Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours

Abstract

Purpose: We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect.

Methods: From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1-22.5, standard deviation ± 5.3). Kaplan-Meier analysis was used to estimate survival rates.

Results: Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %).

Conclusion: The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes.

Fig. 1

a Preoperative radiograph (top panel) and magnetic resonance imaging (coronal T2-weighted turbo spin-echo) (middle panel) of a 44-year-old patient with a painful mass at the right hemipelvis and hereditary multiple exostoses. Histological analysis revealed a secondary chondrosarcoma (American Joint Committee on Cancer staging IIB). Radiograph 3.5 years postoperatively (bottom panel), with a stable prosthesis and a good functional outcome (Musculoskeletal Tumor Society rating 70%). b Osteotomy guide (top panel) and prosthetic component for bony fixation (middle panel) are custom made. The acetabular component is a modular off-the-shelf product, and its anteversion can be adjusted step by step relative to the component fixed at the remaining iliac bone (bottom panel). (Left panel reproduced from [19], with permission)

Fig. 2

Kaplan–Meier curves showing a overall disease-specific survival, b survival for patients after wide or marginal and intralesional tumor resection, c survival after primary and secondary tumor resection, d revision-free survival