Short-to-Mid-Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection

Abstract

Objective: Periacetabular tumors, especially in young to middle-aged patients with invasive benign tumors or low-grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight-bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra-articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients.

Methods: We conducted a retrospective study with a follow-up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low-grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t-tests to compare preoperative and postoperative scores.

Results: The study included 20 patients, and a total median follow-up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3-17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation.

Conclusion: Through multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb-sparing surgery worthy of consideration for carefully selected patients.

Keywords: Acetabulum Reconstruction; Autologous Femoral Head; Periacetabular Tumors; Total Hip Arthroplasty.

FIGURE 1

(A) CT and MRI images of the tumor. (B) Virtual 3D pelvic tumor models using Mimics V20.0 software (tumors are shown in red). (C) The simulation of tumor resection. (D) The morphology was obtained after resection along the osteotomy plane. (E) The femoral head was transplanted to form a new acetabular fossa. (F) and (G) A suitably sized nonbone cement acetabular prosthesis was press‐fitted into place, supplemented with screws as needed.

FIGURE 2

Intraoperative photographs. The autogenous femoral head, the proper shape, shifts to pelvic defect reconstruction for the new acetabulum fossa, appropriate to the size of the acetabulum bone cement prosthesis pressed in place.

FIGURE 3

(A–C) A giant cell tumor (GCT) of bone in zones II + III of the right pelvis of a 49‐year‐old male patient. (D–F) Postoperative radiographs show a good position of the prosthesis. (G, H) CT images at the last follow‐up showed no obvious complications, such as bone resorption and graft loosening.