Pelvic massive allograft reconstruction after periacetabular bone tumor resection

Limb salvage surgery is challenging in pelvic bone tumors. Adequate surgical margins are difficult to achieve and resections involving the acetabulum require demanding reconstructive procedures. Several techniques have been described after periacetabular resections including flail hip, reconstructions with modular orcustom madepelvic prostheses and the use of autograft or allograft coupled with a total hip prosthesis The objective of the present studywas toreview theoutcome of patients treated by periacetabular bone tumor resection and reconstruction with pelvic massive allograft and total hip prosthesis. This series includes 25 patients (diagnosis: 22 high grade sarcoma, 1 giant cell tumor, 1 metastatic carcinoma, 1 plasmocitoma) treated with periacetabular resection between 2000 and 2010. The mean age at time of surgery is 31 years (16–68). Reconstruction was performed with fresh-frozen pelvic allografts, cemented femoral prosthetic stems and self-retaining cemented polyethylene cups with rehinforcement acetabular rings. Allograft fixation was achieved with plates and screws or screws alone whentheentire hemypelvis was replaced. Fifteen patients received chemotherapy and 7 patients radiationtherapy. Alocal recurrence of the tumor was observed in 3 cases and 9 patients presented a metastatic dissemination. Eight patients died as consequence of primary disease and one patient died of other cause. Two patients were alive with disease progression. Three patients had less than 12 months follow-up. The remaining 11 patients were observed at a mean follow-up of 50 months (14–120). Functional results were evaluated following MSTS classification and were excellent in 3 (77%–90%), good in 5 (53%–73%), fair in 2 and poor in 1 case. Early postoperative complications included 6 sciatic nerve palsies (2 persistent after one year) and 4 hip dislocations, healed after closed reduction and brace immobilization in 2 cases and open reduction in 2 cases. Four patients presented a deep infection (16%), requiring allograft removal in two cases and healed after surgical debridement in two cases. Late complications included one cemented cup loosening treated with surgical revision and double motility cemented cup implant. One patient presented periarticular heterotopic ossification without functional impairment. Pelvic massive allografts allowed an anatomical and functional reconstruction in periacetabular resections. Limb salvage was successfully achieved in our series. Seven patients (28%) required surgical revision and none was amputated for any complication or local recurrence. Pelvic allograft resulted to be an effective reconstructive option after periacetabular resections although their use should be reserved to selected cases.