Limb-salvage reconstruction following resection of pelvic bone sarcomas involving the acetabulum

Abstract

Aims Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. Methods The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). Results The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). Conclusion Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795–803.

Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas

“…A recent study from Birmingham compared the surgical outcomes, according to the type of pelvic resection, in the largest cohort of patients who underwent acetabular reconstruction (n = 122; custom-made prosthesis, ice-cream cone prosthesis, extracorporeal irradiated autograft, and nonskeletal reconstruction). The overall functional scores were significantly lower in patients with major complications than in those without (mean MSTS, 52% versus 74%) [84] . In patients who underwent periacetabular resections involving the ilium, the functional scores were higher with a custom-made prosthesis (MSTS, 82%) if no major complication occurred, whereas nonskeletal reconstruction resulted in the highest scores (MSTS, 78%) if patients had major complications [84] .…”

“…The overall functional scores were significantly lower in patients with major complications than in those without (mean MSTS, 52% versus 74%) [84] . In patients who underwent periacetabular resections involving the ilium, the functional scores were higher with a custom-made prosthesis (MSTS, 82%) if no major complication occurred, whereas nonskeletal reconstruction resulted in the highest scores (MSTS, 78%) if patients had major complications [84] . In patients treated with periacetabular resections that do not involve the ilium, ice-cream cone prosthesis, supported with antibiotic-laden cement, resulted in superior functional outcomes (MSTS, 79%).…”

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

“…High complication rates have been reported in acetabular reconstructions [13] , [16] , [32] , [33] , [34] , [35] . Among various types of complications, deep infection and LR are the most serious and frequent and are common causes of implant failure [16] , [19] , [33] , [35] , [36] , [37] , [38] .…”

“…1 ), or the other procedures; cemented THR or trabecular metal acetabular cup (Trabecular Metal Acetabular Augment and Restrictor; Zimmer, Indiana, USA), according to the procedures we previously reported [11] , [13] , [14] , [15] . The pelvic reconstruction type depended on the extent of the resection [16] . Initial reconstructions all involved custom-made prostheses.…”

“…Initial reconstructions all involved custom-made prostheses. This procedure was deemed appropriate if sufficient ilium remained to support the prosthesis tumour resection [11] , [14] , [16] . In 2003, in an attempt to decrease the high infection rates seen in early series of prosthetic reconstruction, the ice-cream cone prosthesis was developed and introduced in our unit [13] , [17] .…”