Publié sur : 25th annual meeting european musculoskeletal oncology society - bologne italie - 2012
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Long term follow up of composite prostheses after periacetabular resection
Gérard Delepine, Fabrice Delepine, S. Alkhalaff, H. Cornille, Nicole Delepine

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Long term follow up of composite prostheses after periacetabular resection

Without reconstruction limb shortening can reaches 5 centimeters

After peri-acetabular resection for bone sarcoma, a reconstructive procedure is necessary to stabilize the hip, avoid limb discrepancy and permit full weight bearing.



Blood loss after periacetabular resection
Resection of acetabula is time and blood consuming. The reconstuctive procedure needs to be easy to perform.



The hand on innominate prosthesis
Described in 2003 (Sarcoma 2003 7,19-27) is made of a titanium cup, a set of long titanium screws and 2 or 3 packs of antibiotics loaded cement.



Fix the cup
The first phase of the reconstruction is to fix the cup with long screws.



Fill the gap with cement and put the polyethylene component
The gap between cup and bone is filled with cement loaded with antibiotics and polyethylene component cemented on the innominate prosthesis.



Patients
Between 1990 and 2007, 84 patients with bone sarcoma (40) or metastases (44) have been treated by internal hemipelvectomy followed by this reconstructive procedure.

Only 23 survivors (20/40 sarcoma and 3/44 metastases) could be followed more than 5 years.



Solitary metastase from kidney carc
Patient aged 45 years solitary metastase from kidney. Primary tumor resected. Metastase primarly treated with radiotherapie. Progressive disease. Resection.



Metastatic Periacetabular Ewing's
Resection of acetabular and iliac wing for ewing sarcoma with solitary metastase on L4.
Resection of primary and of the metatsase.



Bifocal Ewing Sarcoma - DD2 protocol and surgery of both lesions.
DFS 14 years after resection. Fair result. 2cms discrepancy. good acceptance, flexion 60°. some pain. illimited walking without support.



Grade 1 Chondrosarcoma
5/1991 :Grade 1 Chondrosarcoma of pubis. Contaminated resection.



1/1992 local recurrence. Wide resection with reconstruction using composite prosthesis.



7/2011 Complete remission.



Post operative complications
6 patients (25 %) experimented postoperative dislocation of the hip prosthesis.
10 patients (43%) had to be reoperated.



Late complications
- included 2 deep infections,
- 6 polyethylene wear and
- 7 loosening (5 iliac, 2 femoral).
- 10 patients (43%) had to be re operated.

Orthopaedic results
According to grading of European Society for Musculoskeletal Oncology were excellent in 5, good in 12, fair in 3, bad in 3. The mean functional score of patients who have still their prosthesis is 80 %.
No pain, excellent acceptance, length discrepancy < 1 cm, average flexion 100° and illimited walking without support.


Osteosarcoma of zone 2+3



Thyroid Carcinoma
Treatment of liac lesion with composite proshesis.
12 years after resection : No length discrepancy excellent acceptance, flexion 110° illimited walking without support . Little pain.



Solitary metastase from kidney
12 years after resection. No length discrepancy excellent acceptance, flexion 110° illimited walking without support. No pain.



Chondrosarcoma grade 1 - 21 years follow up
After 21 years the acetabular reconstruction has no problem.



Solitary metastase from parotid
DFS 30 months after resection. No length discrepancy excellent acceptance, flexion 110°
illimited walking without support and no pain.



Comments
"Hand on" composite reconstruction gives similar functional result than custom made prosthesis and much better function than alternative techniques.
The use of cement permits the adjunction of antibiotics needed for these complicated cares.

Total iliac wing and Acetablar Resection
It is cheaper, more flexible than custom made prosthesis and can be used even when no part of iliac wing remains.
This device is feasableafter total iliac wing and acetabular resection. No alternative technique of reconstruction has been described.



Conclusions
The immediate advantages and the durability of such procedure plea for using it extensively after acetabulum resection of zone 2 and 3 where we did not observed loosening of the iliac reconstruction.

Such a procedure can also be used after total iliac wing resection even when including zone 4. But in this location loosening is frequent and pleas for reinforcing the reconstruction with the head and neck of femur when there are free of tumor.

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