Reconstruction of the Pelvis After Resection of Tumors About the Acetabulum

Abstract

Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis and shortened limb. The current authors describe a reconstruction technique using Steinmann pins augmented with methylmethacrylate reconstruction, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis. For this study, the results of 15 patients at two institutions who had surgery by the same surgeons were retrospectively reviewed. The patients had primary malignant tumors of the pelvis, and had limb-sparing resections between 1985 and 2000. Three measures of outcome were evaluated: survival, function, and pain. The surgical method uses Steinmann pins with bone cement to fill in areas of bone loss that cannot be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Twelve patients had chondrosarcoma and one patient had osteosarcoma. The remaining two patients had alveolar sarcoma of soft parts. Six patients died of disease. Seven patients were alive with no evidence of disease, and two were alive with disease at the most recent followup. Early return to ambulation without assistive devices occurred in nine of 15 patients. The functional outcome of this technique compares favorably with others reported. Sixty percent of patients ambulated independently without assistive devices, compared with 0% to 10% in other studies reviewed. The time required for independent gait is similar to recovery from a total hip arthroplasty. Moreover, this method minimized leg length discrepancy, while also producing a favorable cosmetic result.

Outcome after pelvic sarcoma resection and reconstruction with a modular hemipelvic prostheses

“…Numerous reconstruction methods and kinds of differently designed endoprostheses after pelvic tumour resection have been reported (Table 3). Satcher et al [34] reported 15 patients received a reconstruction method of autoclaved autograft and attained a 60% survival rate at five years. Aljassir et al [5] reported 27 cases reconstructed with saddle prostheses and 59% survival rate.…”

Evaluation of blood loss during limb salvage surgery for pelvic tumours

“…In one report [13] of 28 patients with internal hemipelvectomy and prosthetic reconstruction of pelvic tumours, the average blood loss was 4,793 ml (range: 1,500-12,000 ml). In another study [22], the blood loss of 15 procedures of tumour resection about the acetabulum ranged between 500 and 35,000 ml. A wide variety of risk factors influence perioperative blood volume loss.…”

Reliability and Validity of a Japanese-language and Culturally Adapted Version of the Musculoskeletal Tumor Society Scoring System for the Lower Extremity

“…Extirpation of tumor tissue is expected to cause some degree of functional impairment; therefore, efforts should be made to decrease such impairment. Studies have reported on the functional outcomes of impairments on musculoskeletal tumor treatment [9,10,14,16,17,19,21].…”

“…Since then, this system has been used in numerous studies to evaluate functional outcomes [9,10,14,16,17,19,22], making it one of the most widely used functional evaluation tools. The original scoring system was written in English and subsequently has been translated into Brazilian Portuguese and Japanese.…”