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. 2024 Jan 1;106-B(1):93-98.
doi: 10.1302/0301-620X.106B1.BJJ-2023-0594.R1.

Reconstruction following oncological iliosacral resection

Samuel E Broida  1 , Kim M Tsoi  2   3 , Peter S Rose  1 , Peter C Ferguson  2   3 , Anthony M Griffin  2   3 , Jay S Wunder  2   3 , Matthew T Houdek  1
Affiliations

Reconstruction following oncological iliosacral resection

Samuel E Broida et al. Bone Joint J. .

Abstract

Aims: The sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed.

Methods: A total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19).

Results: Overall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a deep infection (48% vs 12%; p = 0.003). Nine reconstructed patients had a hardware failure, with five requiring revision. Postoperatively 55 (92%) patients were ambulatory, with no difference in the proportion of ambulatory patients (89% vs 94%; p = 0.649) or mean Musculoskeletal Tumor Society Score (59% vs 65%; p = 0.349) score between patients who did or did not have a reconstruction. The ten-year disease-specific survival was 69%, with no difference between patients who were reconstructed and those who were not (78% vs 45%; p = 0.316). There was no difference in the rate of metastasis between the two groups (hazard ratio (HR) 2.78; p = 0.102).

Conclusion: Our results demonstrate that SIJ reconstruction is associated with longer operating times, greater need for blood transfusion, and more postoperative infections, without any improvement in functional outcomes when compared to patients who did not have formal SIJ reconstruction.

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Conflict of interest statement

M. T. Houdek reports consulting fees from Link Orthopaedics, unrelated to this study. M. T. Houdek also reports leadership or a fiduciary role, paid or unpaid, for the Musculoskeletal Tumor Society, Connective Tissue Oncology Society, and Sarcoma Alliance for Research through Collaboration. P. S. Rose reports leadership or a fiduciary role, paid or unpaid, for the International Society of Limb Salvage and the Sacral Tumor Study Group, and is Editor of the Journal of the American Academy of Orthopaedic Surgeons.

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