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Acetabular Reconstruction With Femoral Head Autograft After Intraarticular Resection of Periacetabular Tumors is Durable at Short-term Followup.

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Arthroplasty, Replacement, Hip

Osteotomy

Keywords
Journal Title clinical orthopaedics and related research
Publication Year Start




PMID- 28948491
OWN - NLM
STAT- MEDLINE
DCOM- 20171113
LR  - 20171117
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Linking)
VI  - 475
IP  - 12
DP  - 2017 Dec
TI  - Acetabular Reconstruction With Femoral Head Autograft After Intraarticular
      Resection of Periacetabular Tumors is Durable at Short-term Followup.
PG  - 3060-3070
LID - 10.1007/s11999-017-5505-4 [doi]
AB  - 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
      debridement), 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.
FAU - Tang, Xiaodong
AU  - Tang X
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
FAU - Guo, Wei
AU  - Guo W
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
      [email protected]
FAU - Yang, Rongli
AU  - Yang R
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
FAU - Yan, Taiqiang
AU  - Yan T
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
FAU - Tang, Shun
AU  - Tang S
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
FAU - Li, Dasen
AU  - Li D
AD  - Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11
      Xizhimen South Street, Xicheng District, Beijing, 100044, China.
LA  - eng
PT  - Journal Article
DEP - 20170925
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - AIM
SB  - IM
MH  - Acetabulum/diagnostic imaging/pathology/*surgery
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Arthroplasty, Replacement, Hip/adverse effects/instrumentation/mortality
MH  - Autografts
MH  - Bone Neoplasms/diagnostic imaging/mortality/pathology/*surgery
MH  - Bone Transplantation/adverse effects/*methods/mortality
MH  - Disease Progression
MH  - Female
MH  - Femur Head/diagnostic imaging/pathology/*surgery
MH  - Hip Prosthesis
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local
MH  - *Osteotomy/adverse effects/mortality
MH  - Pelvic Neoplasms/diagnostic imaging/mortality/pathology/*surgery
MH  - Pilot Projects
MH  - Prosthesis Design
MH  - Retrospective Studies
MH  - Time Factors
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC5670074
EDAT- 2017/09/28 06:00
MHDA- 2017/11/14 06:00
CRDT- 2017/09/27 06:00
PMCR- 2018/12/01 00:00
PHST- 2017/05/08 00:00 [received]
PHST- 2017/09/12 00:00 [accepted]
PHST- 2018/12/01 00:00 [pmc-release]
PHST- 2017/09/28 06:00 [pubmed]
PHST- 2017/11/14 06:00 [medline]
PHST- 2017/09/27 06:00 [entrez]
AID - 10.1007/s11999-017-5505-4 [doi]
AID - 10.1007/s11999-017-5505-4 [pii]
PST - ppublish
SO  - Clin Orthop Relat Res. 2017 Dec;475(12):3060-3070. doi:
      10.1007/s11999-017-5505-4. Epub 2017 Sep 25.