Limb-salvage reconstruction with MUTARS® hemipelvic endoprosthesis: A prospective multicenter study

Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors

“…Dislocation and aseptic loosening of endoprostheses are other major postoperative complications. The rates of dislocation (16%) and aseptic loosening (8%) in the present series were also comparable to other reported series: 2.5% to 17% for dislocation [1,11,14,24,27,[36][37][38]] and 3.7% to 25% for aseptic loosening of implants [11,14,21,27,38]. Four patients sustained dislocations caused by violent falls despite the use of a constrained joint mechanism, three of whom also had concomitant deep infection.…”

“…Several hemipelvic implants with a similar concept as our C-THA, with a constrained hip mechanism, have been recently reported [11,24,38] and are now widely available. Their mean MSTS/ISOLS functional scores were also similar to the present series although postoperative function was considerably affected by complications such as deep infection and implant dislocation.…”

“…hemipelvic prostheses [1,18,27,36,37], 11% to 24% in modular-type hemipelvic prostheses [11,14,24,38], and 8% to 60% in allograft reconstruction [2,22,23,26,39]. To reduce the risk of postoperative deep infection, we need to adopt intraoperative repeated and meticulous ultrasonic irrigation, routine use of antibiotic-loading bone cement, application of muscle/or musculocutaneous flap, and twostaged reconstruction after tumor resection followed by a ''Reconstruction cup'' (C-THA) endoprosthesis 55% (30%-80%) 32%…”

“…A polyethylene terephthalate synthetic mesh, named the Trevira tube (Implantcast, Buxtehude, Germany), is useful to prevent dislocation by forming a pseudocapsule around the hip [11,18,38]. We alternatively use a proline synthetic mesh to reduce the risk of C-THA dislocation in some cases on demand.…”

“…However, limb-salvage reconstruction of malignant pelvic tumors, especially in the periacetabular region, remains challenging because of the complex anatomy, the difficulty achieving wide surgical margins, and large bone and soft tissue defects after tumor resection. The reconstructive options include resection arthroplasty [7,30,33], iliofemoral or ischiofemoral arthrodesis [9,12], hip transposition method (pseudarthrosis) [3,12,32], free-vascularized fibular graft for pelvic ring reconstruction [29], allograft [2,22,23,26,39], recycled autologous bone graft [16,20], and endoprosthetic replacement [1,4,11,14,18,21,24,25,27,28,34,[36][37][38]. However, no standard reconstructive procedure exists after internal hemipelvectomy for malignant periacetabular tumors.…”