Abstract
Introduction: Pelvic and acetabular reconstruction following tumor resections are often difficult and fraught with complications. This is the first report of a reconstruction utilizing sacral implantation of an acetabular component, a relatively simple procedure.
Materials and Methods: A 74 year-old man developed recurrent low-grade chondrosarcoma in his ilium. Prior resections had included total hip reconstruction with massive cemented acetabular components. A combined Type I and II internal hemipelvectomy with endoprosthetic reconstruction were performed. Following resection, his sacrum and a small fragment of remaining ilium at the sacroiliac joint was reamed to accept a 48 mm porous coated acetabular component. It was press- fit into place and further secured with two central and three rim screws. A constrained cup liner was used. A proximal femoral endoprosthesis was constructed from a commercially available modular oncology system. Additional resection of the superior and inferior pubic ramie was required to minimize the likelihood of endoprosthetic impingement and leverage-induced dislocation. A soft tissue reconstruction of the abductors was accomplished.
Results: He remains free of recurrence 15 months post-operative. He ambulates full weight bearing with crutches. His leg is neurovascularly intact and he is pleased with his results. A videotape, demonstrating his gait, will be shown
Discussion: The author knows of one similar reconstruction that was performed at another center (unpublished data). That other patient suffered acetabular component dislodgement. The intraoperative leverage-induced dislocation of the hip was the important determination. Pubic rami resection may be required to prevent femoral impingement and instability. The use of multiple fixation screws also improved component fixation.
Conclusion: Placement of a well fixed, constrained, acetab-ular component into a retained sacrum at the level of the SI joint provides an alternative limb salvage technique.
The abstracts were prepared by Nico Verdonschot. Correspondence should be addressed to him at Orthopaedic Research Laboratory, University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
