Connective Tissue Oncology Society

2001 CTOS Annual Meeting—Oral Presentations

RECONSTRUCTION OF THE PELVIS FOLLOWING RESECTION OF TUMORS ABOUT THE ACETABULUM
R. L. Satcher, Jr.¹, R. J. O'Donnell¹, J. O. Johnston¹
¹University of California, San Francisco Department of Orthopaedic Surgery UCSF Comprehensive Cancer Center Orthopaedic Oncology Service 1701 Divisadero Street Suite 280, ²The Permanente Medical Group, Inc. Department of Musculoskeletal Oncology 1200 El Camino Real

OBJECTIVE: Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weight-bearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis and a shortened limb. This abstract describes a reconstruction technique using rebar, cement, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis.

METHODS: This study retrospectively reviewed the results of 15 patients at 2 institutions who had surgery by the same surgeons. The patients had primary malignant tumors of the pelvis, and underwent limb-sparing resections between 1985 and 2000. The surgical method utilized threaded Steinman pins with bone cement to fill areas of bone loss that could not be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Three outcome measures were evaluated: survival, function, and pain.

RESULTS: Twelve patients had chondrosarcoma, two had alveolar soft parts sarcoma, and one had osteosarcoma. According to the Enneking-Dunham classification, there were 10 type II resections, and one each of types I, I/II, I/II/III, II/III, and III. There were 9 living and 6 deceased patients. For living patients, follow-up averaged 75 months (range 26 to 164) and for deceased patients, follow-up averaged 28 months (range 12 to 46). For chondrosarcoma patients, the local recurrence rate was 25% (3/12). All patients except one were ambulatory; 9 were able to walk without an assistive device. According to the MSTS Rating System, scores averaged 23/30 for living patients (range 10 to 27). Eleven patients were community ambulators and narcotics were used occasionally by only 2 patients. Surgical complications included 2 prosthetic dislocations, 2 wound hematomas, and 1 peroneal nerve palsy.

CONCLUSION: Reconstruction of massive pelvic defects with cement, rebar, autoclaved autograft, and constrained total hip replacements is a technique that compares favorably with other methods that have been reported. Functional outcome in terms of ambulatory capacity is substantially better than has been noted historically. The time required for independent gait is similar to recovery from routine total hip arthroplasty. Moreover, this method limits leg length discrepancy, while producing a favorable cosmetic result.