Page 79 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

chondrosarcoma; n = 22 [47%]), osseous metastases of distant carcinoma in ve (11%), multiple myeloma with acetabular destruction in three (6%), and acetabular metastases of a previously resected femoral osteosarcoma in one (2%). Whether patients with metastatic disease were candidates for a pelvic resection and prosthetic reconstruction depended on the extent of acetabular destruction, patient prognosis (based on tumor type, Karnofsky performance score, and the presence of visceral or brain metastases), and morbidity. The technical feasibility of a limb-salvaging resection and subsequent reconstruction was assessed in multidisciplinary teams preoperatively.
The resections were type 2 in 21 patients (45%) and type 2–3 in 26 (55%). Twenty 4 patients (43%) had an extra-articular resection. Nine patients (19%) had surgery
before the LUMiC reconstruction, including three pedestal cup reconstructions
(6%; all had failed as a result of infection) and two allograft reconstructions (4%;
one failed as a result of graft resorption, one as a result of local recurrence) (table 1).
LUMiC
Table 1. Study data
Variable Number
Sex
Male 26 55
Female 21 45
Percent
Indications for primary resection
Chondrosarcoma grade 2 or 3 Metastatic carcinoma
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma grade 1
Multiple myeloma
Pleomorphic undi erentiated sarcoma Sarcoma not otherwise speci ed Phosphaturic mesenchymal tumor
Indications for revision procedures (original diagnosis in parentheses)
Pedestal cup reconstruction (two grade 2 chondrosarcomas, one clear cell chondrosarcoma)
THA (grade 2 chondrosarcoma)
Internal hemipelvectomy (P2) reconstructed with massive pelvic allograft and THA (grade 2 chondrosarcoma)
Total femoral replacement (osteosarcoma)
THA and Müller cage (chondroblastoma)
Partial resection of iliac wing (P1) (dedi erentiated chondrosarcoma)
Partial resection of periacetabulum (P2) reconstructed with femoral head interposition (grade 2 chondrosarcoma)
13 28 5 11 5 11 4 9 4 9 3 6 1 2 1 2 1 2
3 6
1 2 1 2
1 2 1 2 1 2 1 2
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