Acetabular Reconstruction With Femoral Head Autograft After Intraarticular Resection of Periacetabular Tumors is Durable at Short-term Followup View Full Text


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Article Info

DATE

2017-09-25

AUTHORS

Xiaodong Tang, Wei Guo, Rongli Yang, Taiqiang Yan, Shun Tang, Dasen Li

ABSTRACT

BackgroundPelvic reconstruction after periacetabular tumor resection is technically difficult and characterized by a high complication rate. Although endoprosthetic replacement can result in immediate postoperative functional recovery, biologic reconstructions with autograft may provide an enhanced prognosis in patients with long-term survival; however, little has been published regarding this approach. We therefore wished to evaluate whether whole-bulk femoral head autograft that is not contaminated by tumor can be used to reconstruct segmental bone defects after intraarticular resection of periacetabular tumors.Questions/purposesIn a pilot study, we evaluated (1) local tumor control, (2) complications, and (3) postoperative function as measured by the Musculoskeletal Tumor Society score.MethodsBetween 2009 and 2015, we treated 13 patients with periacetabular malignant or aggressive benign tumors with en bloc resection, bulk femoral head autograft, and cemented THA (with or without a titanium acetabular reconstruction cup), and all were included for analysis here. During that time, the general indications for this approach were (1) patients anticipated to have a good oncologic prognosis and adequate surgical margins to allow this approach, (2) patients whose pelvic bone defects did not exceed two types (Types I + II or Types II + III as defined by Enneking and Dunham), and (3) patients whose medical insurance would not cover what otherwise might have been a pelvic tumor prosthesis. During this period, another 91 patients were treated with pelvic prosthetic replacement, which was our preferred approach. Median followup in this study was 36 months (range, 24–99 months among surviving patients; one patient died 8 months after surgery); no patients were lost to followup. Bone defects were Types II + III in five patients, and Types I + II in eight. After intraarticular resection, ipsilateral femoral head autograft combined with THA was used to reconstruct the segmental bone defect of the acetabulum. In patients with Types I + II resections, the connection between the sacrum and the acetabulum was reestablished with a fibular autograft or a titanium cage filled with dried bone-allograft particles which was enhanced by using a pedicle screw and rod system. Functional evaluation was done in 11 patients who remained alive and maintained the femoral head autograft at final followup; one other patient received secondary resection involving removal of the femoral head autograft and internal fixation, and was excluded from functional evaluation. Endpoints were assessed by chart review.ResultsTwo patients experienced local tumor recurrence. Finally, eight patients did not show signs of the disease, one patient died of disease for local and distant tumor relapse, and four patients survived, but still had the disease. Three of these four patients had distant metastases without local recurrence and one had local control after secondary resection but still experienced system relapse. We observed the following complications: hematoma (one patient; treated surgically with hematoma clearance), delayed wound healing (one patient; treated by débridement), deep vein thrombosis (one patient), and hip dislocation (one patient; treated with open reduction). The median 1993 Musculoskeletal Tumor Society score was 83% (25 of 30 points; range, 19–29 points), and all patients were community ambulators; one used a cane, three used a walker, and nine did not use any assistive devices.ConclusionsIn this small series at short-term followup, we found that reconstruction of segmental bone defects after intraarticular resection of periacetabular tumors with femoral head autograft does not appear to impede local tumor control; complications were in the range of what might be expected in a series of large pelvic reconstructions, and postoperative function was generally good.Level of EvidenceLevel IV, therapeutic study. More... »

PAGES

3060-3070

References to SciGraph publications

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URI

http://scigraph.springernature.com/pub.10.1007/s11999-017-5505-4

DOI

http://dx.doi.org/10.1007/s11999-017-5505-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091920334

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28948491


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39 schema:description BackgroundPelvic reconstruction after periacetabular tumor resection is technically difficult and characterized by a high complication rate. Although endoprosthetic replacement can result in immediate postoperative functional recovery, biologic reconstructions with autograft may provide an enhanced prognosis in patients with long-term survival; however, little has been published regarding this approach. We therefore wished to evaluate whether whole-bulk femoral head autograft that is not contaminated by tumor can be used to reconstruct segmental bone defects after intraarticular resection of periacetabular tumors.Questions/purposesIn a pilot study, we evaluated (1) local tumor control, (2) complications, and (3) postoperative function as measured by the Musculoskeletal Tumor Society score.MethodsBetween 2009 and 2015, we treated 13 patients with periacetabular malignant or aggressive benign tumors with en bloc resection, bulk femoral head autograft, and cemented THA (with or without a titanium acetabular reconstruction cup), and all were included for analysis here. During that time, the general indications for this approach were (1) patients anticipated to have a good oncologic prognosis and adequate surgical margins to allow this approach, (2) patients whose pelvic bone defects did not exceed two types (Types I + II or Types II + III as defined by Enneking and Dunham), and (3) patients whose medical insurance would not cover what otherwise might have been a pelvic tumor prosthesis. During this period, another 91 patients were treated with pelvic prosthetic replacement, which was our preferred approach. Median followup in this study was 36 months (range, 24–99 months among surviving patients; one patient died 8 months after surgery); no patients were lost to followup. Bone defects were Types II + III in five patients, and Types I + II in eight. After intraarticular resection, ipsilateral femoral head autograft combined with THA was used to reconstruct the segmental bone defect of the acetabulum. In patients with Types I + II resections, the connection between the sacrum and the acetabulum was reestablished with a fibular autograft or a titanium cage filled with dried bone-allograft particles which was enhanced by using a pedicle screw and rod system. Functional evaluation was done in 11 patients who remained alive and maintained the femoral head autograft at final followup; one other patient received secondary resection involving removal of the femoral head autograft and internal fixation, and was excluded from functional evaluation. Endpoints were assessed by chart review.ResultsTwo patients experienced local tumor recurrence. Finally, eight patients did not show signs of the disease, one patient died of disease for local and distant tumor relapse, and four patients survived, but still had the disease. Three of these four patients had distant metastases without local recurrence and one had local control after secondary resection but still experienced system relapse. We observed the following complications: hematoma (one patient; treated surgically with hematoma clearance), delayed wound healing (one patient; treated by débridement), deep vein thrombosis (one patient), and hip dislocation (one patient; treated with open reduction). The median 1993 Musculoskeletal Tumor Society score was 83% (25 of 30 points; range, 19–29 points), and all patients were community ambulators; one used a cane, three used a walker, and nine did not use any assistive devices.ConclusionsIn this small series at short-term followup, we found that reconstruction of segmental bone defects after intraarticular resection of periacetabular tumors with femoral head autograft does not appear to impede local tumor control; complications were in the range of what might be expected in a series of large pelvic reconstructions, and postoperative function was generally good.Level of EvidenceLevel IV, therapeutic study.
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46 MethodsBetween 2009
47 Musculoskeletal Tumor Society score
48 PurposesIn
49 ResultsTwo patients
50 Society Score
51 THA
52 Walker
53 acetabular reconstruction
54 acetabulum
55 adequate surgical margins
56 aggressive benign tumors
57 ambulators
58 analysis
59 approach
60 assistive devices
61 autograft
62 benign tumors
63 biologic reconstruction
64 bloc resection
65 bone defects
66 bulk femoral head autograft
67 cages
68 cane
69 chart review
70 community ambulators
71 complication rate
72 complications
73 connection
74 control
75 deep vein thrombosis
76 defects
77 devices
78 disease
79 dislocations
80 distant metastasis
81 distant tumor relapse
82 en bloc resection
83 endoprosthetic replacement
84 endpoint
85 evaluation
86 evidenceLevel IV
87 femoral head autograft
88 fibular autograft
89 final followup
90 fixation
91 followup
92 function
93 functional evaluation
94 functional recovery
95 general indications
96 healing
97 hematoma
98 high complication rate
99 hip dislocation
100 indications
101 insurance
102 internal fixation
103 intraarticular resection
104 levels
105 local control
106 local recurrence
107 local tumor control
108 local tumor recurrence
109 long-term survival
110 margin
111 median followup
112 medical insurance
113 metastasis
114 months
115 oncologic prognosis
116 particles
117 patients
118 pedicle screws
119 pelvic bone defects
120 pelvic reconstruction
121 periacetabular tumor resection
122 periacetabular tumors
123 period
124 pilot study
125 postoperative function
126 postoperative functional recovery
127 preferred approach
128 prognosis
129 prosthesis
130 prosthetic replacement
131 range
132 rate
133 reconstruction
134 recovery
135 recurrence
136 relapse
137 removal
138 replacement
139 resection
140 review
141 rod system
142 sacrum
143 scores
144 screws
145 secondary resection
146 segmental bone defects
147 series
148 short-term followup
149 signs
150 small series
151 study
152 surgical margins
153 survival
154 system
155 therapeutic studies
156 thrombosis
157 time
158 titanium cage
159 tumor control
160 tumor prosthesis
161 tumor recurrence
162 tumor relapse
163 tumor resection
164 tumors
165 type I
166 type II
167 types
168 vein thrombosis
169 wound healing
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