Abstract
Background
Limb-salvage reconstruction for periacetabular malignant tumors is one of the most challenging problems in orthopaedic oncology. Reconstructive options include resection arthroplasty, endoprosthesis, allograft, recycled autobone graft, arthrodesis, and pseudarthrosis. However, no standard procedure exists because of rarity and clinical variability of the disease. We previously developed a megaprosthetic system with a constrained total hip mechanism (C-THA).
Questions/purposes
We evaluated (1) survival of patients and C-THA; (2) postoperative function; and (3) complications.
Methods
We retrospectively reviewed 25 patients with primary periacetabular tumors treated using C-THA between 1985 and 2009. There were 18 male and seven female patients with a median age of 44 years (range, 16–72 years). They included 11 chondrosarcomas, eight osteosarcomas, two giant cell tumors of bone (one locally aggressive benign, one malignant), and others in four. Surgical margin was wide in 18 patients, marginal in five, and intralesional in two. The minimum postoperative followup for survivors was 32 months (median, 163 months; range, 32–285 months).
Results
The 10-year overall survival rate of all patients was 47%. C-THA implants survived in 19 of 25 patients at last followup. Twenty-one patients acquired ambulatory activity. There were seven local recurrences, resulting in hemipelvectomy in one patient. Postoperative complications included deep infection in eight of the 25 patients, dislocation in four, and aseptic loosening in two, necessitating five revision surgeries and three implant removals.
Conclusions
Our observations suggest C-THA using an acetabular reconstruction cup is a useful reconstructive option after resection of periacetabular malignant tumors despite frequent postoperative complications.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Acknowledgments
We primarily thank Prof Atsumasa Uchida for his major contribution to the development of this C-THA system. We also thank Dr Norifumi Naka for his assistance with data collection and Dr Nobuyuki Hashimoto, Dr Kenichiro Hamada, Dr Susumu Joyama, Dr Ikuo Kudawara, and Dr Akira Myoui for their dedication to the treatment of the patients and their assistance with data analysis.
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No funding was received in support of this study. One or more of the authors (TU, NA) have been involved in the development of this reconstruction cup implant system possibly with some conflict of interests or biases in connection with this article.
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Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and approval for informed consent for participation in the retrospective study was obtained.
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Ueda, T., Kakunaga, S., Takenaka, S. et al. Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors. Clin Orthop Relat Res 471, 741–749 (2013). https://doi.org/10.1007/s11999-012-2625-8
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DOI: https://doi.org/10.1007/s11999-012-2625-8