Pelvic reconstruction with compound osteosynthesis following hemipelvectomy

A clinical study

C. Gebert, M. Wessling, G. Gosheger, M. Aach, A. Streitbürger, M. P. Henrichs, U. Dirksen, J. Hardes

Abstract

To date, all surgical techniques used for reconstruction of the pelvic ring following supra-acetabular tumour resection produce high complication rates. We evaluated the clinical, oncological and functional outcomes of a cohort of 35 patients (15 men and 20 women), including 21 Ewing’s sarcomas, six chondrosarcomas, three sarcomas not otherwise specified, one osteosarcoma, two osseous malignant fibrous histiocytomas, one synovial cell sarcoma and one metastasis. The mean age of the patients was 31 years (8 to 79) and the latest follow-up was carried out at a mean of 46 months (1.9 to 139.5) post-operatively.

We undertook a functional reconstruction of the pelvic ring using polyaxial screws and titanium rods. In 31 patients (89%) the construct was encased in antibiotic-impregnated polymethylmethacrylate. Preservation of the extremities was possible for all patients. The survival rate at three years was 93.9% (95% confidence interval (CI) 77.9 to 98.4), at five years it was 82.4% (95% CI 57.6 to 93.4). For the 21 patients with Ewing’s sarcoma it was 95.2% (95% CI 70.7 to 99.3) and 81.5% (95% CI 52.0 to 93.8), respectively. Wound healing problems were observed in eight patients, deep infection in five and clinically asymptomatic breakage of the screws in six. The five-year implant survival was 93.3% (95% CI 57.8 to 95.7). Patients were mobilised at a mean of 3.5 weeks (1 to 7) post-operatively. A post-operative neurological defect occurred in 12 patients. The mean Musculoskeletal Tumor Society score at last available follow-up was 21.2 (10 to 27).

This reconstruction technique is characterised by simple and oncologically appropriate applicability, achieving high primary stability that allows early mobilisation, good functional results and relatively low complication rates.

Cite this article: Bone Joint J 2013;95-B:1410–16.

Footnotes

  • C. Gebert and M. Wessling contributed equally to this work.

    This work was supported by Deutsche Krebshilfe: 50-2551-Jü3 and 50-2551-Jü4, DKH-108128 and by the Federal Ministry of Education and Research Germany. BMBF (TranSaRNet), Deutsches Zentrum für Luft- und Raumfahrt e.V. 01GM0869, EuroBoNet, EU-FP6; ENCCA EU-FP7; PROVABES ERA-Net-TRANSCAN. Part of the data for Ewing’s sarcoma was presented at the SIOP-Meeting in Mumbai in 2007.

    The authors wish to thank S. Klco-Brosius for assistance with translation and B. Niesmann and the Ewing’s trial staff, Muenster, for their kind support.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    This article was primary edited by D. Rowley and first-proof edited by G. Scott.

  • Received February 7, 2013.
  • Accepted June 19, 2013.
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