Outcome in Two Groups of Patients with Allograft-Prosthetic Reconstruction of Pelvic Tumor Defects

Beadel, G.; McLaughlin, Catherine E; Wunder, Jay S.; Griffin, Anthony M.; Ferguson, Peter C.; Bell, Robert S.

doi:10.1097/01.blo.0000180048.43208.2f

Cited by 50 publications

(41 citation statements)

References 26 publications

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“…In this way we try to explain the long-lasting pain-free course of the surviving patients, even if we observed a slowly decreasing range of motion within time. The main risk in large pelvic resections is the peri-operative mortality also observed by others [2]. Once healed, the pelvic allograft functions surprisingly well [2,15].…”

Section: Discussionmentioning

confidence: 95%

“…The main risk in large pelvic resections is the peri-operative mortality also observed by others [2]. Once healed, the pelvic allograft functions surprisingly well [2,15]. We observed necrosis in the adjacent healthy bone in LR-local recurrence, F graft fracture, res.-resorption of graft, PA-pseudoarthrosis, Met-bone metastases, MM-multiple myeloma, CHS-chondrosarcoma, EWS-Ewing sarcoma, OSA-osteosarcoma, GCT-giant cell tumour two cases: patient in Fig.…”

Section: Discussionmentioning

confidence: 97%

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Massive allografts in tumour surgery

Matéjovský

Kofránek

2006

International Orthopaedics (SICOT)

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We offer our personal experience of the use of massive bone allografts after tumour resection. We demonstrate the long-term results from 71 patients (72 allografts) operated on between 1961 and 1990. The long-term survival rate in osteoarticular and intercalary grafts is around 60%. Fractures of the graft can be salvaged in most cases. Infection leads to the removal of the graft in almost all cases. Factors influencing the survival, remodelling and complications of the grafts are discussed. The regime of cryopreservation, fixation and loading of the graft influence these factors, as do the use of autologous bone chips around the allograft-host junction and the application of chemotherapy or radiation. Fracture of the graft can be salvaged in most cases, as opposed to infection which remains the most severe complication and can occur at any time. Even with the improvement of tumour endoprostheses, the use of allografts remains an option, especially in young patients. Résumé Les auteurs rapportent leur expérience de l'utilisation des allogreffes massives après résection tumorale.Les résultats à long terme de 71 patients (73 allogreffes) opérés entre 1961 et 1990 sont rapportés avec un taux de survie dans les greffes articulaires et intercalaires voisin de 60%. Les fractures de greffes peuvent être rattrapées dans de nombreux cas, mais l'infection conduit à retirer la greffe dans la plupart des cas. Les facteurs influençant le remodelage et les complications des allogreffes sont discutés. Le régime de cryopréservation, la fixation et la remise en contrainte des greffes influencent ces facteurs ainsi que la disposition de lamelles d'autogreffe à la jonction hôte-allogreffe et l'aexistence de radio ou chimiothérapie. La rupture de la greffe peut être récupérée dans la plupart des cas, contrairement à l'infection qui demeure la complication la plus grave qui peut se produire à tout moment. Même avec le développement des prothèses massives pour tumeur l'utilisation des allogreffes reste une option interessante spécialement chez les patients jeunes.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

Massive allografts in tumour surgery

Matéjovský

Kofránek

2006

International Orthopaedics (SICOT)

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“…In our series, an association between the rate of infection and type of resection (periacetabular versus other types) was not found. Despite the similar complication rate, Puri et al did not reconstruct any of the resections that excluded the acetabulum [38], whereas others advocate restoring the pelvic ring after Type I or Types I to IV pelvic resections [6,41]. In our series, half of the patients with Type I or Types I to IV pelvic resections underwent reconstruction because of a massive bone defect and pelvic instability to avoid complications, including a shortened limb or limb discrepancy, pain, and diastasis of the symphysis pubis.…”

Section: Discussionmentioning

confidence: 99%

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

Angelini

Drago

Trovarelli

et al. 2014

Clinical Orthopaedics &Amp; Related Research

129

122

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Background Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. Questions/purposes We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. Methods From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection.Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. Results A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection.

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“…However, pelvic surgery is characterized by a high number of complications [5][6][7]. Various methods currently are used to reconstruct the hemipelvis after periacetabular reconstruction including resection arthroplasty, ischiofemoral arthrodesis or pseudoarthrosis, iliofemoral arthrodesis or pseudoarthrosis [8], structural allograft [9], autoclaved autograft [10], custom-made prosthesis or modular prosthesis [4,11,12], and alloprosthetic composites [13]. However, there is no consensus for the most appropriate or efficacious method reconstruction [14].…”

Section: Introductionmentioning

confidence: 99%