletal Tumor Society (MSTS) scoring system. We believe there is a subset of patients whose tumors in this location can be resected while preserving all or most of the weightbearing acetabulum using navigation and careful surgical planning. Questions/purposes (1) What complications were associated with this resection; (2) what oncological outcomes (histological margins and local recurrence) were achieved; and (3) what is the function achieved by these patients? Methods This was a retrospective study of patients with periacetabular primary malignancy. From 2008 to 2014, we treated 12 patients who had periacetabular primary malignant tumors and in five, we performed resection with the weightbearing portion spared. During this period, our general indications to perform a resection that spared the acetabulum were the tumor with its resection margin not involving the weightbearing portion of the acetabulum. However, we did not perform this procedure in patients who had more cranial lesion involving the weightbearing portion or whose hip stability might be in question after the tumor excision. Three patients were women and the other two were men. Four were chondrosarcomas, whereas the other one was synovial sarcoma. Ages ranged from 46 to 60 years (average, 53 years). Minimum followup was 14 months (median, 37 months; range, 14-88 months); no patients were lost to followup before a 1-year minimum was achieved, and all patients have been seen within the last 9 months. Results There were no intraoperative or early postoperative complications. None of the five patients had a positive margin by histological assessment. No local recurrences were detected. The median functional score by MSTS was 28 out of 30 (range, 27-30). Conclusions The roof of the acetabulum is the weightbearing portion of the acetabulum. It also maintains the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed cons...

Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors

“…Marginal and intralesional resection may result in 70%–100% local recurrence 15,16. Consequently, accurate preoperative imaging assessment is vital for bone tumors 17,18. CT and MRI are the most effective modalities for this purpose.…”

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

“…In order to reduce the local recurrence rate and improve the hip function, wide resection should be performed; meanwhile, traditional wide resection of region II should be avoided. In a study of five patients with malignant neoplasms of the periacetabular region, Lam et al [ 9 ] performed acetabular-preserving resections that preserved the weight-bearing acetabulum, and satisfactory outcomes were obtained with a median follow-up of 37 months. Gerbers and Jutte [ 10 ] reported one patient with chondrosarcoma of the region III treated by partly resecting the frontal part of the acetabulum with computer assistance to obtain a safe margin and achieved an excellent postoperative function with a follow-up of 3.5 years.…”

“…This can provide precise imaging and achieve desired safe margins. Lam et al [ 9 ] reported that the precise planning of the resection was carried out with computer navigation software. In the current study, we use the Mimics software to visualize and segment the CT images and render 3D pelvic bone.…”

“…The technique “multiplanar osteotomy with limited margins” has been described by Avedian et al [ 8 ], who used this modality to successfully treat the selected patients with high-grade bone sarcomas by making angled bone cuts around a tumor; this preserves as much host bone as possible with the goal of minimizing bone and soft tissue ablation. Similarly, the technique of multiplanar osteotomy was successfully performed by Lam et al [ 9 ] and Gerbers and Jutte [ 10 ] for periacetabular neoplasm in selected patients. However, there was no reconstruction for the resulting defect following resection of periacetabular bone; this may contribute to some hip instability, accelerated osteoarthritis, and postoperative hip dislocation [ 9 , 10 ].…”

“…Similarly, the technique of multiplanar osteotomy was successfully performed by Lam et al [ 9 ] and Gerbers and Jutte [ 10 ] for periacetabular neoplasm in selected patients. However, there was no reconstruction for the resulting defect following resection of periacetabular bone; this may contribute to some hip instability, accelerated osteoarthritis, and postoperative hip dislocation [ 9 , 10 ]. Autogenous femoral head bone grafts have been widely applied for reconstruction of acetabular deficiency in cementless total hip arthroplasty (THA) for developmental dysplasia of the hip [ 11 , 12 ], and the long-term results are satisfactory.…”