Early Results of Acetabular Reconstruction After Wide Periacetabular Oncologic Resection

• Published in: Journal of bone and joint surgery. American volume 2017-02, Vol.99 (3), p.e9-e9
• Main Authors: Abdel, Matthew P., von Roth, Philipp, Perry, Kevin I., Rose, Peter S., Lewallen, David G., Sim, Franklin H.
• Format: Article
• Language: English
• Subjects: Acetabulum; Acetabulum - pathology; Acetabulum - surgery; Adult; Aged; Arthroplasty, Replacement, Hip; Biocompatibility; Biomedical materials; Bone cancer; Bone loss; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Bone tumors; Chondrosarcoma; Clinical outcomes; Complications; Disability Evaluation; Dislocations; Fatalities; Female; Fixation; Gait; Hip dislocation; Hip Prosthesis; Humans; Joint surgery; Male; Males; Malignancy; Middle Aged; Osteosarcoma; Patients; Postoperative Complications; Range of Motion, Articular; Sarcoma; Surgical implants; Tantalum; Thromboembolism; Thrombosis; Total hip arthroplasty; Treatment Outcome; Wound healing
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.16.00803

Reliable acetabular fixation in total hip arthroplasty following periacetabular resections is challenging. Tantalum components have been successfully implemented for difficult revision arthroplasties, but, to our knowledge, have not been reported for acetabular reconstruction following oncologic periacetabular resection. The primary purpose of the current study was to determine the early clinical outcomes, complications, and radiographic findings for acetabular reconstruction after oncologic periacetabular resection. In addition, a novel classification scheme for primary periacetabular resections and reconstructions is presented. We reviewed 10 consecutive patients treated with tantalum acetabular reconstruction following periacetabular resection. All patients had a primary acetabular malignancy including chondrosarcoma (n = 7) and osteosarcoma (n = 3). The cohort included 6 males (60%). The mean age was 54 years (range, 30 to 73 years). The mean follow-up was 59 months (range, 8 to 113 months). At the most recent follow-up, 9 patients were alive and 1 had died of the respective disease. All patients obtained full ambulatory status with the use of gait aids. Postoperative complications included dislocation (n = 3), wound-healing disturbance (n = 1), and deep venous thrombosis (n = 1). Two patients underwent reoperations for recurrent dislocations. The mean postoperative Harris hip score was 75 points (range, 49 to 92 points). Preliminary results of tantalum reconstruction following periacetabular resections provide reasonable improvement in early clinical outcomes and stable fixation in situations with massive bone loss and compromised bone quality. As expected due to the lack of a functioning abductor mechanism from the wide oncologic resection, early dislocations remain a concern. As such, we now consider the primary use of increasing constraint, but it must be balanced with the often compromised host bone. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.