RECONSTRUCTION OF THE ACETABULAR REGION USING A PROXIMAL FEMUR GRAFT AND TOTAL HIP ARTHROPLASTY

Abstract

Purpose: We report oncological and functional outcome after ten pelvis reconstructions using the Puget technique.

Material and methods: Ten patients (six men and four women), mean age 50 years (37–71) with malignant bone tumours, generally a chondrosarcoma, were included in this series. The tumour involved zone II in five patients, zones II and III in the other five. Resection was followed by reconstruction using the superior portion of the homolateral femur and a cemented total hip arthroplasty. Mean resection was 13 cm (7–23). Mean operative time was 386 min and mean blood loss was 5490 ml. The resection was wide in seven patients, marginal in two and resection margins were contaminated in one. The patients were reviewed at three, six and twelve months then each year. The function score (Enneking) was recorded for all patients. Living patients also filled out a TESS quality of life questionnaire.

Results: At mean follow-up of 22 months (7–42), four patients were living and disease free and two patients were living with recurrent disease. Three patients had died from their disease and one from pulmonary embolism. Postoperative complications were: one dislocation, one phlebitis, one reflex dystrophy, one injury to the internal genital nerve, two infections and one necrosis of the scar tissue. Bone healing was obtained at a mean five months. The mean Enneking function score was 68% and the mean TESS score was 75%.

Discussion: The high proportion of deaths is related to the severe prognosis of these pelvic tumours. This reconstruction technique described by Puget, provides an interesting alternative to other reconstruction methods for the acetabular region. The autogenous graft combined with a standard total hip arthroplasty makes this a rather easy to perform and low-cost procedure.

Conclusion: Functional outcome has been, in our experience, better than with arthrodesis, acetabular prosthesis, or saddle prosthesis and massive allograft of the pelvis.