Results of modular endoprosthetic reconstruction of periacetabular bone defects in patients with tumors of the acetabulum and hip joint

Introduction. surgical treatment of patients with pelvic bone tumors, in particular periacetabular tumors, remains challenging. There are many different reconstruction options after resection of these tumors. These include allo- and autografts, megaprosthesis, saddle endoprosthesis, custom-made endoprosthesis, 3D printing endoprosthesis, and femur transposition with the formation of neo-arthrosis. However, all of them are characterized by technical complexity and high risk of postoperative complications. There is still no standard procedure for reconstruction after resection of malignant periacetabular tumors. To date, modular endoprosthesis is a well-established reconstructive device in orthopaedic oncology to manage wide bone resections. Modular systems provide patient-specific endoprostheses that could be modified during surgery. In this article, we present the results of modular acetabular endoprostheses in the treatment of patients with periacetabular tumors.

Material and Methods. From 2011 to 2018, 30 patients underwent modular endoprosthetic reconstruction after periacetabular resection. There were 13 (43 %) male and 17 (57 %) female patients aged from 23 to 63 years (median age 45 years). Primary malignant bone tumors were detected in 19 (63 %) patients, giant cell tumor in 5 (17 %), local soft tissue sarcoma in 1 (3 %), solitary metastases of kidney cancer in 2 (7 %) and recurrent sarcoma after previous surgical treatment in 3 (10 %) patients.

Results. The average duration of surgery was 310 minutes (range: 145-520 minutes), blood loss was 5520 ml (range: 600-20000 ml). The median follow-up time was 36 months. Histological examination revealed a positive resection margin in 3 (10 %) patients. At a follow-up from 6 to 40 months, disease progression was detected in 10 (33 %) patients. Eight (27 %) patients died on disease progression. Complications of various types were diagnosed in 11 (37 %) patients. Infectious complications were the most common (30 % of patients). The average value of the functional assessment by the MSTS scale was 59 % (15-82%).

Conclusion. Modular endoprosthetic replacement for tumors of the acetabulum and hip joint is a promising surgical technique allowing adequate functional results to be achieved.

1. Kaprin A.D., Starinsky V.V, Petrova G.V Incidence of malignant neoplasms in the population of Russia in 2014 (incidence and mortality). Moscow, 2016. 250 p. (in Russian).

2. GrimerR.J., ChandrasekarC.R., CarterS.R.,AbuduA., TillmanRM., JeysL. Hindquarter amputation. Bone Joint J. 2013 Jan; 95-B(1): 127-31. doi: 10.1302/0301-620X.95B1.29131.

3. Higinbotham N.L., Marcove R.C., Casson P. Hemipelvectomy: A clinical study of 100 cases with five year follow-up on 60 patients. Surgery. 1966;59:706-8.

4. Karakousis C.P., Vezeridis M.P. Variants of hemipelvectomy. Am J Surg. 1983 Feb; 145(2): 273-7. doi: 10.1016/0002-9610(83)90079-x.

5. Derzhavin VA., Karpenko V.Y., Bukharov A.V, Volchenko N.N., Yadrina A.V, Ivanova M.V. Modular endoprosthetic replacement of the periacetabular region in the tumor involvement of the acetabulum and hip joint. Preliminary results. Oncology. P.A. Gertsen Herald. 2018; 7(2): 26-32. (in Russian). doi: 10.17116/onkolog20187226-32.

6. Menendez L.R., Ahlmann E.R., Falkinstein Y., Allison D.C. Peri-acetabular Reconstruction with a New Endoprosthesis. Clin Orthop Relat Res. 2009 Nov; 467(11): 2831-7. doi: 10.1007/s11999-009-1043-z.

7. Jeys L.M., Kulkarni A., Grimer R.J., Carter S.R., Tillman R.M., AbuduA. Endoprosthetic Reconstruction for the Treatment of Musculoskeletal Tumors of the Appendicular Skeleton and Pelvis. J Bone Joint Surg Am. 2008 Jun; 90(6): 1265-71. doi: 10.2106/JBJS.F.01324.

8. Falkinstein Y., AhlmannE.R., MenendezL.R. Reconstruction of type II pelvic resection with a new peri-acetabular reconstruction endoprosthesis. J Bone Joint Surg Br. 2008 Mar; 90(3): 371-6. doi: 10.1302/0301-620X.90B3.20144.

9. Kim D, Lim J.Y., Shim K.W., Han J.W., Yi S., Yoon D.H., Kim K.N., Ha Y., Ji G.Y., ShinD.A. Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result. Yonsei Med J. 2017; 58(2): 453-57. doi: 10.3349/ymj.2017.58.2.453.

10. Satcher R.L.Jr., O'Donnell R.J., Johnston J.O. Reconstruction of the Pelvis After Resection of Tumors About the Acetabulum. Clin Orthop Relat Res. 2003 Apr; (409): 209-17. doi: 10.1097/01.blo.0000057791.10364.7c.

11. Aljassir F., Beadel G.P., Turcotte R.E., Griffin A.M., Bell R.S., Wunder J.S., IslerM.H. Outcome after Pelvic Sarcoma Resection Reconstructed with Saddle Prosthesis. Clin Orthop Relat Res. 2005 Sep; 438: 36-41. doi: 10.1097/00003086-200509000-00009.

12. Barrientos-Ruiz I., Ortiz-Cruz E., Peleteiro-Pensado M. Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results? Clin Orthop Relat Res. 2017; 475(3): 735-741. doi: 10.1007/s11999-016-4747-x.

13. Witte D., BerndL., Bruns J., Gosheger G., Hardes J., Hartwig E., Zeifang F Limb-salvage reconstruction with MUTARS® hemipelvic endoprosthesis: A prospective multicenter study. Eur J Surg Oncol. 2009; 35(12): 1318-1325. doi: 10.1016/j.ejso.2009.04.011.

14. Fisher N.E., Patton J. T., Grimer R.J., Porter D., Jeys L., Tillman RM., Abudu A., Carter S.R. Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement. J Bone Joint Surg Br. 2011 May; 93(5): 684-8. doi: 10.1302/0301-620X.93B5.25608.

15. De Paolis M., Biazzo A., Romagnoli C., AH N., Giannini S., Donati D.M. The Use of Iliac Stem Prosthesis for Acetabular Defects following Resections for Periacetabular Tumors. Scientific World Journal. 2013 Oct 22; 2013: 717031. doi: 10.1155/2013/717031.

16. Bus M., Szafranski A., Sellevold S., Goryn T., Jutte P.C., Bra-mer A. M., Fiocco M., Streitburger A., Kotrych D., Van de Sande M., Dijkstra S. LUMiC Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results. Clin Orthop Relat Res. 2017 Mar; 475(3): 686-695. doi: 10.1007/s11999-016-4805-4.

17. Enneking W.F, Dunham W., Gebhardt M.C., Malawar M., Pritchard D.J. A System for the Functional Evaluation of Reconstructive Procedures After Surgical Treatment of Tumors of the Musculoskeletal System. Clin Orthop Relat Res. 1993 Jan; (286): 241-6.

18. O’ConnorM.I. Malignant pelvic tumors: Limb-sparing resection and reconstruction. Semin Surg Oncol. 1997 Jan-Feb; 13(1): 49-54.

19. Campanacci M., Capanna R. Pelvic malignancies - resections of the pelvic bones. Current concepts of diagnosis and treatment of bone and soft tissue tumors. Berlin: Heidelberg Springer, 1984. P. 359-365.

20. Guzik G. Treatment of metastatic lesions localized in the acetabulum. J Orthop Surg Res. 2016 Apr 28; 11(1): 54. doi: 10.1186/s13018-016-0384-z.

21. Guo W., LiD., TangX., Yang Y., Ji T. Reconstruction With Modular Hemipelvic Prostheses For Periacetabular Tumor. Clin Orthop Relat Res. 2007 Aug; 461: 180-8. doi: 10.1097/BLO.0b013e31806165d5.

22. Han I., Lee YM., ChoH.S., Oh J.H., Lee S.H., Kim H.-S. Outcome after Surgical Treatment of Pelvic Sarcomas. Clin Orthop Surg. 2010; 2(3): 160. doi:10.4055/cios.2010.2.3.160.

23. Gebert C., Wessling M., Hoffmann C., Roedl R., Winkelmann W., Gosheger G., Hardes J. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol. 2011 Mar; 103(3): 269-75. doi: 10.1002/jso.21820.

24. Hoffmman C., Gosheger G., Gebert C., Jurgens H., Winkell-mann W. Functional results and quality of life after treatment of pelvic sarcomas involving the acetabulum. JBJS. 2006; 88(3): 575-82. doi: 10.2106/00004623-200603000-00017.

25. Karpenko V.U., Derzhavin VA., Shchupak M.U., Zheravin AA., Buharov A.V, Bondarev A.V, Zhamgaryan G.S. Reconstruction with modular endoprosthesis after periacetabular resections in patiens with pelvic tumors. early results. multicentral report. Siberian Journal of Oncology. 2016; 15(1): 11-18. (in Russian). doi: 10.21294/1814-4861-2016-15-1-11-18.

26. Jaiswal P.K., Aston W.J., Grimer RJ., Abudu A., Carter S.,Blunn G., Briggs T. W., Cannon S. Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum. J Bone Joint Surg Br. 2008 Sep; 90(9): 1222-7. doi: 10.1302/0301-620X.90B9.20758.

27. Moura D.L., Fonseca R., Freitas J., Figueiredo A., Casanova J. Reconstruction with iliac pedestal cup and proximal femur tumor prosthesis after wide resection of chondrosarcoma - 10-year follow-up results. Rev Bras Ortop. 2016 Dec 30; 52(6): 748-754. doi: 10.1016/j.rboe.2016.11.007.