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Surgical technique: Porous tantalum reconstruction for destructive nonprimary periacetabular tumors.

Abstract Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail.
PMID
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Authors

Mayor MeshTerms

Hip Prosthesis

Tantalum

Keywords
Journal Title clinical orthopaedics and related research
Publication Year Start




PMID- 21989784
OWN - NLM
STAT- MEDLINE
DCOM- 20120227
LR  - 20170220
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Linking)
VI  - 470
IP  - 2
DP  - 2012 Feb
TI  - Surgical technique: Porous tantalum reconstruction for destructive nonprimary
      periacetabular tumors.
PG  - 594-601
LID - 10.1007/s11999-011-2117-2 [doi]
AB  - BACKGROUND: Large bone loss and frequently irradiated existing bone make
      reconstructing metastatic and other nonprimary periacetabular tumors challenging.
      Although existing methods are initially successful, they may fail with time.
      Given the low failure rates of porous tantalum acetabular implants in other
      conditions with large bone loss or irradiated bone, we developed a technique to
      use these implants in these neoplastic cases where others might fail. DESCRIPTION
      OF TECHNIQUE: After local tumor curettage, a large uncemented tantalum shell
      (sometimes with tantalum augments) was fixed to remaining bone using numerous
      screws. When substantial medial bone loss was present, an antiprotrusio cage was 
      placed over the top of the cup and secured to remaining ilium and ischium.
      PATIENTS AND METHODS: We retrospectively reviewed 20 patients who underwent THAs 
      for neoplastic bone destruction with the described technique. Their mean age was 
      60 years (range, 22-80 years). We recorded pain and ambulatory status, pain
      medication use, and Harris hip scores. We assessed for progressive radiolucent
      lines and component migration on followup radiographs. Eleven of the 20 patients 
      died at a mean of 17 months after surgery. The minimum followup for surviving
      patients was 26 months (mean, 56 months; range, 26-85 months). RESULTS: Harris
      hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively.
      We observed no cases of progressive radiolucent lines or component migration.
      Complications included one perioperative death, two superficial infections, one
      deep vein thrombosis, and one dislocation. CONCLUSION: Our initial experience has
      made tantalum reconstruction our preferred method for dealing with major
      periacetabular neoplastic bone loss. Additional studies comparing this technique 
      with alternatives are required. LEVEL OF EVIDENCE: Level IV, therapeutic study.
      See Guidelines for Authors for a complete description of levels of evidence.
FAU - Khan, Fazel A
AU  - Khan FA
AD  - Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
      55905, USA. [email protected]
FAU - Rose, Peter S
AU  - Rose PS
FAU - Yanagisawa, Michiro
AU  - Yanagisawa M
FAU - Lewallen, David G
AU  - Lewallen DG
FAU - Sim, Franklin H
AU  - Sim FH
LA  - eng
PT  - Journal Article
DEP - 20111012
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
RN  - 6424HBN274 (Tantalum)
SB  - AIM
SB  - IM
MH  - Acetabulum/diagnostic imaging/pathology/*surgery
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthralgia/etiology
MH  - Arthroplasty, Replacement, Hip/adverse
      effects/*instrumentation/*methods/mortality
MH  - Bone Neoplasms/diagnostic imaging/mortality/secondary/*surgery
MH  - Bone Screws
MH  - Curettage
MH  - Female
MH  - Hip Joint/diagnostic imaging/pathology/physiopathology/*surgery
MH  - *Hip Prosthesis
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Minnesota
MH  - Pain Measurement
MH  - Pain, Postoperative/etiology
MH  - Porosity
MH  - Prosthesis Design
MH  - Radiography
MH  - Range of Motion, Articular
MH  - Recovery of Function
MH  - Registries
MH  - Retrospective Studies
MH  - *Tantalum
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC3254739
OID - NLM: PMC3254739
EDAT- 2011/10/13 06:00
MHDA- 2012/03/01 06:00
CRDT- 2011/10/13 06:00
PHST- 2010/12/14 00:00 [received]
PHST- 2011/09/21 00:00 [accepted]
PHST- 2011/10/13 06:00 [entrez]
PHST- 2011/10/13 06:00 [pubmed]
PHST- 2012/03/01 06:00 [medline]
AID - 10.1007/s11999-011-2117-2 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2012 Feb;470(2):594-601. doi: 10.1007/s11999-011-2117-2.
      Epub 2011 Oct 12.