Tumors of the pelvis: complications after reconstruction
- 503 Downloads
Complications after pelvic sarcoma surgery are frequent; however, the reports on complications are limited. Results of the authors' experience with 110 primary pelvic tumor resections and methods to achieve low complication rates for pelvic reconstruction are reported.
Materials and methods
From 1982 to 1996, 110 patients with pelvic sarcoma (42 Ewing sarcomas, 40 chondrosarcomas, 21 osteosarcomas, and 7 other malignant tumors) underwent surgery. Sixteen patients underwent implantation of a hemipelvic megaprosthesis, 13 patients had implantation of an allograft for sacroiliac arthrodesis, 12 patients had implantation of an autograft for sacroiliac arthrodesis, and 17 patients underwent hip transposition. There were 9 hindquarter amputations, 6 implantations of allograft and total hip endoprosthesis, 1 implantation of prosthesis with autograft, and 1 implantation of allograft and autograft. No skeletal reconstruction was done in 35 patients.
Postoperative function was as follows: 37% in patients with prosthesis, 60% in allograft, 66% in autograft, 66% in hip transposition, 37% in amputation, and 79% without reconstruction. In total, 10/16 patients with prosthetic replacement, 9/13 with allograft implantation, 4/12 with autograft implantation, 7/17 with hip transposition, 5/9 with amputation, 6/6 with prosthesis and allograft, and 12/35 without skeletal reconstruction had complications. Frequent complications depending on the reconstruction were infection in 6/10 prostheses and in 5/13 allografts, leg length discrepancy in 2/12 autografts and 4/17 hip transpositions, hematoma in 3/9 amputations, and infection (6) and skin problems (5) in 6 prostheses with allograft.
Because of the small number of complications and good function, autograft implantation after iliac resection and hip transposition after acetabular resection are advisable.
KeywordsPelvis reconstruction Complication Sarcoma
- 1.Ahrens S, Hoffmann C, Jabar S, Braun-Munzinger G, Paulussen M, Dunst J, Rube C, Winkelmann W, Heinecke A, Gobel U, Winkler K, Harms D, Treuner J, Jurgens H (1999) Evaluation of prognostic factors in a tumor volume-adapted treatment strategy for localized Ewing sarcoma of bone: the CESS 86 experience. Cooperative Ewing Sarcoma Study. Med Pediatr Oncol 32:186–195CrossRefPubMedGoogle Scholar
- 2.Bielack S, Kempf-Bielack B, Schwenzer D, Birkfellner T, Delling G, Ewerbeck V, Exner GU, Fuchs N, Gobel U, Graf N, Heise U, Helmke K, Hochstetter ARvon , Jurgens H, Maas R, Munchow N, Salzer-Kuntschik M, Treuner J, Veltmann U, Werner M, Winkelmann W, Zoubek A, Kotz R (1999) Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the Cooperative osteosarcoma study group COSS of 925 patients (in German). Klin Padiatr 211:260–270PubMedGoogle Scholar
- 4.Enneking WF (1987) Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In: Enneking WF (ed) Limb salvage in musculoskeletal oncology. Bristol-Myers/Zimmer Orthopaedic Symposium. Churchill-Livingstone, New York, pp 626–682Google Scholar
- 10.Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1996) High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand 67:333–338Google Scholar
- 11.Ozaki T, Hillmann A, Lindner N, Blasius S, Winkelmann W (1997) Chondrosarcoma of the pelvis. Clin Orthop :226–239Google Scholar