Page 88 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 4
reoperations were performed and four reconstructions failed as a result. Previously, we reported an infection rate of 47% in reconstructions with the pedestal cup prosthesis9. We attempted to reduce the risk of infection by introducing silver- coated cups, but with the numbers we had, we could not demonstrate an advantage with this approach. However, only the outside of the 60-mm cup was silver-coated, and limited patient numbers hampered us. It has been shown that the release of silver ions protects against infection and favorable results have been reported by others30, 31; future studies will need to evaluate this in greater depth. With interest we noted the promising infection rate reported by Fisher et al6; three infections occurred in 27 patients (11%), and none resulted in implant failure in their short-term follow-up study. The authors theorized that the large amount of antibiotic-laden bone cement that they apply around the prosthesis minimizes the infection risk and allows e ective treatment if it occurs. We are of the opinion that surgical duration should also be considered and, although this did not reach statistical signi cance, we found that the duration of surgery was greater for patients who developed an infection. This was in concordance with previous reports32. It is conceivable that surgical duration decreases when surgeons perform these procedures more often and in experienced teams; therefore, it might be worth considering having centralized centers that treat the majority of these patients so that patients can bene t from a team that has extensive experience in these reconstructions.
Overall cumulative incidences of implant failure at two and ve years were 6.4% and 17.9%, respectively. Most studies on pelvic endoprostheses have not reported implant survival rates; however, our results compare favorably with others, reporting Kaplan-Meier estimated survival rates of 78% to 84% at two years13, 14 and 40% to 60% at ve years13, 18.
Mean MSTS score was 70%; this is comparable with two previous studies reporting mean scores of 69% and 70%6, 13 with either MSTS23 or Toronto Extremity Salvage Score (TESS)33 questionnaires. Most authors report worse functional outcome with mean scores typically ranging between 47% and 64%14, 16-18, 26.
At short-term follow-up, the LUMiC prosthesis demonstrated a low frequency of mechanical complications and reoperations when used to reconstruct the acetabulum in patients who underwent major pelvic tumor resections, and we believe this is a useful reconstruction for certain periacetabular resections for tumor or failed prior reconstructions. Still, like with any type of pelvic reconstruction, complications are common after these complex procedures and we have not
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