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Tsuchiya R, Iwata S, Fukushima S, Osaki S, Ogura K, Kobayashi E, Ohtori S, Kawai A. Developmental Patterns and Risk Factors of Scoliosis After Hemipelvectomy for the Pelvic Bone Tumor. Diagnostics (Basel) 2024; 14:2392. [PMID: 39518360 PMCID: PMC11545142 DOI: 10.3390/diagnostics14212392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/20/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Postoperative scoliosis is often seen after hemipelvectomy for malignancies involving the pelvic area, but the details remain unclear. The objectives were to investigate the development patterns and risk factors of scoliosis after hemipelvectomy. METHODS We retrospectively reviewed 30 patients who underwent hemipelvectomy at our hospital between 1998 and 2020. The risk factors of scoliosis with a Cobb angle of ≥10° were investigated. RESULTS The postoperative Cobb angle significantly increased in all patients compared with the preoperative one (p < 0.001), and the change ratio of the Cobb angle was significantly higher during the first postoperative year than thereafter. The external hemipelvectomy (EH) group demonstrated a larger Cobb angle and a higher change ratio than the internal hemipelvectomy group. Nine patients developed scoliosis with a final Cobb angle of ≥10°, and the risk factors were EH (p = 0.017), P1+2+3+4 resection according to the Enneking classification (p = 0.005), iliac crest resection (p = 0.004), L5/S resection (p = 0.020), and no pelvic ring reconstruction after hemipelvectomy (p = 0.004). CONCLUSIONS Approximately 30% of patients who underwent hemipelvectomy developed scoliosis with a Cobb angle of ≥10°, and this angle increased rapidly during the first postoperative year. Hence, careful follow-up of scoliosis is required after hemipelvectomy.
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Affiliation(s)
- Ryuto Tsuchiya
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan;
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
| | - Suguru Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
| | - Shuhei Osaki
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
| | - Koichi Ogura
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan;
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (R.T.); (S.F.); (S.O.); (K.O.); (E.K.); (A.K.)
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Vucicevic RS, Zavras AG, Fice MP, Khan ZA, Gusho C, Gasparro M, Gitelis S, Blank A, Colman MW. Internal hemipelvectomy: A single institution's learning curve and longitudinal experience. J Surg Oncol 2024; 129:981-994. [PMID: 38287517 DOI: 10.1002/jso.27585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND OBJECTIVES Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. METHODS This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. RESULTS A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). CONCLUSION While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.
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Affiliation(s)
- Rajko S Vucicevic
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Michael P Fice
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles Gusho
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew Gasparro
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Blank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Chobpenthai T, Poosiripinyo T, Warakul C. Reconstruction After En Bloc Resection of a Distal Radius Tumor. An Updated and Concise Review. Orthop Res Rev 2023; 15:151-164. [PMID: 37576613 PMCID: PMC10422987 DOI: 10.2147/orr.s416331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
The distal radius is rarely affected by either primary or metastatic bone cancers. The most frequent tumors of the distal radius are giant cell tumors, which are benign tumors with the propensity to invade. En bloc excision of giant cell tumors of the distal radius achieves a low recurrence rate but compromises the wrist joint, necessitates a significant reconstruction, and has functional consequences. Reconstruction after en bloc resection of a distal radius bone tumor is challenging. Furthermore, orthopedic oncologists disagree on treating such long bone anomalies most effectively. The present article summarizes the various biological and non-biological reconstruction techniques performed after en bloc resection of a distal radius tumor, discusses the advantages and disadvantages of each reconstruction strategy, and summarizes several case studies and case reports.
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Affiliation(s)
- Thanapon Chobpenthai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Chawin Warakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
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Ajit Singh V, Yasin NF, Mansor A, Mohamed Elhadi AE, Sharifudin MA. The outcome of type 1 pelvic resection and reconstruction with pedicle screw-rod system without bone grafting in malignant pelvic tumour: A case series and short term review. J Orthop Surg (Hong Kong) 2022; 30:10225536221119510. [PMID: 35982537 DOI: 10.1177/10225536221119510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There is no consensus regarding the reconstruction method for type 1 resections around the pelvis. Various methods are currently used, such as resection without reconstruction, bone graft (autologous, recycled, allograft) with simple fixation, and pedicle screw-rod fixation with or without bone grafting. We aim to study the outcome of pedicle screw-rod reconstruction without bone grafting in type 1 pelvic resections involving sacroiliac joint to show that pedicle screw-rod construct alone is stable and has low risk of failure. MATERIAL AND METHODS This is a retrospective review of eight patients who underwent type 1 resection of malignant pelvic tumours and reconstruction with a pedicle screw-rod system between 2011 and 2018. All patients who underwent type 1 resection and reconstruction with pedicle screw without bone grafting were included into this study. We reported their clinical (complication and radiological outcome), oncological (local recurrence and metastasis), and functional outcome based on Musculoskeletal Tumour Society Score (MSTS) and The Toronto Extremity Salvage Score (TESS) at their last follow-up. RESULTS Eight patients were recruited into the study. The mean follow-up period was 58.5 months (range: 40 - 121 months). There were three postoperative complications in three different patients: superficial infection, surgical hernia with ipsilateral femoral avascular necrosis (AVN), and femoral nerve injury. At the end of the study period, one patient passed away due to disease progression, one patient was alive with disease, and the rest were disease-free. Mean MSTS score during last follow-up was 77.1% (range: 66.7% - 93.3%), while mean TESS score was 75.6% range (63.3% - 80.2%). There were no cases of implant failure. CONCLUSION Type 1 pelvic reconstruction with a pedicle screw-rod system is stable without a concurrent biological reconstruction, and it is feasible, with few complications, and an excellent functional outcome.
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Affiliation(s)
- Vivek Ajit Singh
- National Orthopaedic Centre of Excellence in Research & Learning (Noceral), Department of Orthopaedic Surgery, Faculty of Medicine, 37447Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Faissal Yasin
- National Orthopaedic Centre of Excellence in Research & Learning (Noceral), Department of Orthopaedic Surgery, Faculty of Medicine, 37447Universiti Malaya, Kuala Lumpur, Malaysia
| | - Azura Mansor
- National Orthopaedic Centre of Excellence in Research & Learning (Noceral), Department of Orthopaedic Surgery, Faculty of Medicine, 37447Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Mohd Ariff Sharifudin
- Department of Orthopaedic Surgery, Faculty of Medicine, 65246Universiti Sultan Zainal Abidin (UNISZA), Marang Terengganu, Malaysia
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Zavras AG, Fice MP, Dandu N, Munim MA, Colman MW. Comparison of Reconstruction Techniques Following Sacroiliac Tumor Resection: A Systematic Review. Ann Surg Oncol 2022; 29:7081-7091. [PMID: 35904659 DOI: 10.1245/s10434-022-11890-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although internal hemipelvectomies with sacroiliac resections are not traditionally reconstructed, surgeons are increasingly pursuing pelvic ring reconstruction to theoretically improve stability, function, and early ambulation. This study aims to systematically compare complications and functional and oncologic outcomes of sacroiliac resection with and without reconstruction. METHODS PubMed and MEDLINE were queried for studies published between January 1990 and October 2020 pertaining to sacroiliac neoplasm resection with subsequent reconstruction. Patient demographics, histopathologic diagnoses, reconstruction techniques, Musculoskeletal Tumor Society (MSTS) functional scores, and oncologic outcomes were pooled. RESULTS Twenty-three studies (201 patients) were included for analysis. Reconstruction was performed in 79.1% of patients, most commonly with nonvascularized autografts (45.8%). The overall complication rate was 54.8%; however, resection followed by reconstruction demonstrated significantly higher complication (62.3% versus 25.7%, p < 0.001) and infection rates (13.7% versus 0%, p = 0.020). Mean MSTS functional score trended higher in nonreconstructed patients (82% versus 71.6%). CONCLUSIONS Reconstruction after sacroiliac resection produced higher complication rates and poorer physical recovery when compared with nonreconstructed resection. This systematic review suggests that patients without spinopelvic junction instability may experience superior outcomes without reconstruction. Ultimately, the need to reconstruct the pelvic girdle depends on tumor size, prognosis, and functional goals.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael P Fice
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mohammed A Munim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Asavamongkolkul A, Chotikawanich E. Late Distal Ureteral Stricture in Internal Hemipelvectomy Without Bone Reconstruction: A Case Report. Res Rep Urol 2022; 14:275-280. [PMID: 35923889 PMCID: PMC9343173 DOI: 10.2147/rru.s370265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
We report the case of a patient with Ewing sarcoma involving the right pelvis in a 14-year-old girl who had multicycles of neo-adjuvant chemotherapy and preoperative radiation therapy. She underwent an internal hemipelvectomy type I resection, according to Enneking and Dunham’s classification without bony reconstruction. There was no intra- and perioperative complication. The patient has good function and needs no gait aids. She can walk with equinus foot compensated for leg shortening 5 centimeters and without a shoe-lift. There is no sign of disease relapse. However, she developed late ureteral stricture at 8-year postoperatively and was successfully treated with a ureteral stent.
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Affiliation(s)
- Apichat Asavamongkolkul
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Apichat Asavamongkolkul, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand, Tel/Fax +66 2-419-7968, Email
| | - Ekkarin Chotikawanich
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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García-Sevilla M, Moreta-Martinez R, García-Mato D, Pose-Diez-de-la-Lastra A, Pérez-Mañanes R, Calvo-Haro JA, Pascau J. Augmented Reality as a Tool to Guide PSI Placement in Pelvic Tumor Resections. SENSORS 2021; 21:s21237824. [PMID: 34883825 PMCID: PMC8659846 DOI: 10.3390/s21237824] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
Patient-specific instruments (PSIs) have become a valuable tool for osteotomy guidance in complex surgical scenarios such as pelvic tumor resection. They provide similar accuracy to surgical navigation systems but are generally more convenient and faster. However, their correct placement can become challenging in some anatomical regions, and it cannot be verified objectively during the intervention. Incorrect installations can result in high deviations from the planned osteotomy, increasing the risk of positive resection margins. In this work, we propose to use augmented reality (AR) to guide and verify PSIs placement. We designed an experiment to assess the accuracy provided by the system using a smartphone and the HoloLens 2 and compared the results with the conventional freehand method. The results showed significant differences, where AR guidance prevented high osteotomy deviations, reducing maximal deviation of 54.03 mm for freehand placements to less than 5 mm with AR guidance. The experiment was performed in two versions of a plastic three-dimensional (3D) printed phantom, one including a silicone layer to simulate tissue, providing more realism. We also studied how differences in shape and location of PSIs affect their accuracy, concluding that those with smaller sizes and a homogeneous target surface are more prone to errors. Our study presents promising results that prove AR's potential to overcome the present limitations of PSIs conveniently and effectively.
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Affiliation(s)
- Mónica García-Sevilla
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain; (M.G.-S.); (R.M.-M.); (D.G.-M.); (A.P.-D.-d.-l.-L.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
| | - Rafael Moreta-Martinez
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain; (M.G.-S.); (R.M.-M.); (D.G.-M.); (A.P.-D.-d.-l.-L.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
| | - David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain; (M.G.-S.); (R.M.-M.); (D.G.-M.); (A.P.-D.-d.-l.-L.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
| | - Alicia Pose-Diez-de-la-Lastra
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain; (M.G.-S.); (R.M.-M.); (D.G.-M.); (A.P.-D.-d.-l.-L.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
| | - Rubén Pérez-Mañanes
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - José Antonio Calvo-Haro
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain; (M.G.-S.); (R.M.-M.); (D.G.-M.); (A.P.-D.-d.-l.-L.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; (R.P.-M.); (J.A.C.-H.)
- Correspondence: ; Tel.: +34-91-624-8196
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Bastoni S, Lucattelli E, Cipriani F, Cannamela G, Innocenti M, Menichini G. Pelvic ring reconstruction with double-barreled fibular free flap: A systematic review. Microsurgery 2021; 42:287-294. [PMID: 34498772 DOI: 10.1002/micr.30806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/17/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pelvic ring reconstruction after internal hemipelvectomy is an extremely challenging surgical procedure, and mandatory reconstruction is to provide a durable and pain-free functional outcome, especially for young, active patients. One of the most widely employed techniques is reconstruction with a double-barreled fibular free flap (DBF). The aim of our work was an in-depth analysis of the outcome of pelvic ring reconstruction performed using the above-mentioned method, in particular looking for a correlation between the fixation technique and either ambulation status or complications. MATERIALS AND METHODS A systematic review was performed in November 2020 using PubMed and MedLine Ovid databases according to the PRISMA guidelines and the results were statistically analyzed. RESULTS Studies were published between 1994 and 2015. A DBF was used in each case, with a total of 30 patients. Reconstruction was performed with screws in 13 cases, Cotrel-Dubousset rod fixation in 6, screws and plate in 5, screws with external fixation in 4, and ISOLA in 2. Follow-up time ranged from 3 to 131 months. Functional outcome was excellent in 4 patients and good in 26 patients. Statistical analysis showed no statistical evidence of existing correlation between fixation technique and complications (p = .873), while statistical correlation between age and fixation technique was found (p < .001). CONCLUSION Reconstruction of pelvic ring with DBF provides an overall good functional outcome. Our data indicate that there is no statistical evidence of existing correlation between the fixation technique and either complications or ambulation status.
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Affiliation(s)
- Stefano Bastoni
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Federico Cipriani
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | | | - Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Giulio Menichini
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
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Ito T, Fujibayashi S, Otsuki B, Tanida S, Okamoto T, Matsuda S. Remaining spine deformity after revision surgery for pelvic reconstruction and spinopelvic fixation: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21209. [PMID: 35854861 PMCID: PMC9265178 DOI: 10.3171/case21209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Pelvic deformity after resection of malignant pelvic tumors causes scoliosis. Although the central sacral vertical line (CSVL) is often used to evaluate the coronal alignment and determine the treatment strategy for scoliosis, it is not clear whether the CSVL is a suitable coronal reference axis in cases with pelvic deformity. This report proposes a new coronal reference axis for use in cases with pelvic deformity and discusses the pathologies of spinal deformity remaining after revision surgery.
OBSERVATIONS
A 14-year-old boy who had undergone internal hemipelvectomy and pelvic ring reconstruction 2 years prior was referred to our hospital with severe back pain. His physical and radiographic examinations revealed severe scoliosis with pelvic deformity. The authors planned a surgical strategy based on the CSVL and performed pelvic ring reconstruction using free vascularized fibula graft and spinopelvic fixation from L5 to the pelvis. After the procedure, although the patient’s back pain was relieved, his scoliosis persisted. At the latest follow-up, his spinal deformity correction was acceptable with corset bracing. Therefore, the authors did not perform additional surgeries.
LESSONS
The CSVL may not be appropriate for evaluating coronal alignment in cases with pelvic deformity. Accurate preoperative planning is required to correct spinal deformities with pelvic deformity.
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Affiliation(s)
- Takayuki Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shimei Tanida
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Okamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kar BK, Kumar Yadav S, Venishetty N, Kowshik S. Internal Hemipelvectomy and Pelvic Reconstruction With Non-Vascularized Fibular Graft for Chondrosarcoma Ilium. Cureus 2021; 13:e16292. [PMID: 34381651 PMCID: PMC8351254 DOI: 10.7759/cureus.16292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/31/2022] Open
Abstract
Chondrosarcoma is the third most common primary malignant bone tumor. The pelvis is the most common site with iliac bone being frequently involved. Hindquarter amputation was the standard treatment for pelvic osteosarcoma for years. Resection of tumors with wide margins gained popularity with advances in the medical field. The only resection without reconstruction of the pelvis has its own demerits which paved way for methods of reconstruction. One of these is pelvic reconstruction with non-vascularised fibular graft among many other methods, which is simple, cost-effective, and has a good functional outcome. Here, we are reporting a case of exophytic chondrosarcoma of intermediate grade in ilium in a 19-year-old male for whom internal hemipelvectomy (Enneking and Dunham type 1) and pelvic reconstruction with non-vascularised fibular graft was done with the excellent functional and radiological outcome, with a two-year follow-up.
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Affiliation(s)
- Bikram K Kar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sandeep Kumar Yadav
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nagaraju Venishetty
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sharath Kowshik
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint. INTERNATIONAL ORTHOPAEDICS 2021; 45:1793-1802. [PMID: 34086124 DOI: 10.1007/s00264-021-05096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported. Surgical procedures Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis. METHODS The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51 months (range, 9 to 96 months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated. RESULTS The mean age of four females and two males at the initial surgery was 37.2 years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12 weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and four years after surgery, for which one patient required rod replacement. CONCLUSIONS The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.
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Erol B, Sofulu O, Sirin E, Saglam F, Baysal O, Tetik C. Pelvic Ring Reconstruction After Iliac or Iliosacral Resection of Pediatric Pelvic Ewing Sarcoma: Use of a Double-Barreled Free Vascularized Fibular Graft and Minimal Spinal Instrumentation. J Bone Joint Surg Am 2021; 103:1000-1008. [PMID: 33770022 DOI: 10.2106/jbjs.20.01332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients undergoing iliosacral resections, pelvic ring reconstruction can maintain stability of the pelvis and spinal column, which is expected to achieve good functional outcomes. However, no optimal reconstruction method has been established. We aimed to analyze the outcome of pelvic ring reconstruction using double-barreled free vascularized fibular graft (FVFG) and internal fixation after iliosacral resections in children. METHODS We retrospectively reviewed 16 children with pelvic Ewing sarcoma who underwent pelvic ring reconstruction using double-barreled FVFG after iliosacral resection. The fibular graft was placed between the supraacetabular region distally and the remaining ilium or sacrum proximally. The stability of the remaining pelvis and spinal column was provided by minimal spinal instrumentation. RESULTS Eleven Type-I and 5 Type-I+IV resections were performed for 10 boys and 6 girls, who had a mean age of 13.4 years (range, 10 to 18 years). The mean follow-up was 49.8 months (range, 28 to 96 months). At the time of the final follow-up, 14 patients were alive and 2 patients had died of disease. The mean time for bone union was 9 months (range, 6 to 12 months). Graft hypertrophy was evident in all patients at 12 months. The median Musculoskeletal Tumor Society (MSTS) score at the time of the final follow-up was 80% (range, 60% to 96.6%). Seven patients had complications. Three complications required reoperation: 1 deep infection, 1 hematoma, and 1 wound dehiscence. Three patients had disease relapse in terms of lung metastases. CONCLUSIONS This reconstruction method can achieve a high rate of bone union and can provide good functional outcomes following resection of pediatric pelvic Ewing sarcomas with iliosacral involvement. Complications are usually manageable without a need for revision surgical procedures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bulent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Evrim Sirin
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fevzi Saglam
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozgur Baysal
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihangir Tetik
- Departments of Orthopaedics and Traumatology, Acıbadem University Hospital, Istanbul, Turkey
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Surgical Management of Pelvic Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Sheridan GA, Cassidy JT, Donnelly A, Noonan M, Kelly PM, Moore DP. Non-vascularised Fibular Autograft for Reconstruction of Paediatric Bone Defects: An Analysis of 10 Cases. Strategies Trauma Limb Reconstr 2020; 15:84-90. [PMID: 33505524 PMCID: PMC7801896 DOI: 10.5005/jp-journals-10080-1462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim and objective Fibular autograft is a known technique for the reconstruction of traumatic and non-traumatic bone defects in both adult and paediatric populations. We aim to describe our outcomes using various stabilisation methods for non-vascularised fibular autograft to reconstruct both benign and malignant tumours in a paediatric population in a National Paediatric Centre over the past 14 years. Materials and methods This was a retrospective review of 10 paediatric cases with non-traumatic primary bone defects in a National Paediatric Centre. Criteria for inclusion were all non-traumatic primary bone defects requiring reconstruction with a non-vascularised fibular autograft in the diaphyseal or metaphyseal regions of the bone. The primary outcome measures were union and time to union (weeks). Time to union was illustrated using Kaplan–Meier curves. Secondary outcome measures included postoperative fracture, infection (deep and superficial), time to full weight-bearing and all-cause revision surgery. Results The mean length of follow-up was 63 months for the entire cohort (9–168, SD = 48.6). There was no loss to follow-up. Six lesions were located in the tibia, two in the femur and the remaining two were located in the ulna and third metacarpal. Union was ultimately achieved in 8 of the 10 patients using this donor autograft. The mean time to union was 28 weeks (10–99, SD = 29.8). There were four complications of autograft fracture. The mean time to fracture was 17 weeks (9–32, SD = 10.71). In all four of these cases, the patient achieved union at final follow-up. There were two superficial and two deep infections recorded. Three resolved with the use of antimicrobial therapy and one deep infection ultimately required insertion of an intercalary prosthesis to treat the infected non-union of the fibular graft site. Conclusion The use of non-vascularised fibular autograft for the reconstruction of tumours is an effective surgical technique in a paediatric cohort. We report the largest known series of malignant paediatric tumours treated with this technique to date. Clinical significance Non-vascularised fibular autograft is successful in the reconstruction of large bone defects secondary to malignant paediatric bone tumours. How to cite this article Sheridan GA, Cassidy JT, Donnelly A, et al. Non-vascularised Fibular Autograft for Reconstruction of Paediatric Bone Defects: An Analysis of 10 Cases. Strategies Trauma Limb Reconstr 2020;15(2):84–90.
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Affiliation(s)
- Gerard A Sheridan
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - John T Cassidy
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Aaron Donnelly
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Maria Noonan
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Paula M Kelly
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - David P Moore
- Department of Orthopaedics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Liang YH, He HB, Zhang C, Liu YP, Wan J. Epiphyseal distraction and hybrid reconstruction using polymethyl methacrylate construct combined with free non-vascularized fibular graft in pediatric patients with osteosarcoma around knee: A case report. World J Clin Cases 2019; 7:3632-3638. [PMID: 31750347 PMCID: PMC6854415 DOI: 10.12998/wjcc.v7.i21.3632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement, joint-sparing surgery seems to be an ideal way to retain knee joint function. However, there are two points of debate with regard to the technique: How to accurately achieve a safe surgical margin, and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.
CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis. Epiphyseal distraction was applied to separate the epiphysis and metaphysis, and this provided a safe surgical margin. The massive bone defect was reconstructed with a custom-made antibiotic-loaded polymethyl methacrylate (PMMA) construct combined with a free non-vascularized fibular graft. Six months after surgery, bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography (CT) examination. Moreover, considerable callus formation was found around the PMMA construct. After 28 mo of follow-up, there was no sign of recurrence or metastasis. The patient could walk without any aid and carry out her daily life activities satisfactorily.
CONCLUSION In cases of osteosarcoma without epiphysis involvement, epiphyseal distraction can be easily applied to obtain a safe margin. Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture, less time-consuming to place, and less likely to get infected, while also ensuring bone union. Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.
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Affiliation(s)
- Yin-Hua Liang
- Department of Operation, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Hong-Bo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yu-Peng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jun Wan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Lin P, Shao Y, Lu H, Zhang Z, Lin H, Wang S, Li B, Li H, Wang Z, Lin N, Ye Z. Pelvic reconstruction with different rod-screw systems following Enneking type I/I + IV resection: a clinical study. Oncotarget 2018; 8:38978-38989. [PMID: 28465495 PMCID: PMC5503588 DOI: 10.18632/oncotarget.17164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022] Open
Abstract
The mechanical outcomes of patients with pelvic bone tumors involving zone I or zone I + IV who received resection and different reconstructions are not clear. Therefore, the purpose of this study was to compare the outcomes of different rod-screw systems in reconstruction for these patients, and evaluate the relative risk of mechanical failure for them. We reviewed 30 patients for a mean duration of 40.4 months of follow-up (range, 13.1–162.2 months), five patients had mechanical complications. The mechanical survival rate of two-rod and four-screw (TRFS) group was significantly higher than one-rod and two-screw (ORTS) group (p = 0.000). The implant survival rate was correlated with ages (p = 0.010), younger people are more likely to fail. Thus, TRFS fixation for pelvic reconstruction after Enneking type I/I + IV resection can provide better short to long-term mechanical stability compared with ORTS fixation, the strength of ORTS fixation is not enough. In addition, biological reconstruction such as autologous bone graft is recommended for the patients who are younger or suffered from benign tumor. As for the patients who are older, with malignant tumors, underwent adjuvant radiotherapy or chemotherapy, functional reconstruction with bone cement is a good choice.
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Affiliation(s)
- Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai 317000, China
| | - Youyou Shao
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Huigen Lu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
| | - Zhengliang Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, Dongyang People's Hospital, Jinhua 322100, China
| | - Haiqing Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
| | - Shengdong Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Binghao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Hengyuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
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Acetabular Reconstruction With Femoral Head Autograft After Intraarticular Resection of Periacetabular Tumors is Durable at Short-term Followup. Clin Orthop Relat Res 2017; 475:3060-3070. [PMID: 28948491 PMCID: PMC5670074 DOI: 10.1007/s11999-017-5505-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pelvic 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/PURPOSES In a pilot study, we evaluated (1) local tumor control, (2) complications, and (3) postoperative function as measured by the Musculoskeletal Tumor Society score. METHODS Between 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. RESULTS Two 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. CONCLUSIONS In 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 EVIDENCE Level IV, therapeutic study.
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Ewings sarcoma of ilium: Resection and reconstruction with femoral head allograft. J Clin Orthop Trauma 2017; 8:S53-S57. [PMID: 28878542 PMCID: PMC5574857 DOI: 10.1016/j.jcot.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
Ewing's sarcoma is a common malignant bone tumor seen in 5-15 years age group. It often arises from diaphysis of long bones. Ewing's sarcoma arising from the ilium is very rare, and it has an unfavourable prognosis. We present a rare case report of Ewings sarcoma of ilium with no metastasis in a two and a half year old boy, who was treated with neoadjuvant chemotherapy followed by surgical excision of the tumor and reconstruction using allograft from the femoral head fixed with multiple k-wires and screw. The patient is disease free at one year follow up and the allograft has taken the shape of growing ilium and excellent functionality and gait with minimal limp. Through this report, we emphasize on the occurrence of Ewings sarcoma in unusual site and resection and reconstruction of the tumor utilizing the allograft.
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Lenze U, Kasal S, Hefti F, Krieg AH. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord 2017; 18:289. [PMID: 28679368 PMCID: PMC5499012 DOI: 10.1186/s12891-017-1640-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/26/2017] [Indexed: 12/23/2022] Open
Abstract
Background The reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts. Methods We retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years). Results Primary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%). Conclusions Due to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.
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Affiliation(s)
- Ulrich Lenze
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland.
| | - Stefanie Kasal
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Fritz Hefti
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Andreas Heinrich Krieg
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
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Hipfl C, Stihsen C, Puchner SE, Kaider A, Dominkus M, Funovics PT, Windhager R. Pelvic reconstruction following resection of malignant bone tumours using a stemmed acetabular pedestal cup. Bone Joint J 2017; 99-B:841-848. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0944.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/13/2017] [Indexed: 11/05/2022]
Abstract
Aims Pelvic reconstruction after the resection of a tumour around the acetabulum is a challenging procedure due to the complex anatomy and biomechanics. Several pelvic endoprostheses have been introduced, but the rates of complication remain high. Our aim was to review the use of a stemmed acetabular pedestal cup in the management of these patients. Patients and Methods The study involved 48 patients who underwent periacetabular reconstruction using a stemmed pedestal cup (Schoellner cup; Zimmer Biomet Inc., Warsaw, Indiana) between 2000 and 2013. The indications for treatment included a primary bone tumour in 27 patients and metastatic disease in 21 patients. The mean age of the patients at the time of surgery was 52 years (16 to 83). Results At a median follow-up of 6.6 years (95% confidence interval 4.6 to 8.2), local control was achieved in all patients; 19 patients had died (16 of disease). Complications occurred in 19 patients (40%), of which deep infection was the most common, affecting eight patients (17%). Seven patients (15%) had a dislocation of the hip. Aseptic loosening was found in three patients (6%). Two (4%) underwent hindquarter amputation for non-oncological reasons. The risk of revision, with death being treated as a competing event, was 28% at one year, 39% at five years and 48% at ten years post-operatively. The mean Musculoskeletal Tumour Society Score at final follow-up was 71% (27% to 93%). Conclusion This type of reconstruction is a satisfactory option for the treatment of patients with a periacetabular tumour. There remains, however, a high rate of complication, which may be reduced by future modifications of the device such as silver coating and tripolar articulation. Cite this article: Bone Joint J 2017;99-B:841–8.
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Affiliation(s)
- C. Hipfl
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - C. Stihsen
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - S. E. Puchner
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - A. Kaider
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - M. Dominkus
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - P. T. Funovics
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
| | - R. Windhager
- Vienna General Hospital, Waehringer
Gürtel 18-20, 1090 Vienna, Austria
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Louer CR, Nassif NA, Brodt MD, Leib DJ, Silva MJ, McDonald DJ. Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection. Clin Biomech (Bristol, Avon) 2016; 38:35-41. [PMID: 27564578 PMCID: PMC6097531 DOI: 10.1016/j.clinbiomech.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reconstruction of iliosacral defects following oncologic resection is a difficult clinical problem associated with a high incidence of failure. Technical approaches to this problem are heterogeneous and evidence supporting specific techniques is sparse. Maximizing construct stability may improve union rates and functional outcomes. The purpose of this study is to compare construct stiffness, load to failure, and mechanism of failure between two methods of iliosacral reconstruction in an ex-vivo model to determine if either is mechanically superior. METHODS Eight third-generation composite pelves reconstructed with a plate-and-screw technique were tested against seven pelves reconstructed with a minimal spinal instrumentation technique using axial loading in a double-leg stance model. FINDINGS The pelves from the plate group demonstrated higher stiffness in the direction of applied load (102.9 vs. 66.8N/mm; p=0.010) and endured a significantly larger maximum force (1416 vs. 1059N; p=0.015) than the rod group prior to failure. Subjectively, the rod-reconstructed pelves were noted to be rotationally unconstrained while pivoting around their single point-of fixation in each segment leading to earlier failure. INTERPRETATION Plate-reconstruction was mechanically superior to spinal instrumentation in the manner performed in this study. More than one point of fixation in each segment should be achieved to minimize the risk of rotational deformation.
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Affiliation(s)
- Craig R. Louer
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Nader A. Nassif
- Newport Orthopedic Institute, 22 Corporate Plaza Drive, Newport Beach, CA 92660, USA,Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA 92618, USA
| | - Michael D. Brodt
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Daniel J. Leib
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Matthew J. Silva
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Douglas J. McDonald
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
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Akiyama T, Kanda S, Maeda A, Saita K. Inferior gluteal artery detection at the greater sciatic notch with a computer-assisted navigation system during pelvic and sacral tumor resection. Comput Assist Surg (Abingdon) 2016; 21:18-24. [DOI: 10.3109/24699322.2016.1174305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shotaro Kanda
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akinori Maeda
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Akiyama T, Saita K, Ogura K, Kawai A, Imanishi J, Yazawa Y, Kawashima N, Ogata T. The effect of an external hip joint stabiliser on gait function after surgery for tumours located around the circumference of the pelvis: analysis of seven cases of internal hemipelvectomy or proximal femur resection. INTERNATIONAL ORTHOPAEDICS 2015; 40:561-7. [PMID: 26555185 DOI: 10.1007/s00264-015-3023-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Limb-sparing resection of malignant pelvic tumours provides the opportunity for patients to obtain better post-operative mobility. However, because few studies have examined in detail the gait function of patients following pelvic tumour resection, the factors affecting gait performance remain to be clarified. Here, with the laboratory-based computer-assisted gait analysis, we evaluated these patients' gait objectively and the impact of a hip-stabilising supporter on gait improvement was simultaneously examined. METHODS Three-dimensional gait analysis was performed to obtain cross-sectional data for seven post-operative patients (mean age, 42.7 years; range, 20-61 years) who underwent various types of resection, including P1/4 internal hemipelvectomy (IH), P1/2/3 IH, and proximal femur resection with prosthetic reconstruction. To assess the immediate effects of a hip joint stabiliser, we instructed subjects to walk at their self-selected preferred speed and compared gait parameters with and without use of the hip stabiliser. RESULTS At baseline, the average walking speed was 0.75 m/s (95% CI 0.53-0.97). As shown by the intra-subject comparison, the hip stabiliser increased walking speed in all but one subject, increasing both temporal and spatial parameters. Ground reaction force of operated limbs increased for some subjects, while step length increased on at least one side in all subjects. CONCLUSIONS Improvement in the gait parameters is indicative of better control provided by the external hip stabiliser over the affected limb. Moreover, our findings show the potential of a biomechanical approach to improve gait function following pelvic tumour resection.
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Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jungo Imanishi
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasuo Yazawa
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan
| | - Toru Ogata
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.
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Tan TJ, Aljefri AM, Clarkson PW, Masri BA, Ouellette HA, Munk PL, Mallinson PI. Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours. Eur J Radiol 2015; 84:1782-90. [PMID: 26104572 DOI: 10.1016/j.ejrad.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases.
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Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Ahmad M Aljefri
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul W Clarkson
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul I Mallinson
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Abstract
Ewing sarcoma (ES) is rare in Japanese people, and only 30-40 patients develop the disease annually. To diagnose ES, molecular techniques that aim to detect characteristic fusion genes are commonly used in combination with conventional histological and immunohistochemical examinations. The treatment strategy for ES is characterized by multi-disciplinary collaboration between pediatric oncologists, medical oncologists, radiation oncologists, and orthopedic surgeons. In recent years, numerous large-scale national or international multi-institutional studies of ES have been performed. Pre- and postoperative intensive systemic chemotherapy with multiple anticancer drugs is the standard treatment method for ES. Depending on the obtained surgical margin, postoperative radiation might also be performed. If preoperative radiological examinations indicate that surgical excision would be difficult, preoperative radiation can be administered. As the treatment outcomes of ES have improved, late complications and secondary malignancies have become a problem. After treatment, patients with ES require very long-term follow-up in order to detect secondary malignancies and growth-related musculoskeletal complications.
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Affiliation(s)
- Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama, 700-8558, Japan,
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26
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Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor. Arch Orthop Trauma Surg 2015; 135:619-25. [PMID: 25795428 PMCID: PMC4544562 DOI: 10.1007/s00402-015-2197-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In patients undergoing limb-salvage internal hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal hemipelvectomy with special reference to long-term complications. MATERIALS AND METHODS We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3-131 months). RESULTS The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3-7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up. CONCLUSIONS In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary.
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Shao QD, Yan X, Sun JY, Xu TM. Internal hemipelvectomy with reconstruction for primary pelvic neoplasm: a systematic review. ANZ J Surg 2014; 85:553-60. [PMID: 25387591 DOI: 10.1111/ans.12895] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemipelvectomy is a major operation with significant risks including infection, prosthesis failure and fracture. This systematic review was designed to review the functional outcomes, oncologic outcomes and complications in patients who received internal hemipelvectomy and pelvic reconstruction for primary pelvic tumour. METHODS Searches on MEDLINE, the Cochrane Library, Embase and Google Scholar were performed to locate studies involving patients receiving internal hemipelvectomy and pelvic reconstruction using a prosthesis, implant or bone graft. All studies were either prospective or retrospective observational studies published in English. RESULTS This systematic review included 12 studies from 1990 to 2011 involving 217 patients from 5 to 77 years of age who had received follow-up for a period from 3 weeks to 15 years. Among the 12 studies, the mortality rate, disease-free rate and incidence of local recurrence were 10-69.2, 23.1-90.0 and 9.1-41.7%, respectively. The post-operative Musculoskeletal Tumor Society (MSTS) functional score ranged from 50 to 70 in the more recent studies. Compared with prostheses and other implants, patients who received allografts had the highest post-operative function, as shown by their MSTS scores, but also had a greater incidence of post-operative infection. On the other hand, the prosthesis group was associated with the highest percentage of fracture and dislocations, as well as other significant complications. CONCLUSION This comprehensive review provided informative details regarding the goals, outcomes and complications associated with this procedure and underscored the need for further investigation into the various surgical approaches currently available.
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Affiliation(s)
- Qing Dong Shao
- Department of Orthopedics, PLA Fourth Fifty-Five Hospital (455 Hospital), Shanghai, China
| | - Xu Yan
- Department of Orthopedics, PLA Fourth Fifty-Five Hospital (455 Hospital), Shanghai, China
| | - Jiu Yi Sun
- Department of Orthopedics, PLA Fourth Fifty-Five Hospital (455 Hospital), Shanghai, China
| | - Tian Ming Xu
- Department of Orthopedics, PLA Fourth Fifty-Five Hospital (455 Hospital), Shanghai, China
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Wafa H, Grimer RJ, Jeys L, Abudu AT, Carter SR, Tillman RM. The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection. Bone Joint J 2014; 96-B:1404-10. [PMID: 25274929 DOI: 10.1302/0301-620x.96b10.33470] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to evaluate the functional and oncological outcome of extracorporeally irradiated autografts used to reconstruct the pelvis after a P1/2 internal hemipelvectomy. The study included 18 patients with a primary malignant bone tumour of the pelvis. There were 13 males and five females with a mean age of 24.8 years (8 to 62). Of these, seven had an osteogenic sarcoma, six a Ewing’s sarcoma, and five a chondrosarcoma. At a mean follow-up of 51.6 months (4 to 185), nine patients had died with metastatic disease while nine were free from disease. Local recurrence occurred in three patients all of whom eventually died of their disease. Deep infection occurred in three patients and required removal of their graft in two while the third underwent a hindquarter amputation for extensive flap necrosis. The mean Musculoskeletal Tumor Society functional score of the 16 patients who could be followed-up for at least 12 months was 77% (50 to 90). Those 15 patients who completed the Toronto Extremity Salvage Score questionnaire had a mean score of 71% (53 to 85). Extracorporeal irradiation and re-implantation of bone is a valid method of reconstruction after an internal hemipelvectomy. It has an acceptable morbidity and a functional outcome that compares favourably with other available reconstructive techniques. Cite this article: Bone Joint J 2014;96-B:1404–10
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Affiliation(s)
- H. Wafa
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
| | - R. J. Grimer
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
| | - L. Jeys
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
| | - A. T. Abudu
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
| | - S. R. Carter
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
| | - R. M. Tillman
- The Royal Orthopaedic Hospital NHS Trust, Bristol
Road South, Northfield, Birmingham, West
Midlands, B31 2AP, UK
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Starantzis KA, Sakellariou VI, Rose PS, Yaszemski MJ, Papagelopoulos PJ. A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula. J Neurosurg Spine 2014; 21:195-202. [DOI: 10.3171/2014.1.spine13245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a technical note of pelvic reconstruction performed by an advanced multidisciplinary team. The authors report a new 3-stage reconstruction of the hemipelvis after Type 3 sacrectomy involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients.
The anterior stage of the procedure begins with a transabdominal approach to mobilize the viscera and to free up the tumor from the vessels. The posterior divisions of internal iliac vessels, the middle sacral vessels, and the lateral sacral vessels are then ligated. An anterior vertebrectomy is done at the appropriate level, followed by an anterior osteotomy through the lateral planed surgical margin of the sacrum close to the salvaged sacroiliac joint. The second stage includes a major sacral resection with lower-extremity amputation from the pubic symphysis through the intact side of the sacrum, ipsilateral pedicled fibula harvesting, and closure with an ipsilateral pedicled quadriceps flap. The final stage involves reconstruction with lumboiliac instrumentation. The pedicled fibular graft left from the second stage is then placed distally within the previously created iliopectineal docking site and proximally within the L-5 docking site.
The authors believe that this is a feasible and reproducible technique with theoretical advantages that have to be proved in the long-term follow-up.
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Affiliation(s)
- Konstantinos A. Starantzis
- 1Centre for Spinal Studies and Surgery, Nottingham University Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | | | - Peter S. Rose
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | - Panayiotis J. Papagelopoulos
- 4First Department of Orthopaedics, Athens University Medical School, Attikon University General Hospital, Chaidari, Greece
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Gebert C, Wessling M, Gosheger G, Aach M, Streitbürger A, Henrichs MP, Dirksen U, Hardes J. Pelvic reconstruction with compound osteosynthesis following hemipelvectomy: A clinical study. Bone Joint J 2013; 95-B:1410-6. [PMID: 24078542 DOI: 10.1302/0301-620x.95b10.31123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To date, all surgical techniques used for reconstruction of the pelvic ring following supra-acetabular tumour resection produce high complication rates. We evaluated the clinical, oncological and functional outcomes of a cohort of 35 patients (15 men and 20 women), including 21 Ewing's sarcomas, six chondrosarcomas, three sarcomas not otherwise specified, one osteosarcoma, two osseous malignant fibrous histiocytomas, one synovial cell sarcoma and one metastasis. The mean age of the patients was 31 years (8 to 79) and the latest follow-up was carried out at a mean of 46 months (1.9 to 139.5) post-operatively. We undertook a functional reconstruction of the pelvic ring using polyaxial screws and titanium rods. In 31 patients (89%) the construct was encased in antibiotic-impregnated polymethylmethacrylate. Preservation of the extremities was possible for all patients. The survival rate at three years was 93.9% (95% confidence interval (CI) 77.9 to 98.4), at five years it was 82.4% (95% CI 57.6 to 93.4). For the 21 patients with Ewing's sarcoma it was 95.2% (95% CI 70.7 to 99.3) and 81.5% (95% CI 52.0 to 93.8), respectively. Wound healing problems were observed in eight patients, deep infection in five and clinically asymptomatic breakage of the screws in six. The five-year implant survival was 93.3% (95% CI 57.8 to 95.7). Patients were mobilised at a mean of 3.5 weeks (1 to 7) post-operatively. A post-operative neurological defect occurred in 12 patients. The mean Musculoskeletal Tumor Society score at last available follow-up was 21.2 (10 to 27). This reconstruction technique is characterised by simple and oncologically appropriate applicability, achieving high primary stability that allows early mobilisation, good functional results and relatively low complication rates.
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Affiliation(s)
- C Gebert
- Orthopaedic Hospital Volmarstein, Department of Tumour & Revision Surgery, Lothar-Gau-Str. 11, D-58300 Wetter, and The University of Muenster, Germany
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31
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Nassif NA, Buchowski JM, Osterman K, McDonald DJ. Surgical technique: Iliosacral reconstruction with minimal spinal instrumentation. Clin Orthop Relat Res 2013; 471:947-55. [PMID: 23065355 PMCID: PMC3563802 DOI: 10.1007/s11999-012-2643-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/01/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior pelvic ring reconstruction can be challenging and controversial. The choice regarding whether to reconstruct and how to reconstitute the pelvic ring is unclear. Many methods provide stability but often are technically difficult and require excessive dissection. DESCRIPTION OF SURGICAL TECHNIQUE: This unique reconstructive technique uses the anterior aspect of the iliac crest with its attached muscle pedicle to provide a biologic scaffold for healing. The construct is secured with pedicle screws into the posterior column and S1 vertebral body with a spinal rod locked in compression. No additional fixation is used proximally into the lumbar spine. The iliac crest remains attached to the gluteus medius, allowing potential abductor function. METHODS We retrospectively reviewed six patients who underwent iliosacral resection with this reconstruction. The mean age of the patients was 41 years. Complications were recorded. One patient died 6 months postoperatively. Musculoskeletal Tumor Society 1993 (MSTS '93) score and Toronto Extremity Salvage Score (TESS) were obtained at a minimum 1-year followup in five patients. Healing was assessed radiographically. The minimum followup was 6 months (median, 33 months; range, 6-53 months). RESULTS The mean MSTS '93 score was 72% and mean TESS was 66. All posterior column graft sites healed. At last followup, four of the five surviving patients had a stable pseudarthrosis at the proximal sacral site. One patient had a local recurrence and experienced failure of instrumentation without collapse or rotation of the hemipelvis 3 years postoperatively. CONCLUSIONS This technique provides a simple way to reconstruct the pelvic ring after iliosacral resection with clinical outcomes comparable to those for other methods. The method is a potential alternative for reconstruction of the posterior pelvic ring after resecting the ilium although reliable healing of the sacral site needs to be improved.
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Affiliation(s)
- Nader A. Nassif
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St Louis, MO 63110 USA
| | - Jacob M. Buchowski
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St Louis, MO 63110 USA
| | - Kelly Osterman
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St Louis, MO 63110 USA
| | - Douglas J. McDonald
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St Louis, MO 63110 USA
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Asavamongkolkul A, Waikakul S. Using polypropylene mesh graft for soft-tissue reconstruction in internal hemipelvectomy: a case report. World J Surg Oncol 2012; 10:124. [PMID: 22742759 PMCID: PMC3407738 DOI: 10.1186/1477-7819-10-124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/28/2012] [Indexed: 11/29/2022] Open
Abstract
We report the case of a patient with chondrosarcoma involving the right pelvis and contralateral pubic area in a 45-year-old male who underwent an extensive internal hemipelvectomy without bony reconstruction. We demonstrate the technique of using polypropylene mesh graft for soft-tissue reconstruction. Follow-up at 7.5 years showed a good oncological and functional outcome.
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Affiliation(s)
- Apichat Asavamongkolkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok, 10700, Thailand
| | - Saranatra Waikakul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok, 10700, Thailand
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33
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Jeong ST, Park HB, Hwang SC, Kim DH, Nam DC. Use of intramedullary nonvascularized fibular graft with external fixation for revisional Charcot ankle fusion: a case report. J Foot Ankle Surg 2011; 51:249-53. [PMID: 22055490 DOI: 10.1053/j.jfas.2011.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Indexed: 02/03/2023]
Abstract
We describe a case of Charcot ankle arthropathy in a 43-year-old male patient who underwent revision surgery for tibiotalocalcaneal arthrodesis with a retrograde intramedullary nonvascularized fibular graft. After 3 months of postoperative stabilization with a ring external fixator, successful radiographic union was identified. The findings obtained at 33 months postoperatively showed maintenance of solid fusion and restoration of hindfoot alignment without any complications.
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Affiliation(s)
- Soon-Taek Jeong
- Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine, Jinju, Gyeongnam, Republic of Korea
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Fisher NE, Patton JT, Grimer RJ, Porter D, Jeys L, Tillman RM, Abudu A, Carter SR. Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement. ACTA ACUST UNITED AC 2011; 93:684-8. [DOI: 10.1302/0301-620x.93b5.25608] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endoprosthetic replacement of the pelvis is one of the most challenging types of limb-salvage surgery, with a high rate of complications. In an attempt to reduce this and build greater versatility into the reconstruction process, a new type of pelvic endoprosthesis was developed in 2003, based on the old McKee-Farrar prosthesis. This study reviews the outcomes in 27 patients who had an ice-cream cone pelvic prosthesis inserted at two different specialist bone tumour centres in the United Kingdom over the past six years. The indications for treatment included primary bone tumours in 19 patients and metastatic disease in two, and six implants were inserted following failure of a previous pelvic reconstruction. Most of the patients had a P2+P3 resection as classified by Enneking, and most had resection of the ilium above the sciatic notch. The mean age of the patients at operation was 49 years (13 to 81). Complications occurred in ten patients (37.0%), of which dislocation was the most common, affecting four patients (14.8%). A total of three patients (11.1%) developed a deep infection around the prosthesis but all were successfully controlled by early intervention and two patients (7.4%) developed a local recurrence, at the same time as widespread metastases appeared. In one patient the prosthesis was removed for severe pain. This method of treatment is still associated with high morbidity, but early results are promising. Complications are diminishing with increasing experience.
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Affiliation(s)
- N. E. Fisher
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - J. T. Patton
- The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK
| | - R. J. Grimer
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - D. Porter
- The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK
| | - L. Jeys
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - R. M. Tillman
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - A. Abudu
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - S. R. Carter
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
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35
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Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. ACTA ACUST UNITED AC 2010; 92:1568-73. [PMID: 21037354 DOI: 10.1302/0301-620x.92b11.24893] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively evaluated 18 patients with a mean age of 37.3 years (14 to 72) who had undergone pelvic reconstruction stabilised with a non-vascularised fibular graft after resection of a primary bone tumour. The mean follow-up was 10.14 years (2.4 to 15.7). The mean Musculoskeletal Tumor Society Score was 76.5% (50% to 100%). Primary union was achieved in the majority of reconstructions within a mean of 22.9 weeks (7 to 60.6). The three patients with delayed or nonunion all received additional therapy (chemotherapy/radiation) (p = 0.0162). The complication rate was comparable to that of other techniques described in the literature. Non-vascularised fibular transfer to the pelvis is a simpler, cheaper and quicker procedure than other currently described techniques. It is a biological reconstruction with good results and a relatively low donor site complication rate. However, adjuvant therapy can negatively affect the outcome of such grafts.
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Affiliation(s)
- A H Krieg
- Paediatric Orthopaedic Department, University Children's Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland.
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