Clinical Orthopaedics and Related Research®

, Volume 471, Issue 3, pp 741–749 | Cite as

Constrained Total Hip Megaprosthesis for Primary Periacetabular Tumors

  • Takafumi Ueda
  • Shigeki Kakunaga
  • Satoshi Takenaka
  • Nobuhito Araki
  • Hideki Yoshikawa
Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China

Abstract

Background

Limb-salvage reconstruction for periacetabular malignant tumors is one of the most challenging problems in orthopaedic oncology. Reconstructive options include resection arthroplasty, endoprosthesis, allograft, recycled autobone graft, arthrodesis, and pseudarthrosis. However, no standard procedure exists because of rarity and clinical variability of the disease. We previously developed a megaprosthetic system with a constrained total hip mechanism (C-THA).

Questions/purposes

We evaluated (1) survival of patients and C-THA; (2) postoperative function; and (3) complications.

Methods

We retrospectively reviewed 25 patients with primary periacetabular tumors treated using C-THA between 1985 and 2009. There were 18 male and seven female patients with a median age of 44 years (range, 16–72 years). They included 11 chondrosarcomas, eight osteosarcomas, two giant cell tumors of bone (one locally aggressive benign, one malignant), and others in four. Surgical margin was wide in 18 patients, marginal in five, and intralesional in two. The minimum postoperative followup for survivors was 32 months (median, 163 months; range, 32–285 months).

Results

The 10-year overall survival rate of all patients was 47%. C-THA implants survived in 19 of 25 patients at last followup. Twenty-one patients acquired ambulatory activity. There were seven local recurrences, resulting in hemipelvectomy in one patient. Postoperative complications included deep infection in eight of the 25 patients, dislocation in four, and aseptic loosening in two, necessitating five revision surgeries and three implant removals.

Conclusions

Our observations suggest C-THA using an acetabular reconstruction cup is a useful reconstructive option after resection of periacetabular malignant tumors despite frequent postoperative complications.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We primarily thank Prof Atsumasa Uchida for his major contribution to the development of this C-THA system. We also thank Dr Norifumi Naka for his assistance with data collection and Dr Nobuyuki Hashimoto, Dr Kenichiro Hamada, Dr Susumu Joyama, Dr Ikuo Kudawara, and Dr Akira Myoui for their dedication to the treatment of the patients and their assistance with data analysis.

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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Takafumi Ueda
    • 1
    • 2
  • Shigeki Kakunaga
    • 1
    • 2
  • Satoshi Takenaka
    • 1
    • 3
  • Nobuhito Araki
    • 1
    • 4
  • Hideki Yoshikawa
    • 1
    • 3
  1. 1.Osaka University Orthopaedic Oncology GroupOsakaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka National HospitalChuo-ku, OsakaJapan
  3. 3.Department of OrthopaedicsOsaka University Graduate School of MedicineSuita, OsakaJapan
  4. 4.Department of Orthopaedic SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan

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