Pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours

Abstract

BackgroundThe treatment of periacetabular malignant bone tumours is challenging. Many methods of reconstruction after internal hemipelvectomy have been reported and each method has its own limitations. The aim of this study was to evaluate the oncological and functional outcomes of pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours.MethodsTen patients (six male, four female) with periacetabular malignant tumours, who underwent resection and reconstruction with pasteurized autograft, were retrospectively reviewed. The patients’ average age at diagnosis was 40 years (range 13–65 years). There were five patients with chondrosarcoma, three with osteosarcoma, one with Ewing’s sarcoma, and one with solitary metastatic thyroid carcinoma.ResultsAt the last follow-up, seven patients were alive (six with no evidence of the primary disease and one with lung metastasis for 5 months). The three other patients died of metastasis of the primary disease with a mean survival time of 12 (range 8–17) months postoperatively. The mean follow-up time for all patients was 45 (range 8–87) months. Local recurrence rate was 10%. The mean time of bone union was 12 (range 6–21) months after the operation. The mean Musculoskeletal Tumor Society score for all living patients at the last follow-up was 70.5% (range 43.3–86.7%).ConclusionsReconstruction with pasteurized autograft is a feasible method for treating periacetabular malignant bone tumours, with satisfactory oncological and functional outcomes and a relatively low incidence of complications.

Acetabular reconstruction with an ice‐cream cone prosthesis following resection of pelvic tumors: Does computer navigation improve surgical outcome?

“…The cumulative incidence of implant failure in this study was satisfactory compared with the other reconstructions 54‐58 . Bus et al 11 reported that the cumulative incidence of implant failure of LUMiC, the other stemmed‐cone acetabular prosthesis, was 17.3% for mechanical reasons and 9.2% for infection at 5 years.…”

Reconstruction of the hip after resection of periacetabular oncological lesions

“…Autograft reconstructions were used in five studies, involving 54 patients. 8 , 14 , 27 , 33 , 60 In this technique, the resected hemipelvis is pasteurised with heat to sterilise the malignancy and re-implanted with plates, screws, and prostheses. Most, 47 (87%), were for a primary malignancy.…”

Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?

“…The high risk of complications has been a major problem associated with surgery for pelvic sarcomas. The reported rate of major complications, which required additional surgical interventions, has been 28% to 65% in endoprosthetic reconstruction, 29% to 60% in allograft reconstruction, 20% to 57% in recycled autograft reconstruction . Among these major complications, deep infection is the most serious and frequent one, and is a common cause of implant failure .…”

“…been 28% to 65% in endoprosthetic reconstruction, 23,29,[33][34][35][36]49,61,62 29% to 60% in allograft reconstruction, 39,48,63,64 20% to 57% in recycled autograft reconstruction. 41,43,65 Among these major complications, deep infection is the most serious and frequent one, and is a common cause of implant failure. 23,66 While the details of surgical outcomes for pelvic ES involving the acetabulum has been limited, the existing publications have revealed high rates of major complications, ranging from 30% to 40%.…”

“…[21][22][23][24][25] While selected cases involving neurovascular structures still require external hemipelvectomy, [25][26][27] limb-salvage through pelvic reconstruction achieves greater postoperative function and quality of life. 28 The reconstructive options include endoprosthetic reconstruction, 23,[29][30][31][32][33][34][35][36][37] biological reconstruction using allograft 38,39 or autograft, [40][41][42][43][44] iliofemoral arthrodesis, 24,45 or hip transposition arthroplasty. 28,46,47 The high complication rate is a major problem of these reconstructive procedures except for hip transposition arthroplasty, which includes superficial/deep infection, dislocation, neurovascular and visceral damage, mechanical and structural failure, and wound dehiscence/necrosis, 24,25,29,32,[48][49][50] and these complications are associated with poor functional outcomes.…”