Pelvic reconstructions following peri-acetabular bone tumour resections using a cementless ice-cream cone prosthesis with dual mobility cup
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
KeywordsComplications 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.
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 was obtained from all individual participants included in the study.
- 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
- 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. https://doi.org/10.1302/0301-620X.99B6.BJJ-2016-0944.R1 CrossRefPubMedGoogle Scholar
- 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
- 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
- 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. https://doi.org/10.1007/s00167-016-4309-5