Page 204 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 10
General Summary
Reconstructions for tumor resections in the pelvis and appendicular skeleton are amongthemostchallengingproceduresinmodernorthopaedics.Thisthesisaimed to evaluate the outcomes of various reconstructive techniques, and to identify risk factors for complications or impaired outcome following reconstruction. Part I focused on the management of pelvic bone tumors; it discussed the management and outcome of conventional primary central chondrosarcoma of the pelvis, and two techniques for periacetabular reconstruction. Part II focused on di erent types of allograft reconstructions, as well as reconstructions with modular endoprostheses.
Part I – Management of Pelvic Bone Tumors
Chondrosarcoma is the most common pelvic bone tumor in adults, and poses speci c challenges to orthopaedic surgeons because of the lack of e ective adjuvant treatment modalities and the high rates of local relapse. Chapter 2 contained a retrospective evaluation of 162 patients who were treated for a conventional primary central chondrosarcoma of the pelvis in ve European centers of musculoskeletal oncology. Thirty-eight percent of our patients experienced a local recurrence, 30% had metastases. Tumor grade, resection margins and maximal tumor size were found to be independent factors of in uence on disease- speci c survival. Deep infection (19%) was the predominant complication, and the risk of infection was higher for patients with an endoprosthetic reconstruction. Our study included the largest series to date focusing on patients with a conventional primary central chondrosarcoma of pelvic bone. Because of the inability to reliably distinguish low- and high-grade tumors preoperatively, we concluded that any central pelvic chondrosarcoma should be treated with aggressive primary resection with the aim of obtaining wide resection margins.
Periacetabular tumor resections and their subsequent reconstruction are among the most challenging procedures in orthopaedic oncology. In chapter 3, we retrospectively evaluated the mid- to long-term clinical outcome of periacetabular reconstruction with the pedestal cup endoprosthesis. Between 2003 and 2009, a total of 19 patients underwent reconstruction with this implant in the two contributing centers. Complications occurred in 15 patients. Three (16%) had recurrent dislocations and three experienced aseptic loosening. There were
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