Page 81 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

inserts (implacross; implantcast) are available in a neutral version and with 4-mm o set. The ACCIS liner (Accis BV, Baarn, The Netherlands) was rst used in 2010 and o ers the possibility of dual-mobility articulation when combined with the Polaric femoral head (implantcast).
Tumor resections were planned on an array of conventional imaging, CT, and
MRI. Patients were positioned in the lateral decubitus position, allowing them to
be rotated to nearly prone or supine positions. Before surgery, patients received intravenous cephalosporin antibiotics; these were usually continued for one to
ve days. Eighteen patients (38%) received tranexamic acid. The surgical approach
and technique depended on the surgeon and tumor location. After resection, 4 a cannulated probe was introduced in the remaining ilium; uoroscopy or
computer navigation was used to make sure the iliac cortices were not perforated.
Use of computer navigation (n = 15 [32%]) depended on center preferences. A
Kirschner wire was inserted through the probe, after which the ilium was reamed
and a trial shaft was inserted. Next, the femoral component was implanted
according to appropriate procedures. The cup was connected to the trial stem
and a trial reduction was performed. After assessment of reconstruction length
and soft tissue tension, the de nitive stem was impacted (or cemented) and the
cup was connected; a second trial reduction was then performed. Attachment
(Trevira) tubes (implantcast) were used to reattach soft tissues and to stimulate neocapsule formation in 16 (34%) reconstructions19. Twenty-four patients (51%)
had a dual-mobility cup; these were mainly used in case of a higher presumed risk
of dislocation in the early period of our study. Later, dual-mobility cups became
the standard for the majority of the reconstructions. Silver-coated acetabular cups
were used in 29 reconstructions (62%); its use depended on the cup size that was
chosen, because only the largest cup size was available with silver coating (table 2).
The iliac stem was cemented in four (9%; two multiple myelomas, one metastatic
carcinoma, one chondrosarcoma). Twenty-three patients (49%) had standard hip
prostheses and 23 (49%) had proximal femoral replacements; one patient (2%) had
a previously implanted total femoral arthroplasty.
Adequate margins were obtained in 39 of the 41 procedures (95%) intended to achieve clear margins; tumor spill occurred in two (5%; one clear cell chondrosarcoma, one phosphaturic mesenchymal tumor). Six patients (13%) had intentional intralesional surgery ( ve metastatic carcinomas, one chondroblastoma).
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