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. 2021 Nov 1:31:100401.
doi: 10.1016/j.jbo.2021.100401. eCollection 2021 Dec.

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Tomohiro Fujiwara  1   2 , Yusuke Tsuda  1 , Jonathan Stevenson  1 , Michael Parry  1 , Lee Jeys  1
Affiliations

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Tomohiro Fujiwara et al. J Bone Oncol. .

Abstract

Background: While extra-articular resection (EAR) of the knee and shoulder joint is associated with poorer clinical outcomes, the oncological and functional risks of EAR of the hip joint are unknown. We aimed to compare these risks between EAR of the hip joint and intra-articular resection (IAR).

Methods: We conducted a comparative study of 75 patients who underwent en-bloc tumour resection and limb-salvage reconstruction for bone sarcomas of the peri-acetabulum between 1996 and 2016. We divided patients into two groups for analyses; EAR (n = 21) and IAR (n = 54).

Results: There was no statistical difference in oncological outcomes; the 5-year cumulative incidence of disease-specific death was 34% and 35% in the EAR and IAR groups, respectively (p = 0.943), and the 5-year cumulative incidence of LR was 26% and 34%, respectively (p = 0.482). The most common complications were dislocation (28%) and deep infection (28%); there was equally no difference between the groups. The mean Musculoskeletal Tumour Society score was 66% and 65% in the EAR and IAR groups, respectively (p = 0.795), and were significantly lower in patients with deep infection (52% vs. 69%; p = 0.013). In a sub-analysis on the outcomes in patients who underwent PI-uninvolved PII-resection for chondrosarcoma, no major differences in oncologic and functional outcomes were confirmed.

Conclusion: Patients undergoing EAR and limb-salvage reconstructions of the hip joint have undistinguishable oncological, clinical and functional outcomes compared to those undergoing IAR and reconstructions. If preoperative imaging suggests articular tumour involvement, there appears to be no detrimental effect of undertaking EAR to optimise local control.

Keywords: Extra-articular resection; Hip joint; Intra-articular resection; Pelvis; Sarcoma.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A 57-year-old female with grade 2 chondrosarcoma. The axial (A) and coronal (B) images of T2-weighted magnetic resonance (MR) imaging. Tumour invasion into hip joint was suspected (yellow arrows). (C) Plain radiograph after extra-articular resection and reconstruction with an ice-cream cone prosthesis and proximal femoral replacement.
Fig. 2
Fig. 2
Competing analysis showing the cumulative incidence of disease-specific death (p = 0.943; A), local recurrence (p = 0.482; B), and implant failure (p = 0.240; C). EAR, extra-articular resection; IAR, intra-articular resection.
See this image and copyright information in PMC

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