Document Detail


Constrained total hip megaprosthesis for primary periacetabular tumors.
MedLine Citation:
PMID:  23054518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Limb-salvage reconstruction for periacetabular malignant tumors is one of the most challenging problems in orthopaedic oncology. Reconstructive options include resection arthroplasty, endoprosthesis, allograft, recycled autobone graft, arthrodesis, and pseudarthrosis. However, no standard procedure exists because of rarity and clinical variability of the disease. We previously developed a megaprosthetic system with a constrained total hip mechanism (C-THA).
QUESTIONS/PURPOSES: We evaluated (1) survival of patients and C-THA; (2) postoperative function; and (3) complications.
METHODS: We retrospectively reviewed 25 patients with primary periacetabular tumors treated using C-THA between 1985 and 2009. There were 18 male and seven female patients with a median age of 44 years (range, 16-72 years). They included 11 chondrosarcomas, eight osteosarcomas, two giant cell tumors of bone (one locally aggressive benign, one malignant), and others in four. Surgical margin was wide in 18 patients, marginal in five, and intralesional in two. The minimum postoperative followup for survivors was 32 months (median, 163 months; range, 32-285 months).
RESULTS: The 10-year overall survival rate of all patients was 47%. C-THA implants survived in 19 of 25 patients at last followup. Twenty-one patients acquired ambulatory activity. There were seven local recurrences, resulting in hemipelvectomy in one patient. Postoperative complications included deep infection in eight of the 25 patients, dislocation in four, and aseptic loosening in two, necessitating five revision surgeries and three implant removals.
CONCLUSIONS: Our observations suggest C-THA using an acetabular reconstruction cup is a useful reconstructive option after resection of periacetabular malignant tumors despite frequent postoperative complications.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Takafumi Ueda; Shigeki Kakunaga; Satoshi Takenaka; Nobuhito Araki; Hideki Yoshikawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-04-03     Revised Date:  2014-03-09    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  741-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acetabulum / pathology,  physiopathology,  radiography,  surgery*
Adolescent
Adult
Aged
Arthroplasty, Replacement, Hip / adverse effects,  instrumentation*,  mortality
Biomechanical Phenomena
Bone Neoplasms / mortality,  pathology,  physiopathology,  radiography,  surgery*
Device Removal
Female
Hemipelvectomy
Hip Joint / pathology,  physiopathology,  radiography,  surgery*
Hip Prosthesis*
Humans
Kaplan-Meier Estimate
Limb Salvage
Male
Middle Aged
Neoplasm Recurrence, Local
Prosthesis Design
Prosthesis Failure
Reconstructive Surgical Procedures / adverse effects,  instrumentation*,  mortality
Recovery of Function
Reoperation
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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