Pelvic Reconstruction with a Structural Pelvic Allograft After Resection of a Malignant Bone Tumor

Abstract

Pelvic reconstruction after a limb-sparing resection is associated with a high risk of surgical complications and usually should be reserved for patients with a primary bone sarcoma. A pelvic allograft can restore the anatomy and provide good functional results, especially in young patients. Nonunion was the most common allograft-related complication.

What Are the Functional Results and Complications From Allograft Reconstruction After Partial Hemipelvectomy of the Pubis?

“…These complications must be weighed against the potential benefits that may be reported in this series. For example, we report an operative infection rate of two of 14 patients, which is within the range of what has been previously reported for other series of allograft reconstructions of the pelvis [1,3,7,10,11]. One patient developed a symptomatic inguinal incisional hernia that was discovered to be the result of a defect in the abdominal wall adjacent to the mesh that was placed at the time of his pelvic resection.…”

“…In addition, allograft or autograft pelvic ring reconstruction is traditionally thought to add complexity and risk to the procedure, including infection, nonunion, and fracture. The infection rate, for instance, in a previously published series of patients at our institution who underwent allograft reconstruction after internal hemipelvectomy for malignant pelvic bone tumors was 20% [11], although reported rates of infection with pelvic allografts have ranged from one in 13 to five in 13 [1,3,7,10]. Rates of pelvic allograft fracture have been reported ranging from zero of 16 to three of 14 with nonunion reported in one series as three of 16 [3,6,10,13,18].…”

Surgical inaccuracy of tumor resection and reconstruction within the pelvis: An experimental study

“…Surgery with an adequate margin is necessary for a low risk of local recurrence (Kawaguchi et al 1995, Pring et al 2001, Weber et al 2002. Local recurrence rates from 28% to 35% have been reported after limb-salvage procedures for pelvic tumors (Delloye et al 2007).…”

Two-staged revision with custom made prosthesis in septic failure of massive allograft reconstruction after type II-III pelvic resection

“…The main advantages of massive allograft reconstruction are restoration of the pelvic bony architecture, a durable fixation with bony union providing normal biology, and good function in concomitance with a total hip prosthesis. [1][2][3][4] However, high complication rates are associated with allograft reconstruction after pelvic resections. [4][5][6] Infection is one of the most frequent and disastrous complications.…”

“…Structural massive allograft reconstruction in young and high-demand patients has been reported to have good functional outcomes. [1] However, high infection rates were associated with allograft reconstruction. [1,2] In this article, we report a case of massive allograft reconstruction after type II-III pelvic resection which eventually failed due to an infection, and was treated with a two-staged revision with a custom-made pelvic prosthesis.…”