Proximal femur versus acetabular extra-articular resection of the hip joint for primary malignant bone tumors: a retrospective comparative review of 33 cases

Abstract

Introduction Extra-articular resection (EAR) of the hip joint is prone to significant complications and morbidity. Thus, this study evaluates the cumulative incidences and main reasons of reoperation following EAR of primary malignant bone tumors (PMBT) of the hip to determine whether the outcomes are different between EAR of the pelvis and that of the proximal femur. Patients and methods Thirty-three patients presented with a PMBT of the proximal femur or pelvis were included in this study. Among all PMBTs, 58% originated from the pelvis and 42% were from the proximal femur. Twenty patients had chondrosarcomas (61%), 10 had osteosarcomas (30%), and 3 had sarcomas of another histological subtype (9%). Results The mean follow-up was of 76 months (range: 24–220 months). The cumulative probabilities of revision for any reason were 52% (95% confidence interval [CI] 30–70%) 5 years after surgery. The 5-year cumulative probabilities of revision were 13% (95% CI 4–27%), 24% (95% CI 10–42%), and 34% (95% CI 14–56%) for mechanical, infectious, and tumoral reasons, respectively. The 5-year cumulative probabilities of revision for any reason were 78% (95% CI 37–94%) and 14% (95% CI 2–38%) for the pelvis and proximal femur, respectively (p = 0.004). Posterior column preservation was significantly associated with more mechanical complications even after adjusting for the resection site (p = 0.043). Conclusion Half of patients undergoing EAR of the hip joint for PMBT of the proximal femur or acetabulum will require another operation. EAR of the pelvis is associated with significantly worse outcome than EAR of the proximal femur.

Less is better than more with resection of periacetabular tumors – A retrospective 16 years study and literature review

“…In the current study 3 patients (19%) had a deep infection, this might be attributed to the versatility of the different types of sarcomas included in the study and the substantial insult to the surrounding soft tissue. Nonetheless, these numbers are significantly low compared to the reported literature on reconstruction surgeries (20)(21)(22)32). In contrast, the reported postoperative complication rates for resectioning periacetabular tumors without reconstruction are much lower.…”

“…However, the novelty of 3D-printing techniques limits most comparisons in the literature. Infection is one of the most prevalent complications, which tremendously affects the patients' wellbeing, hospitalization time, and revision surgery (20)(21)(22)32). Ogura and colleagues (32).…”

“…The authors reported on deep infection rate of 39% with a mean follow-up period of 65 months. Housset et al ( 21 ) reported on 33 patients with primary malignant bone tumors involving the proximal femur or acetabular who underwent resection and reconstruction, with a mean follow-up of 76 months. The total infection rate was 27.3%, with 21.2% of deep infection.…”

Surgical Management and Reconstruction of Dedifferentiated Chondrosarcoma in the Proximal Femur: A Case Report

“…Primary malignant bone tumors in the proximal femur are infrequent, comprising approximately 9% to 10% of cases, with chondrosarcomas being the most prevalent type. Nonetheless, the proximal femur is subject to a high occurrence of bone metastasis from osteophilic cancer, resembling spinal metastases [1]. The treatment for proximal femur tumors necessitates a two-part strategy incorporating tumor resection for oncological reasons and bone and soft tissue reconstruction for mechanical purposes [1][2][3] Our report details a case of dedifferentiated chondrosarcoma located in the upper extremity of the femur.…”