Poor Long-term Clinical Results of Saddle Prosthesis After Resection of Periacetabular Tumors

Jansen, Jacqueline; Sande, Michiel A. J. van de; Dijkstra, P. D. Sander

doi:10.1007/s11999-012-2631-x

Cited by 94 publications

(105 citation statements)

References 30 publications

(99 reference statements)

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“…The potential specific complications related to this procedure may include infection, skin necrosis, hematoma, abdominal hernia, fracture, postoperative pain, accelerated osteoarthritis, and postoperative hip dislocation. The complication rate was quite high in the conventional reconstruction [16,22]. In a series of 17 saddle prosthesis reconstructions, there were 14 local complications including infection, dislocation, and limb length discrepancy [16].…”

Section: Discussionmentioning

confidence: 99%

“…The complication rate was quite high in the conventional reconstruction [16,22]. In a series of 17 saddle prosthesis reconstructions, there were 14 local complications including infection, dislocation, and limb length discrepancy [16]. For the allograft reconstruction, there was 28% infection [29].…”

Section: Discussionmentioning

confidence: 99%

“…Jensen et al [16] reported the series of saddle prosthesis reconstruction with a mean MSTS score of 47 out of 100 at long-term followup. With pasteurized autograft, the MSTS score was 61 out of 100 [17].…”

Section: Discussionmentioning

confidence: 99%

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Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Lam

Yau

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Primary malignant tumors located near the acetabulum are usually managed by resection of the tumor with wide margins that include the acetabulum. These resections are deemed P2 resections by the Enneking and Dunham classification. There are various methods to perform the subsequent hip reconstruction. Unfortunately, there is no consensus as to the best management. In general, patients undergoing resection at this level will have substantial levels of pain and disability as measured by the Musculoskeletal Tumor Society (MSTS) scoring system. We believe there is a subset of patients whose tumors in this location can be resected while preserving all or most of the weightbearing acetabulum using navigation and careful surgical planning. Questions/purposes (1) What complications were associated with this resection; (2) what oncological outcomes (histological margins and local recurrence) were achieved; and (3) what is the function achieved by these patients? Methods This was a retrospective study of patients with periacetabular primary malignancy. From 2008 to 2014, we treated 12 patients who had periacetabular primary malignant tumors and in five, we performed resection with the weightbearing portion spared. During this period, our general indications to perform a resection that spared the acetabulum were the tumor with its resection margin not involving the weightbearing portion of the acetabulum. However, we did not perform this procedure in patients who had more cranial lesion involving the weightbearing portion or whose hip stability might be in question after the tumor excision. Three patients were women and the other two were men. Four were chondrosarcomas, whereas the other one was synovial sarcoma. Ages ranged from 46 to 60 years (average, 53 years). Minimum followup was 14 months (median, 37 months; range, 14-88 months); no patients were lost to followup before a 1-year minimum was achieved, and all patients have been seen within the last 9 months. Results There were no intraoperative or early postoperative complications. None of the five patients had a positive margin by histological assessment. No local recurrences were detected. The median functional score by MSTS was 28 out of 30 (range, 27-30). Conclusions The roof of the acetabulum is the weightbearing portion of the acetabulum. It also maintains the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed cons...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Lam

Yau

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Although we performed surgery in patients with many co-morbidities (four patients classified as ASA 4) with extended, generalised metastatic disease we had no intra-or postoperative deaths and observed no major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations as described in other series after performing various methods for pelvic reconstruction [9,14,15,[17][18][19]. Tillman et al have reported similar results in their series of 19 patients treated with a three-pin modified Harrington technique with respect to occurrence of major intra-and postoperative complications as well as the functional outcome [6].…”

Section: Discussionmentioning

confidence: 90%

“…Renard et al noted that osteoporosis and insufficient soft tissue quality have affected the functional results in a series of 15 patients treated with saddle prosthesis for periacetabular tumours [14]. A recent study by Jansen et al reported a high risk of complications and poor long-term function in patients following acetabular reconstruction with saddle prostheses after peri-acetabular tumour surgery [15]. Another technique of endoprosthetic restoration, especially in relation to reconstruction of extended pelvic defects in cases of primary malignant tumours or solitary metastatic bony lesions of the pelvis, is the internal hemipelvectomy and reconstruction with an endoprosthetic pelvic replacement [9,[16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

The modified Harrington procedure for metastatic peri-acetabular bone destruction

Vielgut

Sadoghi

Gregori

et al. 2013

International Orthopaedics (SICOT)

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Purpose We describe the outcome in a series of patients treated for metastatic peri-actetabular and iliac bone destruction using a modified technique of Harrington's procedure. Methods Between 2006 and 2012, nine patients with a mean age of 62.2 years (42-75 years) were treated using a modified Harrington technique. Thereby, total hip replacement implants augmented by two to three threaded pins and cement were used to restore bony continuity of the pelvis and to achieve a stable construction allowing immediate full-weight bearing mobilisation. Results Acetabular destruction was graded according to Harrington's classification of peri-acetabular metastatic destruction, as class IV in one case, class III in six, and class II in two cases. The pre-operative ASA score ranged from II-IV. There were no intra-operative deaths or major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations at final follow-up. Eight patients achieved an improvement of their functional status postoperatively. One reconstruction required revision and four patients died due to their underlying disease ten to 36 months after surgery. Conclusion We found this technique an effective, reproducible, and long-lasting method to relieve pain and improve or restore function in patients with destructive metastatic lesions of the peri-acetabular bone and the iliac wing. Although we performed surgery even in severely ill patients with extended, generalised metastatic disease we had no intra-or postoperative death and observed no major complications.

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Reconstruction using a constrained‐type hip tumor prosthesis after resection of malignant periacetabular tumors: A study by the Japanese Musculoskeletal Oncology Group (JMOG)

Susa

Morioka

Matsumine

et al. 2018

Journal of Surgical Oncology

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Poor Long-term Clinical Results of Saddle Prosthesis After Resection of Periacetabular Tumors

Abstract: Reconstruction with saddle prostheses after periacetabular tumor surgery has a high risk of complications and poor long-term function with limited hip flexion; therefore, we no longer use the saddle prosthesis for reconstruction after periacetabular tumor resections.

Cited by 94 publications

References 30 publications

Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

The modified Harrington procedure for metastatic peri-acetabular bone destruction

Reconstruction using a constrained‐type hip tumor prosthesis after resection of malignant periacetabular tumors: A study by the Japanese Musculoskeletal Oncology Group (JMOG)

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