Publication de Nicole Delepine : Long term follow up of composite prostheses for wide periacetabular malignancies

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Publié sur : 14th International Symposium on Limb Salvage - Hamburg Germany - 2007
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Long term follow up of composite prostheses for wide periacetabular malignancies
G.Delepine, T.Sokolov, F.Delepine, Nicole Delepine

Long term follow up of composite prostheses for wide periacetabular malignancies (about 86 cases)


1975-1986 Internal hemi-pelvectomy without reconstruction


Internet hemi-pelvectomy

I H Without reconstruction leaves a flail hip limb shortening can reaches 5 to 7 centimeters

Introduction



The purpose of this paper is to present it long term results


secondary fracture and loosening

1986-1990 allograft : secondary fracture and loosening

Composite prosthesis

1990 : Composite prosthesis

86 Patients (1990-2003)



suffering from malignant tumors

suffering from malignant tumors of the inominate bone received an "hand on" composite prosthesis.
They were 56 males and 30 females. The mean age of the patients is 28



Histography of tumors




Histography of tumors

54 sarcomas :

- Ewing's sarcoma in 21
- chondrosarcomas in 19
- osteosarcomas in 8
- other sarcomas in 6

and metastases in 32

- primaries were : breast in 8
- kidney in 6, prostate in 3
- 2 thyroid in
- misceallenous in 13


Preoperative planning




Grade 1 Chondrosarcoma


All patients, with sarcomas, except 2 with low grade chondrosarcoma had extracompartimental tumor at presentation : stage II B (41) or III B (11).



All together, 43/86 patients presented with a localized disease and the 43 other with metastases (16 solitary)




Some had very huge tumors



Some had very huge tumors

OS in an italian girl 11Y OS in an african girl 13Y

Medical treatment



Medical treatment

Medical treatment


The composite prosthesis



The composite prosthesis

The inominate prosthesis included 3 components : a titanium cup, long titanium screws and cement.


Surgical complications occurred in 40 patients



Surgical complications

in 12 patients neurological deficits or skin slough in 21 patients Dislocation of the hip. Deep infection in 10


Adequacy of resection



Adequacy of resection


Histologic examination of the resected specimen showed that margins were wide in only 42 patients.
30 resections were marginal and 14 contaminated.
12 local recurrences were observed all after contaminated resection.

Oncologic Results



Patients were followed up separately by their surgeon and their chemotherapist.
Mean follow-up of patients is 9 years At last follow up 44 patients (52 %) were alive and free of disease with a mean follow up of 108 months (12 to 196).
4 were alive with evolutive disease;
36 died from disease and 2 from unrelated event.

chemotherapist


For patients seen with localized sarcoma, the 5 year overall and event free survival rates are 70 % and 50%. 15 % and 12% for metastatic patients.

Function the 46 uncomplicated cases



Patients had no pain and could walk long distances without external support. The hip mobility averaged 100° in flexion and 195° in total. Length discrepancy was inferior to 1 centimeter in 70 and 2 in 10 . The emotional acceptance was excellent and the average score was 28 (80 %) (range 66 % - 94 %).

Zones 1+2 Wide resection for radioresistant metastase



Wide resection for radioresistant metastase

Wide resection for radioresistant metastase


48 yars old man suffering of solitary acetabular metastase from lung carcinoma. Progressive disease under radiotherapy. Composite prosthesis excellent function till death

Zone 1+2 resection for Ewing



resection for Ewing


Ewing's sarcoma with medial gluteus muscle extension. Wide resection disrupting the abdution apparatus. DFS with 108 months F.U.

Zone 1+2 resection for EwinFonction after 108 months



resection for EwinFonction


resection for EwinFonction


resection for EwinFonction


Good function. Complete passive mobility.No pain.But limping due to the resection of medial gluteus muscle.

Fonction after 10 years



Fonction after 10 years


Fonction after 10 years


Excellent fonction but some wear on the polyethylen acetabular component.

Reoperated patients



Have a lower score : 24,5
(70 %, range 50 % - 80%) most due to some degree of pain or limitation of walking.
The patients with flail hip or local recurrence had the worst score : mean value 10 (28 %).

MRI and regional metastases



MRI and regional metastases


MRI and regional metastases


Extraarticular resection of primary and met. Postop dislocation. Sciatic palsy.
Ned with 120 months F U.
Function score 60.

Loosening risk



Loosening risk


With a median folow up of 10 years, 11 loosening of pelvic component have been observed. 6 of them are due to infection or tumoral recurrence.
Aseptic loosening is not frequent (5/86).

Conclusions



Limb salvage for peri-acetabular tumors is technically demanding with a high rate a complications, but gives equivalent oncologic result than external hemipelvectomy.
"Hand on" composite prosthesis is cheaper, easier, and more adaptable than custom made and therefore seems particularly adapted to this blood and time consuming surgery.




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