Functional results of reconstructive hip arthrodesis for periacetabular malignant tumor
Abstract
Background
We followed up four patients receiving reconstructive hip arthrodesis with a free-vascularized fibular graft (FVFG) for malignant bone tumor in order to restore lower limb function after wide resection of the periacetabular bone tumor.
Questions/purposes
As malignant pelvic bone tumors have a poorer prognosis than those affecting the distal extremities, there have been relatively few reports on clinical functional results after long-term follow-up.
Methods
The postoperative follow-up period averaged 11.3 years (range, 8 to 14 years). Radiographs of the AP view of the pelvis were evaluated on the basis of bone union of the FVFG. Clinical results were evaluated with use of the Musculoskeletal Tumor Society (MSTS) scoring system and the Short Form 36 (SF-36).
Results
Successful reconstructive arthrodesis of the hip joint was accompanied by radiological findings of bone union and hypertrophy of the FVFG in three patients. The other patient experienced pseudarthrosis of the graft due to deep infection. The patient who underwent successful reconstruction of a type IIA resection had an MSTS score of 93 %, whereas those undergoing a type IA/IIA/III resection scored 57 % and 83 %, respectively. Our patients scored more than 70 % in the physical component summary of the SF-36 for Japanese people, and good lower limb function was maintained for a long period postoperatively. Unsuccessful reconstruction lowered the MSTS score to 43 % and the physical component summary score of the SF-36 to 29.
Conclusions
Reconstructive hip arthrodesis with FVFG might afford an effective pelvic reconstructive procedure to achieve lower limb sparing and long-term maintenance of lower limb function in patients with periacetabular malignant bone tumor.
Level of evidence Level IV, series of case reports. See Guidelines for Authors for a complete description of levels of evidence.
Keywords
Reconstructive hip arthrodesis Periacetabular malignant bone tumor Free-vascularized fibular graft (FVFG) Functional evaluations PelvisNotes
Conflicts of interest
Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patient/licensing arrangement, etc.) that might pose a conflict of interest in connection with the submitted article.
References
- 1.Abudu A, Grimer RJ, Cannon SR, Sneath RS (1997) Reconstruction of the hemipelvis after the excision of malignant tumours. J Bone Joint Surg Br 79:773–779PubMedCrossRefGoogle Scholar
- 2.Akiyama T, Clark JCM, Miki Y, Choong PFM (2010) The non-vascularised fibular graft. A simple and successful method of reconstruction of the pelvic ring after internal hemipelvectomy. J Bone Joint Surg Br 92:999–1005PubMedCrossRefGoogle Scholar
- 3.Enneking WF, Dunham WK (1978) Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 60:731–746PubMedGoogle Scholar
- 4.Enneking WF, Dunham W, Gebhardt M, Malawar M, Pritchard D (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumours of the musculoskeletal system. Clin Orthop Relat Res 286:241–246PubMedGoogle Scholar
- 5.Fucks B, O’Connor MI, Kaufman KR, Padjett DJ, Sim FH (2002) Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation. Clin Orthop Relat Res 397:29–35CrossRefGoogle Scholar
- 6.Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K (1998) Translation, adaptation, and validation of the SF-36 health survey for use in Japan. J Clin Epidemiol 51:1037–1044PubMedCrossRefGoogle Scholar
- 7.Fukuhara S, Ware JE, Kosinski M, Wada S, Gandek B (1998) Psychometric and clinical tests of validity of the Japanese SF-36 health survey. J Clin Epidemiol 51:1045–1053PubMedCrossRefGoogle Scholar
- 8.Harrington KD (1992) The use of hemipelvic allografts or autoclaved grafts for reconstruction after wide resections of malignant tumors of the pelvis. J Bone Joint Surg Am 74:331–341PubMedGoogle Scholar
- 9.Hoffmann C, Gosheger G, Gebert C, Jurgens H, Winkelmann W (2006) Functional results and quality of life after treatment of pelvis sarcoma involving the acetabulum. J Bone Joint Surg Am 88:575–582PubMedCrossRefGoogle Scholar
- 10.Ikeda T, Nagoya S, Kawaguchi S, Wada T, Ohuchi T, Satoh M (2003) Metastasis from a mixed tumour of the salivary gland. Lancet Oncol 4:702PubMedCrossRefGoogle Scholar
- 11.Nagoya S, Usui M, Wada T, Yamashita T, Ishii S (2000) Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours. J Bone Joint Surg Br 82:1121–1124PubMedCrossRefGoogle Scholar
- 12.O’Connor MI, Sim FH (1989) Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am 71:481–494PubMedGoogle Scholar
- 13.Pring ME, Weber KW, Unni KK, Sim FH (2001) Chondrosarcoma of the pelvis. J Bone Joint Surg Am 83:1630–1642PubMedGoogle Scholar
- 14.Uchida A, Myoui A, Araki N, Yoshikawa H, Ueda T, Aoki Y (1996) Prosthetic reconstruction for periacetabular malignant tumors. Clin Orthop Relat Res 326:238–245PubMedCrossRefGoogle Scholar
- 15.Wada T, Usui M, Nagoya S, Isu K, Yamawaki S, Ishii S (2000) Resection arthrodesis of the knee with a vascularised fibular graft. Medium- to long-term results. J Bone Joint Surg Br 82:489–493PubMedCrossRefGoogle Scholar
- 16.Yadav SS (1990) Dual-fibular grafting for massive bone gaps in the lower extremity. J Bone Joint Surg Am 72:486–494PubMedGoogle Scholar