Page 61 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

The medical records of each patient were used to obtain demographic details,
the indication for surgery, adjuvant therapies, details of the reconstruction,
surgical margins, complications and reoperations. Radiological images were used
to assess for signs of loosening, dislocation and fracture. Failure was de ned as
(partial) removal of the construct, with the exception of revision of the acetabular component. Complications were classi ed according to Henderson et al22. The Musculoskeletal Tumor Society (MSTS) score23 and the Dutch language version of 3 the Short Form (SF)-3624 questionnaires were used to evaluate functional outcome
and quality of life. For quality of life, norm-based outcome scores are presented on
the physical and mental component scales25.
Survival is presented as Kaplan–Meier curves and compared between groups with log-rank tests. Factors of in uence on functional outcome were compared with Mann–Whitney U tests. SPSS v20.0 software (IBM Corp., Armonk, New York) was used for statistical analysis, with the level of signi cance at a p-value < 0.05.
Results
At nal review, seven patients had died (one due to an acute cardiovascular event), after a mean of 39 months (28 days to 8.7 years). The 12 surviving patients (11 free of disease) had a mean follow-up of 7.9 years (4.3 to 10.5). Most patients had undergone type 2/3 resections (n = 14): the medial part of the ilium was preserved in every patient. In one patient, a two-stage procedure had been performed. Adequate surgical margins were obtained in 14 patients (ten wide, four marginal). Two patients, both with a chondrosarcoma, had focally contaminated margins (one of whom was continuously disease-free at 10.5 years follow-up). Three patients, all with metastatic carcinoma, had intended intralesional excisions.
A variety of femoral components were used. Most had standard total hip prostheses, either cemented (n = 6) or uncemented (n = 6). Five patients (four of whom had undergone previous surgery) had a MUTARS proximal femoral replacement (implantcast) and two patients had a CUT femoral neck prosthesis (Orthodynamics, Lübeck, Germany). MUTARS attachment tubes were used in 15 patients. The iliac stem was cemented in two patients because of extensive cortical destruction. Partial resection of the iliopsoas muscle was required in three patients. One patient had permanent loss of function of the lateral femoral cutaneous nerve, in three patients the obturator nerve was sacri ced.
Pedestal cup endoprosthesis
59