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Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint

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Abstract

Introduction

With the development of surgical techniques and improvements in hemi-pelvic prosthesis systems, extra-articular resection can be performed as a limb-salvage procedure in selected patients whose hip joint is invaded by a sarcoma. The aim of this study was to describe the indications for and the technical details, post-operative complications, and oncologic and functional outcomes of this procedure.

Methods

Eighteen patients with Enneking IIB or IB sarcoma who underwent extra-articular resection of the hip joint were enrolled. A modular pelvic endoprosthesis combined with a femoral endoprosthesis was used to reconstruct the bone and joint defect. Pathological diagnoses included osteosarcoma (7 patients), chondrosarcoma (7), undifferentiated high-grade pleomorphic sarcoma (3), and malignant peripheral nerve-sheath tumour (1).

Results

Wide, marginal and intralesional surgical margin was achieved in 13, four and one patients, respectively. There was one peri-operative death and the other 17 patients were followed up for 35.0 months (range, 10–75 months). Three patients had early-stage dislocations. One had a traumatic dislocation three years later. Two patients had wound complications. The average MSTS 93 score was 63.5% ± 10.8%. Four patients had local recurrence. The estimated three-year disease-free survival and overall survival for the 18 patients were both 50.0%.

Conclusion

Although technically demanding, extra-articular resection of hip is a limb-salvage procedure that is worth considering for carefully selected patients.

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Acknowledgements

The authors thank the Musculoskeletal Tumor Center of Peking University People’s Hospital for the patients’ clinical data, Professor Chunfang Zhang for excellent technical assistance, and Professor Danhua Shen and Dr. Kunkun Sun for the pathological review and evaluation, respectively. This work was not supported by any foundation. This study complies with all current relevant laws in China, where this report was produced.

Author information

Study design, Wei Guo. Data acquisition, Dasen Li and Lu Xie. Analysis and interpretation of data, Dasen Li, Lu Xie and Tao Ji. Operations, drafting and critical revision, Dasen Li, Lu Xie, Wei Guo, Xiaodong Tang, Rongli Yang and Tao Ji.

Correspondence to Wei Guo.

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Conflict of interest

No conflicts of interest are declared by any author in this study.

Ethics

Prior to the start of this study we obtained approval from our IRB.

Additional information

Dasen Li and Lu Xie are co-first authors.

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Li, D., Xie, L., Guo, W. et al. Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint. International Orthopaedics (SICOT) 42, 695–703 (2018). https://doi.org/10.1007/s00264-018-3771-8

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Keywords

  • Extra-articular resection
  • Hip
  • Limb salvage
  • Endoprosthesis
  • Sarcoma