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Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint

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Abstract

Background

Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported.

Surgical procedures

Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis.

Methods

The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51 months (range, 9 to 96 months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated.

Results

The mean age of four females and two males at the initial surgery was 37.2 years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12 weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and four years after surgery, for which one patient required rod replacement.

Conclusions

The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.

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Data availability

The data that support the findings of this study are available from the corresponding author, BO, upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan

    Bungo Otsuki, Shunsuke Fujibayashi, Akio Sakamoto, Junya Toguchida, Koichi Murata, Takayoshi Shimizu & Shuichi Matsuda

  2. Department of Orthopaedic Surgery, Otsu Red Cross Hospital, Shiga, Japan

    Takeshi Okamoto

  3. Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan

    Junya Toguchida

Authors
  1. Bungo Otsuki
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  2. Takeshi Okamoto
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  3. Shunsuke Fujibayashi
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  4. Akio Sakamoto
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  5. Junya Toguchida
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  6. Koichi Murata
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  7. Takayoshi Shimizu
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  8. Shuichi Matsuda
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Contributions

BO: conceptualization, methodology, data curation, and writing—original draft preparation. TO, SF, AS, KM, and TS: investigation and writing—reviewing and editing. JT and SM: supervision, reviewing, and editing.

Corresponding author

Correspondence to Bungo Otsuki.

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Ethics approval

This study was performed with the approval of the Institutional Ethics Committee of Kyoto University.

Consent to participate and publish

This study is retrospective study. Patients were not required to give informed consent to the study because the analysis used clinical recorded that were obtained after each patient agreed to treatment by written consent. We also applied opt-out method to obtain consent on this study, which was approved by the Institutional Review Board.

Competing interests

The authors declare no competing interest.

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Otsuki, B., Okamoto, T., Fujibayashi, S. et al. Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint. International Orthopaedics (SICOT) 45, 1793–1802 (2021). https://doi.org/10.1007/s00264-021-05096-0

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  • DOI: https://doi.org/10.1007/s00264-021-05096-0

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