Page 36 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 2
recurrence that was resected (no evidence of disease at follow-up), one grade 3 tumor for which secondary resection was performed (no evidence of disease at the time of latest follow-up), and two grade 1 tumors that recurred and eventually resulted in disease-related death. To minimize bias, patients who underwent curettage were excluded from further analysis. This left 162 patients (118 male patients, 73%) with a median age of 51 years (range, 15 to 78 years) (table 1). All were followed for a minimum of two years or until death. The median follow-up was 12.6 years (95% CI, 8.4 to 16.9). Seventeen of our patients (10%) were included in previous publications: nine (6%) in a study by Fiorenza et al23, and eight (5%) in a study by Andreou et al24. Institutional review board approval was not required for this study.
Tumor grade and size, as well as in ltration of surrounding soft tissues and the hip joint, were assessed on pathology reports of the resected specimen. General criteria used to grade the lesions were cellularity, nuclear size, and the presence of abundant hyaline cartilage matrix (indicating low grade) or mucomyxoid matrix and mitoses (higher grade)1, 25. The tumor was classi ed as grade 1 in 30 patients (19%), grade 2 in 93 (57%) and grade 3 in 39 (24%). The median maximal tumor size was 11 cm (range, 2.5 to 25.0 cm) (data available for 151 patients [93%]). Five patients (3%) had presented with a pathological fracture. Hip (n=57, 35%) and sacroiliac joint (n=14, 9%) in ltration was de ned as any form of joint involvement, either gross or focal. Soft-tissue in ltration was present in 119 patients (73%).
Tumor resections were planned on an array of conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). All patients received prophylactic antibiotics preoperatively, and these were continued for at least one day. The surgical approach, technique, and type of reconstruction depended on tumor location and surgeon preferences ( gures 1 to 3). Primary treatment consisted of internal hemipelvectomy in 135 patients (83%) and of hindquarter amputation in 27 patients (17%). Hindquarter amputation was only performed if it was deemed impossible to obtain clear margins with a limb- salvaging resection, or if two or three of the following structures had to be sacri ced: hip joint, sciatic nerve, and femoral nerve. The most common types of internal hemipelvectomy were P2-3 (n=46, 34%), P1 (n=24, 18%), P3 (n=17, 13%) and P2 (n=14, 10%); 89 (66%) comprised the periacetabulum, 40 of which (45%) were extra-articular resections of the hip. Of 135 hemipelvectomies, 104 (77%) were reconstructed, including 60 with metallic implants (58%), 14 with allograft-
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