Clinical Results following Reconstructive Methods in Pelvic Tumor

Won Seok Song; Wan Hyung Cho; Jong Hoon Park; Soo Yong Lee; Sung Jun Lee; Dae Geun Jeon

doi:10.4055/jkoa.2007.42.3.298

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Song, Cho, Park, Lee, Lee, and Jeon: Clinical Results following Reconstructive Methods in Pelvic Tumor

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(3): 298-304.

Published online: 30 June 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.3.298

Clinical Results following Reconstructive Methods in Pelvic Tumor

Won Seok Song, M.D., Wan Hyung Cho, M.D., Jong Hoon Park, M.D., Soo Yong Lee, M.D., Sung Jun Lee, M.D., Dae Geun Jeon, M.D.

Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.

Address reprint requests to Dae Geun Jeon, M.D. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Tel: +82.2-970-1242, Fax: +82.2-970-2427, dgjeon@kcch.re.kr

Abstract

Purpose

This study evaluated the results of periacetabular resections in patients with pelvic tumors according to the reconstructive methods.

Materials and Methods

Twenty-seven patients, who underwent a periacetabular resection with a minimum one year follow up were eligible for this study. There were 20 primary malignant bone tumors, three benign aggressive tumors, three metastatic tumors and one soft tissue sarcoma. According to Enneking's criteria, a type I+II resection was performed in seven patients, type II+III in 17, and type I+II+III in three. The type of reconstructions used were heat treated autogenous bone-THA composite (APC) in 15, a saddle prosthesis in 6, arthrodesis in 2, and a flail hip in 4 patients. The MSTS functional scores and complications according to the type of reconstruction were evaluated.

Results

Eleven (46%) of the 27 patients were in the disease free state and 7 (26%) patients showed local recurrences. Eleven (73%) out of 15 patients with APC and 2 (33%) out of 6 patients with a saddle prosthesis had complications including infections, dislocations and loosening. The final average MSTS score was 19.6 (65%) and all reconstructive methods produced similar functional results.

Conclusion

Reconstructions of the acetabulum with a prosthesis after a periacetabular resection had a relatively high rate of complications. A flail hip might be one suitable reconstructive options after a periacetabular resection.

Keywords: Pelvic tumor, Periacetabulum, Reconstructive method

Figures and Tables

Fig. 1

(A) Plain radiograph shows a huge calcified mass of the pubic ramus extending to the adductor area. (B) A Type II+III resection was performed and reconstructed with heat treated autogenous bone-THA composite. (C) Four months later, all the implants and pasteurized bone were removed and the reconstruction was changed to a flail hip as a result of an infection.

Fig. 2

(A, B) Preoperative radiograph and MRI show a huge calcified mass of the pubis invading the inferior wall of the acetabulum. (C) A Type II+III resection was done and a limited arthrodesis was performed by wiring between the ilium and femoral head.

Fig. 3

(A, B) Plain radiograph and MRI show a diffuse lesion involving ilium and acetabulum. (C) Flail hip reconstruction after a type I+II resection was performed and proximal migration of the femoral head is observed.

Fig. 4

The Kaplan-Meier survival analysis shows 11% implant survival at 135 months when using heat treated autogenous bone-THA composite or a saddle prosthesis.

Table 1

Summary of the Cases

^*GCT, giant cell tumor; HME, hemangioendothelioma; OS, osteosarcoma; DP, desmoplastic fibroma; CS, chondrosarcoma; Mets, metastatic carcinoma; MFH, malignant fibrous histiocytoma; MPNST, malignant peripheral nerve sheath tumor; ^†w, wide margin; m, marginal margin; i, intralesional resection; ^‡CDF, continuous disease free; NED, no evidence of tumor; DOD, die of disease; AWD, alive with disease; ^§APC, heat treated autogenous bone-THA composite; ^∥D/L, dislocation; ^¶CR, closed reduction.

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