International Orthopaedics

, Volume 42, Issue 8, pp 1987–1997 | Cite as

Pelvic reconstructions following peri-acetabular bone tumour resections using a cementless ice-cream cone prosthesis with dual mobility cup

  • Samir-Pierre IssaEmail author
  • David Biau
  • Antoine Babinet
  • Valérie Dumaine
  • Malo Le Hanneur
  • Philippe Anract
Original Paper



Despite numerous reconstructive techniques and prosthetic devices, pelvic reconstructions following peri-acetabular malignant tumours resections are highly challenging. In the present study, we describe our experience with the Integra® (Lépine, Genay, France) ice-cream cone prosthesis in such indications. The objective was to assess the mid-term outcomes of this device.


Twenty-four patients’ chart with peri-acetabular malignant tumours, who underwent types II or II + III peri-acetabular resections according to Enneking and Dunham with subsequent reconstruction using the Integra® prosthesis between February 2009 and February 2015, were reviewed. Seventeen cases were primary surgeries and seven cases were revisions (i.e., failures of previous reconstructions for pelvic tumours). All living patients with the prosthesis implanted were functionally assessed, using the musculoskeletal tumour society (MSTS) and Postel-Merle d’Aubigné (PMA) scores.


After a mean follow-up of 49 ± 26 months (range, 8 to 94 months), 21 patients were alive (88%), including 15 patients continuously disease-free (63%). MSTS and PMA scores averaged 72 ± 13% (range, 43 to 87%) and 14.6 ± 2.6 (range, 9 to 18), respectively. Fourteen patients (58%) presented at least one complication during follow-up, including four cases of deep infection (17%), four cases of dislocation (17%), and two mechanical failures (8%). At 5 years, the implant survival rate was 75%.


In comparison to previous reconstructive techniques that we used in similar indications, functional and oncologic outcomes were improved with the Integra® implant. However, as commonly observed in pelvic bone tumour surgery, complication rates remain significant.

Level of evidence

Therapeutic, Level IV-Retrospective Cases Series


Complications Functional outcomes Ice-cream cone prosthesis Malignant bone tumour Pelvic reconstruction Pelvic tumour 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Price CH, Jeffree GM (1977) Incidence of bone sarcoma in SW England, 1946-74, in relation to age, sex, tumor site and histology. Br J Cancer 36:511–522CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Steel HH (1978) Partial or complete resection of the hemipelvis: an alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg Am 60-A:719–730CrossRefGoogle Scholar
  3. 3.
    Enneking WF, Dunham WK (1978) Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 60:731–746CrossRefPubMedGoogle Scholar
  4. 4.
    Cottias P, Jeanrot C, Vinh TS, Tomeno B, Anract P (2001) Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors. J Surg Oncol 78:90–100CrossRefPubMedGoogle Scholar
  5. 5.
    Aljassir F, Beadel GP, Turcotte RE et al (2005) Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis. Clin Orthop Relat Res 438:36–41CrossRefPubMedGoogle Scholar
  6. 6.
    Falkinstein Y, Ahlmann ER, Menendez LR (2008) Reconstruction of type II pelvic resection with a new peri-acetabular reconstruction endoprosthesis. J Bone Joint Surg Br 90:371–376. CrossRefPubMedGoogle Scholar
  7. 7.
    Biau DJ, Thevenin F, Dumaine V, Babinet A, Thomeno B, Anract P (2009) Ipsilateral femoral auto-graft reconstruction after resection of a pelvic tumor. J Bone Joint Surg Am 91:142–151. CrossRefPubMedGoogle Scholar
  8. 8.
    Campanacci D, Chacon S, Mondanelli N et al (2012) Pelvic massive allograft reconstruction after bone tumour resection. Int Orthop 36:2529–2536. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Witte D, Bernd L, Bruns J et al (2009) Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study. Eur J Surg Oncol 35:1318–1325. CrossRefPubMedGoogle Scholar
  10. 10.
    Zang W, Guo Y, Yang L, Xie L (2014) Reconstruction of the hemi-pelvis with a modular prosthesis after resection of a primary malignant peri-acetabular tumour involving the sacroiliac joint. Bone Joint J 96-B:399–405. CrossRefPubMedGoogle Scholar
  11. 11.
    Farfalli GL, Albergo JI, Ritacco LE, Ayerza MA, Musculo DL, Aponte-Tinao LA (2015) Oncologic and clinical outcomes in pelvic primary bone sarcomas treated with limb salvage surgery. Muscoloskelet Surg 99:237–242. CrossRefGoogle Scholar
  12. 12.
    Abudu A, Grimer RJ, Cannon SR, Sneath RS (1997) Reconstruction of the hemipelvis after the excision of malignant tumours. Complications and functional outcome of prostheses. J Bone Joint Surg Br 79:773–779CrossRefPubMedGoogle Scholar
  13. 13.
    Angelini A, Calabro T, Pala E, Trovarelli G, Maraldi M, Ruggieri P (2015) Resection and reconstruction of pelvic bone tumors. Orthopedics 38:87–93. CrossRefPubMedGoogle Scholar
  14. 14.
    Angelini A, Drago G, Trovarelli G, Calabro T, Ruggieri P (2014) Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution. Clin Orthop Relat Res 472:349–359. CrossRefPubMedGoogle Scholar
  15. 15.
    Desbonnet P, Connes H, Escare P, Tricoire JL, Trouillas J (2012) Total hip revision using a cup design with a peg to treat severe pelvic bone defects. Orthop Traumatol Surg Res 98:346–351. CrossRefPubMedGoogle Scholar
  16. 16.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246Google Scholar
  17. 17.
    D’Aubigné RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A:451–475CrossRefPubMedGoogle Scholar
  18. 18.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 58:457–481CrossRefGoogle Scholar
  19. 19.
    Wittekind C, Compton CC, Greene FL, Sobin LH (2002) TNM residual tumor classification revisited. Cancer 94:2511–2516. CrossRefPubMedGoogle Scholar
  20. 20.
    Fisher NE, Patton JT, Grimer RJ et al (2011) Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement: early results. J Bone Joint Surg Br 93:684–688. CrossRefPubMedGoogle Scholar
  21. 21.
    Barrientos-Ruiz I, Ortiz-Cruz EJ, Peleteiro-Pensado M (2017) Reconstruction after hemipelvectomy with the ice cream cone prosthesis: what are the short-term clinical results? Clin Orthop Relat Res 475:735–741. CrossRefPubMedGoogle Scholar
  22. 22.
    Capanna R, van Horn JR, Guernelli N et al (1987) Complications of pelvic resections. Arch Orthop Trauma Surg 106:71–77CrossRefPubMedGoogle Scholar
  23. 23.
    Bus MP, Boerhout EJ, Bramer JA, Dijkstra PD (2014) Clinical outcome of pedestal cup endoprosthetic reconstruction after resection of a peri-acetabular tumour. Bone Joint J 96-B:1706–1712. CrossRefPubMedGoogle Scholar
  24. 24.
    Jaiswal PK, Aston WJ, Grimer RJ et al (2008) Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum. J Bone Joint Br 90:1222–1227. CrossRefGoogle Scholar
  25. 25.
    Bus MP, Szafranski A, Sellevold S et al (2017) LUMIC® endoprosthetic reconstruction after periacetabular tumor résection: short-term results. Clin Orthop Relat Res 475:686–695. CrossRefPubMedGoogle Scholar
  26. 26.
    Hipfl C, Stihsen C, Puchner SE et al (2017) Pelvic reconstruction following resection of malignant bone tumours using a stemmed acetabular pedestal cup. Bone Joint J 99-B:841–848. CrossRefPubMedGoogle Scholar
  27. 27.
    Gebert C, Wessling M, Hoffmann C et al (2011) Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol 103:269–275. CrossRefPubMedGoogle Scholar
  28. 28.
    Jansen JA, van de Sande MAJ, Dijkstra PDS (2013) Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors. Clin Orthop Relat Res 471:324–331. CrossRefPubMedGoogle Scholar
  29. 29.
    Puget J, Utheza G (1986) Reconstruction of the iliac bone using the homolateral femur after resection for pelvic tumor. Rev Chir Orthop Reparatrice Appar Mot 72:151–155 [Article in French]PubMedGoogle Scholar
  30. 30.
    Puget J, Utheza G (2014) Reconstruction of the iliac bone using the homolateral femur after resection for pelvic tumor. Orthop Traumatol Surg Res 100:43–47. CrossRefPubMedGoogle Scholar
  31. 31.
    Testut L, Latarjet A (1928) Lower or pelvic limb osteology. In: Traité d’anatomie humaine, 1, 8e éd. Paris: Librairie Doin. 374–375 [Article in French]Google Scholar
  32. 32.
    Ring PA (1968) Complete replacement arthroplasty of the hip by the ring prosthesis. J Bone Joint Surg Br 50-B:720–731CrossRefGoogle Scholar
  33. 33.
    Tricoire JL, Puget J, Connes H, Canevet G, Moscovici J, Guitard J (2004) Anatomical study of the iliac isthmus, base of the acetabular fixation in large osseous defects in hip total arthroplasty revision cases. Morphologie 88:80 [Article in French]CrossRefGoogle Scholar
  34. 34.
    Tricoire JL (2006) The acetabulum and its iliac isthmus: anatomy, anthropology and biomechanics. In: La reprise de prothèse totale de hanche. Montpellier: Sauramps médical. 171–179 [Article in French]Google Scholar
  35. 35.
    Eisler T, Svensson O, Muren C, Elmstedt E (2001) Early loosening of the stemmed McMinn cup. J Arthroplast 16:871–876CrossRefGoogle Scholar
  36. 36.
    Ferreira A, Prudhon JL, Verdier R et al (2017) Contemporary dual-mobility cup regional and private register: methodology and results. Int Orthop 41:439–445. CrossRefPubMedGoogle Scholar
  37. 37.
    Yi Z, Bin S, Jing Y, Zongke K, Fuxing P (2014) No decreased infection rate when using antibiotic-impregnated cement in primary total joint arthroplasty. Orthopedics 37:839–845. CrossRefPubMedGoogle Scholar
  38. 38.
    Walker LC, Barker P, Holleyman R, Deehan D (2016) Microbial resistance related to antibiotic-loaded bone cement: a historical review. Knee Surg Sports Traumatol Arthrosc.

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Cochin HospitalAssistance Publique–Hôpitaux de Paris (APHP)ParisFrance
  2. 2.Paris-Descartes University, Sorbonne Paris CitéParisFrance
  3. 3.INSERM, U1153 (ECaMO)ParisFrance
  4. 4.Department of Orthopedic Surgery, Georges-Pompidou European Hospital (HEGP)Assistance Publique–Hôpitaux de Paris (APHP)ParisFrance

Personalised recommendations