Pelvic reconstruction with a combined hemipelvic prostheses after resection of primary malignant tumor

Abstract 

Background

Hemipelvic resections for primary malignant bone tumor require reconstruction to restore weight bearing along anatomic axes. However, reconstruction of the pelvic arch remains a major surgical challenge because of the high rate of associated complications. We designed a combined hemipelvic prosthetic system to reconstruct the pelvis and purpose of this investigation was to assess the oncology and functional outcome and complication rate following this procedures.

Methods

we retrospectively reviewed 18 patients who had primary malignant pelvic tumor resections and reconstructions with the combined hemipelvic prosthesis using pedicle screw-rod constructs augmented with antibiotic cement in combination with a special designed acetabular reinforcement shell and hip prosthesis between 2001 and 2007. Patients were examined clinically and radiographically and were assessed functionally with Musculoskeletal Tumor Society score.

Results

Five (27.8%) patients had type II periacetabular pelvic resection and 5 (27.8%) had types I and II (periacetabular and ilium) pelvic resections. Six (33.3%) patients had types II and III (periacetabular and pubis) pelvic resections, 1 (5.6%) had types I and II and III resections and 1 (5.6%) had a types I and II and IV (periacetabular and ilium and sacrum) resections. Patient survival status, function, and complications were evaluated at a mean following up of 41 months (range, 7–73 months). Ten patients (55.6%) had no evidence of disease, five patients (27.7%) had died from their disease, and three patients (16.7%) were alive with disease. The overall survival rate was 72.2% at 5 years. Local recurrence occurred in four patients (22.2%). Six of 17 patients (35.3%) showed lung metastatic progression. The average MSTS 93 score was 65.5% and 71.7% at three months after surgery and at the last followup. Six (33.3%) patients had surgery-related complications including dislocation in 2, wound dehiscence in 2, deep-vein thrombosis in 1, screw loosening in 1 and sciatic nerve palsy in 1. There was no infection occurred in this series.

Conclusions

Pelvic reconstruction using combined hemipelvic prosthetic system after a limb-salvage resection is an acceptable method because of its lower complication and satisfactory functional outcome and its feasibility of reconstruction for any type of periacetabular tumor resection without elaborate preoperative customize.

Level of evidence

Level IV, therapeutic study.

Keywords: Pelvic, Tumor, Reconstruction