The purpose of this study is to compare functional results of hemipelvectomy and internal hemipelvectomy following resection of pelvic tumours. The emotional acceptance of such surgery is also examined. From 1998 to 2003, 19 male and 13 female patients, aged from 6 to 76 years, underwent hemipelvectomy, and 12 male and seven female patients, aged from 13 to 65 years, underwent internal hemipelvectomy. In the series as a whole, follow-up ranged from 1 to 156 months. Five patients with external hemipelvectomy, six with internal hemipelvectomy and one who underwent internal hemipelvectomy followed by external hemipelvectomy were evaluated functionally, clinically and psychologically. Patients expressed emotional concern about body image and mobility. Psychosocial adjustment was difficult for all patients, but some were able to overcome their difficulties more easily than others. Patients with internal hemipelvectomy rather than external hemipelvectomy had more difficulty adjusting emotionally. The site of the tumour and morbidity rates, which remain high when limb-sparing surgery is performed for pelvic tumours, are important considerations when deciding upon the type of surgery. Patients and their families need extensive preoperative psychological preparation and postoperative psychotherapy is imperative

Introduction and aims. After internal hemipelvectomy for malignant pelvic tumors, pelvic reconstruction is necessary for eventual weight bearing and ambulation. Non-vascularised, fibular grafts (NVFG) offer fast, and stable reconstruction, post- modified Enneking's type I and I/IV resection. This study aimed to evaluate the success of graft union and patient function after NVFG reconstruction. Methods. From 1996 to 2009, 10 NVFG pelvic reconstructions were performed after internal hemipelvectomy in four cases of chondrosarcoma, three of Ewing's sarcoma, and single cases of osteosarcoma, malignant peripheral nerve sheath tumour, and malignant fibrous histiocytoma. A key indication for internal hemipelvectomy was sciatic notch preservation confirmed by preoperative MRI. Operation time and complications were recorded. The mean follow-up was 31.1 months (range: 5 to 56), and lower limb function was assessed using the Musculoskeletal Tumour Society scoring system. Plain radiographs and/or computer tomography were used to determine the presence or absence of NVFG union. Results. The mean operation time was four hours and 56 mins, with no major intraoperative complications and partial wound break-down in only one patient. The NVFG united successfully in all patients, with a mean union time of 7.3 months. Post-operative deep infection did not occur in any case. Seven patients were eventually able to ambulate without a cane, and overall, the average function rating percentage was 75.4%. Recurrent tumour occurred in two cases following primary resection. Death from tumour-related disease occurred in one of the ten cases. Conclusions. NVFG is a stable and reliable pelvic reconstruction method after type I and type I/IV hemipelvectomy. Reliability may be linked to preservation of graft periosteum, and careful patient selection, limited to those with an intact sciatic notch. Furthermore, the relatively short operative time required should help minimise deep infection

A rare case of malignant transformation of fibrous dysplasia to chondrosarcoma involving the pelvis, treated by hemipelvectomy, was described by our team in a published case report. Twenty-four years later, the patient remains recurrence-free, with a good functional outcome that allows him to be independent in everyday activities and work in full time employment. Functional outcome following hemipelvectomy for pelvic malignancy is an evolving topic, as improved imaging and surgical techniques result in earlier diagnosis and a better overall prognosis. Sarcomas involving the pelvis still represent a challenging topic for surgeons. During the last twenty-four years, there have been some advances in the limb- salvage treatment of pelvic tumours. An internal hemipelvectomy is currently considered to be a reasonable treatment option, with good functional outcomes and achievement of satisfactory tumour clearance margins, in well- selected cases. In all cases however, the main focus should be in the adequate resection of the lesion, followed by restoration of maintenance of stability. We report a fascinating case of a patient who underwent internal hemipelvectomy without reconstruction for chondrosarcomatous transformation of pelvic fibrous dysplasia, with emphasis on the clear surgical resection margins and disease-free status of the patient and satisfactory functional outcome. We support that internal hemipelvectomy is an acceptable treatment option in well- selected cases and can achieve clear tumour resection margins, resulting in long term disease-free results, and a good limb- salvage functional outcome. We believe that joint stability in this patient is mainly a result of preservation of the adductor muscle group, which prevents the hip joint from upward migration and allows the patient to use his left leg for walking

Presentation of two cases of pelvic periacetabular sarcoma, which were treated with wide resection of the tumor, pelvic reconstruction and lower limb salvage. Two patients, one male 23 y.o. with chondrosarcoma and one female 75 y.o. with chondroblastic osteosarcoma, were treated in our clinic. Both tumors were stage II according to Enneking’s classification. Both tumors were treated with Enneking type II internal hemipelvectomy due to their periacetabular localization. After wide resection of tumors, pelvic deficit was reconstructed with allograft, which was internally fixated, and total hip replacement with constrained prosthesis. Clinical evaluation showed absence of pain and satisfactory function of the limb. Imaging evaluation with x-ray, 3D-scan kai MRI showed satisfactory position and condition of allograft and internal fixation without evidence of loosening. Non weight bearing mobilization commenced 3 weeks postoperatively. Internal hemipelvectomy requires precise preoperative planning and surgical knowledge because it is technically demanding due to complex structure of the pelvis, the great number of muscular attachments and the presence of important vessels, nerves and pelvic viscera. Wide pelvic resection and reconstruction with allograft for periacetabular sarcomas is a challenging procedure, which offers the opportunity of limb salvage associated with functional outcome

Purpose: Resection of pelvic sarcoma with limb preservation (internal hemipelvectomy) is a major undertaking. Resection requires large areas of soft-tissue to be removed. Because of wound complications, we manage these defects with immediate tissue transfer (ITT) at the time of resection when a large defect is anticipated. This study compares the outcomes of ITT with primary wound closure (PWC).

Method: Twenty patients undergoing 22 separate procedures (1995–2007) were identified in our prospectively maintained database. Demographics, tumour type, operative data and complications, and functional scores (MSTS-1993, TESS) were collected.

Results: Twelve defects were managed with ITT, nine with pedicled myocutaneous vertical rectus abdominis (VRAM) flaps (one received double VRAM flaps due to the large defect), two with tensor fascia lata (TFL) rotation flaps (one augmented by local V-Y advancement, the other with gluteus maximus rotation flap) and one received latissimus dorsi free tissue transfer. Four wound complications necessitated operative intervention in this group: two debrided VRAM flaps went on to heal and the two TFL flaps required revision: one to VRAM flap and the other to a latissimus dorsi free flap which ultimately suffered chronic infection and hindquarter amputation was performed. Ten defects were managed with PWC, and 5 wound complications occurred, all five suffered infection, one developed hematoma and one dehisced. One wound resolved with debridement, two healed after revision to pedicled gracilis and gluteus maximus myocutaneous flaps. Two patients were converted to hindquarter amputation due to chronic infection. Functional scores were collected on 8 of 12 living patients, at time of writing. The mean TESS scores were 83 and 73 in the ITT and PWC groups. Five patients in the ITT and 3 in the PWC group were deceased.

Conclusion: Soft-tissue closure following pelvic sarcoma resection remains a difficult challenge, and our experience reflects that. There were fewer wound complications (33% v 50%) and slightly better function with ITT than PWC, but this was not statistically significant due to the small size of our study. Although small, this study suggests ITT should be considered whenever a large soft tissue defect is anticipated.

Purpose. Curative treatment of malignancies in the sacrum and lumbar spine frequently requires en-bloc spinopelvic resection. There is no standard classification of these procedures. We present a classification of these resections based on analysis of 45 consecutive cases of oncologic spinopelvic resections. This classification implies a surgical approach, staging algorithm, bony and soft tissue reconstruction, and functional outcomes following surgery. Method. We reviewed oncologic staging, surgical resections, and reconstructions of 45 consecutive patients undergoing spinopelvic resection with curative intent. Mean follow-up of surviving patients was 38 months. Common themes in these cases were identified to formulate the surgical classification. Results. Tumors included chondrosarcoma (n=11), other sarcomas (n=11), osteosarcoma (n=9), chordoma (n=6), locally invasive carcinoma (n=5), and others (n=3). Resections could be divided into 5 types based on the exent of the lumbosacral resection and the need for an associated external hemipelvectomy. Type 1 resections included a total sacrectomy +/− lumbar spine resection. Type 2 resections included hemisacrectomy +/− partial lumbar excision, and iliac wing resection. Type 3 resections encompassed external hemipelvectomy with hemisacrectomy +/− partial lumbar excision. Type 4 resections encompassed external hemipelvectomy with total sacrectomy +/− lumbar excision. Type 5 excisions involved hemicorporectomy type procedures. For each type of resection we have developed guidelines for trans- vs retroperitoneal surgical approaches, staging of the resections, bony and soft tissue reconstructive procedures to re-establish spinopelvic continuity, and predicted functional outcomes for patients. At mean 38 month follow-up on surviving patients, 28 are living and 17 are deceased. Twenty-two of 28 surviving patients are disease free. Nineteen of 26 surviving patients are independent in their activities of daily living. Conclusion. En bloc spinopelvic resections may be classified into five types based on the extent of lumbosacral excision and the need for concurrent hemipelvectomy. Using this classification system, we have formulated treatment strategies to guide surgical approach, procedural staging, bony and soft tissue reconstructive procedures, and expected functional outcomes. Long term survival and independent function can be achieved in this challenging patient population

The June 2012 Oncology Roundup. 360. looks at: avoiding pelvic hemipelvectomy; proximal femoral metastasis; extendible prostheses; rotationplasty; soft-tissue sarcomas; osteosarcoma of the pelvis; recurrent chondrosarcoma ; MRI and the differentiation between benign and malignant lesions; and malignant fibrous histiocytoma

Chondrosarcoma is a malignant tumour and accounts for approximately 20% of bone sarcomas. The pelvis is one of the commonest sites. Chondrosarcoma of the pelvis lends itself to surgical excision and is relatively resistant to irradiation and chemotherapy. A long term survival analysis of this challenging condition is rarely reported in literature. We review and evaluate the oncological and functional results of all the patients operated at our centre and we analyse the survival analysis of these patients with special focus on the prognostic factors. Fifty-four consecutive patients with chondrosarcoma of the pelvis who were treated at the Royal National Orthopaedic Hospital, Stanmore, UK between 1987 and 2001 were included in the study. Demographic data, case notes, histopathological results and follow-up data were obtained and statistically analysed. There were 38 males and 16 females with a mean age of 48.4 years [18-77]. The chondrosarcomas were primary [n=38], secondary [n-7] or recurrences [n=9]. The anatomical sites in the pelvis were in the epicentre I [n=24], II [n=20] and III [n=10]. The surgical procedures performed were local resection [n=28], local resection and hip arthroplasty [n=6], hemipelvectomy (+endoprothesis) [n=16], hemipelvectomy [+fibular strut graf] [n=2] and hinquarter amputation [n=2]. The histological grade was Gr [n=27], Gr 2[n=20] and Gr 3 [n=7]. The complication rate was 24%:wound revision [9%], dislocation [8%] and infection [7%]. There was a 5, 10 and 15 year cumulative survival rate of 74%, 65% and 40%. The overall recurrence rate was 24%. The factors associated with a worse prognosis were high histologic tumour grade, increasing patient age, anatomical location in site I and III, primary surgery outside of tumour centre, inadequate surgical margins, and those treated by local extension. Aggressive surgical approach significantly improves the prognosis of the patients with chondrosarcoma of the pelvis

Adequate resection of malignant osseous tumors of the pelvis within wide margins is demanding surgery. To avoid disabling hemipelvectomies, during the seventies of the last century internal hemipelvectomy combined with a partial pelvic replacement had become a new surgical and meanwhile standard procedure. To achieve adequate reconstructions of the osseous pelvis custom-made replacements were recommended. In the very early stages of this type of surgical procedure using megapros-theses, individual pelvic models were manufactured but, until recently, little is known about the accuracy of such models. Thus, it was the aim of this retrospective study to evaluate this. We analysed the charts of 24 patients (25 pelvic models) for whom an individual model of the osseous pelvis had been constructed to manufacture such a tool and to enable the surgeon a better intraoperative orientation. Two patients refused surgery. Thus, in 23 patients surgical resection of parts of the bony pelvis was performed followed by either a partial pelvic replacement (13 x), hip transposition procedure (5 x), ilio-sacral resection (4 x) or revision surgery (exchange of a partial pelvic replacement). In all patient who received a partial pelvic replacement, the fit of the replacement was optimal, in none of them a major unplanned resection was necessary. The same was observed in patients who received a hip transposition procedure or an ilio-sacral resection. Oncologically, in most of the patients we achieved wide resection margins (14 x). In only 5 patients the margins were marginal (4x) or intralesionsal (1 x). In two cases the aim was a palliative resection because of a metastatic disease (1x) or benign entity (1 x). Thus, pelvic models are helpful tools to planning the manufacture of partial pelvic replacements and ensuring optimal osseous resection of the involved bone. Further attempts have to be made to evaluate the aim of navigational techniques regarding improvement of the accuracy of the osseous and the soft tissue resection

Curative treatment of malignancies in the sacrum and lower lumbar spine frequently requires en bloc spinopelvic resection. There is no standard classification of these procedures. We present outcomes and a classification scheme with oncologic and reconstructive guidelines for spinopelvic tumors based on an analysis of 30 cases of en bloc resection and reconstruction performed with curative intent. Mean follow-up of surviving patients was 38 months. Tumors included osteosarcoma (n=9), chondrosarcoma (n=6), chordoma (n=5), other sarcomas (n=5), neurogenic tumors (n=4), and local extension of carcinoma (n=1). Resections could be divided into 4 types. Type 1 resections (n=12) included a total sacrectomy with lower lumbar spine and bilateral medial iliac resections. Type 2 resections (n=6) included hemisacrectomy, partial lumbar spine excision, and medial iliac resection. Type 3 resections (n=9) encompassed external hemipelvectomy with hemisacrectomy and partial lumbar spine excision. Type 4 resections (n=3) encompassed external hemipelvectomy, total sacrectomy, and lumbar spine excision. For each resection type, we have developed staged surgical approaches to allow resection with wide margins and reconstruction of spinopelvic continuity. Tumor free margins were achieved in all cases. Perioperative mortality was 3/30. Seven additional patients have died of disease, two died of other causes, two are alive with disease, and 16 have no evidence of disease. 13/18 surviving patients are independent in their activities of daily living. In our practice en bloc excision and reconstruction of spinopelvic neoplasms may be classified into four types. For each type, we have devised surgical treatment guidelines to allow for wide resection and reconstruction of spinopelvic continuity. Long term survival and independent function can be achieved in this challenging patient population. This represents the first standardised classification of oncologic spinopelvic resections and reconstructions

Purpose- To review the operative treatment of patients with chondrosarcoma of the pelvis and to study the long-term survival analysis of this cohort group. Methods- A retrospective case study analysis was performed of patients with a diagnosis of chondrosarcoma of the pelvis treated in our hospital between 1990 and 2003. The operative notes and histopathological records were used along with the latest follow up letters. Results- 54 cases (32 males and 22 females) with a mean age of 48.4 years ( 18–77) were identified. The aetiology was primary ( 38), recurrences ( 9) and secondaries ( 7).The sites in the pelvis were in the anatomical epicentre I(24), II(20) and III(10).The surgical procedures performed were local resection (28) , local resection and hip arthoplasty (6), hemipelvectomy (+ endoprosthesis) (16), hemipelvectomy (+ fibular strut graft) (2) and hindquater amputation (2).The histological grade was grade 1 (27), grade 2 (20) and grade 3(7). The complications rate was 24% – Wound revision (9%), dislocation (8%) and infection (7%). There was a 14-year cumulative survival rate of 46 % and 24 patients are surviving to date. The median follow up was 52 months. The cumulative 14-year recurrence rate was 40% and the mean time to recurrence was 20.2 months. Conclusion- There is an increased recurrence rate with epicentre I and III tumours and with those treated by local excision

Purpose: We report a series of patients with malignant tumours of the pelvis that had a tissue expander inserted in the pelvis to facilitate radical radiotherapy, and report functional outcomes following treatment. Introduction: Surgery for malignant tumours affecting the pelvis is challenging. Some tumours are suitable for internal hemipelvectomy and reconstruction, some require hindquarter amputation and some are inoperable. Overall prognosis is poor with high morbidity and mortality rates. There may be a place for alternative treatment with the insertion of pelvic spacers to facilitate radical radiotherapy. This is indicated in patients who have an inoperable tumour, who decline amputation, or who had an internal hemipelvectomy with close margins and high risk of local recurrence. Methods & Results: We performed a retrospective review of all patients who presented with a malignant tumour of the pelvis and who underwent an insertion of a pelvic spacer followed by local high dose radiotherapy. Available patients were followed up and evaluated using the Musculoskeletal Society Tumour Score (MSTS) and the Toronto Extremity Salvage Score (TESS). There were ten patients; 5 had Ewing’s sarcoma, 3 had osteosarcoma, 1 had spindle cell sarcoma and 1 had alveolar soft part sarcoma. 4 patients had metastases on presentation. The average age was 30 years (14 to 56 years), and average follow-up was 15 months (12 to 24 months). 4 patients died and 6 are still alive. There were no surgical complications. The average length of hospital stay was 6 days (2 to 10 days). Patients averaged an MSTS score of 63% and a TESS of 67%. Conclusion: Radical radiotherapy after spacer insertion offers an alternative to morbid surgery and is associated with good functional outcomes

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

The purpose of this study was to evaluate the functional and oncological outcome of recycled autograft reconstruction after a wide excision for primary malignant bone tumor around the hip. From 1998 to 2015, 67 patients with a primary malignant bone tumor involving proximal femur or periacetabular zone (P2) were included. There were 36 males and 31 females with a mean age of 34 years (13 to 58). Of these, 29 patients had grade I or II chondrosarcoma, 28 high-grade osteosarcoma, 6 Ewing's sarcoma and 4 undifferentiated pleomorphic sarcoma. Enneking stage of all 67 patients was stage II. Of the resection classification, proximal femur resection was performed in 29 patients, P1+P2 in 15, P2+P3 in 14, P1+P2+P3 in 4, P2 only in 4, and P2+proximal femur in 1. Extracorporeally irradiated recycled autograft and liquid nitrogen frozen autograft were performed in 44 and 23 patients, respectively. At a mean follow-up of 98 months (10 to 239), 48 patients (72%) were continuously disease-free, 12 (18%) died of disease and 7 (10%) were alive with disease. The tumors of these patients who had died of disease were usually located in pelvic bones (10/12). Of these 37 patients with pelvic tumors, 7 patients (22%) had local recurrence, four of them received external hemipelvectomy. Other complications included hip dislocation in 2 patients, nerve injury in 2 and deep infection in 2. However, the above complications were rarely occurred in the patients with proximal femur reconstruction. The mean Musculoskeletal Tumor Society functional score were 77% (53 to 93). Recycled autograft reconstruction for primary malignant bone tumor around the hip is a valid method with acceptable morbidity and a favorable functional outcome

Ten to 15% of the pelvic girdle tumors are primary malignant bone tumors, while about 80% are osseous metastases. Due to improved function, enhanced quality of life, and acceptable local recurrence rates, limb salvage surgery has replaced external hemipelvectomies in many cases of primary malignancies. However, large segmental bony defects and poor bone quality due to the disease process itself and subsequent treatment (i.e. chemotherapy and radiation) can make stable implant fixation difficult when performing a total hip arthroplasty (THA) for oncologic periacetabular lesions with concurrent fractures. Various methods are available to reconstruct the hemipelvis, and include large structural allografts, allograft-prosthetic composites (APCs), custom-made endoprostheses, modular saddle prostheses, and modular hemipelvis endoprostheses. However, short- and mid-term results from our institution indicate that tantalum reconstructions with adjuvant screw fixation and supplemental reinforcement cages provide reasonable improvement in clinical outcomes and stable fixation in situations with massive bone loss and compromised bone quality. On the femoral side, cemented fixation remains a viable option (including proximal femoral replacements), but uncemented distal fixation with extensively-porous coated cylindrical stems or modular fluted tapered stems can be considered if the disease process (or subsequent treatment) primarily affects the proximal femur. In addition to long-term fixation, post-operative dislocations remain a significant concern given the often compromised abductor mechanism

Surgical wounds are a problem in bone cancer patients undergoing aggressive orthopedical surgeries, such as hemipelvectomy and hip-disarticulation, which are very aggressive to the tissues. Regarding the wound care, the development of Negative Pressure Wound Therapy (NPWT) has shown to have better results than the standard methods often used in wound care. V.A.C. ®. Therapy removes fluids and infectious materials, helps protect the wound environment, helps promote perfusion and a moist healing environment and helps draw together wound edges. So, V.A.C. ®. Therapy has shown to provide cost-effective and clinically proven wound therapy. The aim of our study is to describe nursing care in the management of V.A.C. ®. Therapy, having in mind the benefits that this therapy will bring to the patient, such as reduced complications, reduced costs and time spent on the ward, helping preparing their discharges

Introduction. The aim of this study is to evaluate the functional and oncological outcome of extracorporeally irradiated autografts as a method of pelvic reconstruction after internal hemipelvectomy. Methods. The study included fifteen patients with primary malignant bone tumours of the pelvis. There were 10 males and 5 females with a mean age of 21.5 years (range, 8 to 46 years). Six patients had Ewing's sarcoma, six osteosarcoma, and three chondrosarcoma. Results. At a mean follow-up of 52.3 months (range, 4 to 180 months), five patients were free from disease, nine had died with metastatic disease, while one patient was alive with pulmonary metastasis. Local recurrence occurred in three patients (20%) and all eventually died of disease progression. Two patients developed deep infection which necessitated graft removal. The mean MSTS functional score in those thirteen patients who could be followed up for at least 12 months was 77% (range, 60-87%). According to Mankin's allograft functional grading system, there were five excellent, five good, one fair result and two failures. Discussion. Periacetabular reconstruction after tumour resection is a real challenge to orthopaedic surgeons. There is no ideal method of reconstruction and the decision needs to be individualized. Extracorporeal irradiation and re-implantation of bone is a valid method of reconstruction after pelvic resections with acceptable morbidity rate and functional outcome that compares favourably to other available reconstructive techniques

Aims: A series of pelvic bone tumors with special reference to innovative operative procedures were examined. Methods: The series consisted of all patients treated surgically for pelvic bone tumors between 1981–2001. Results: There were 65 benign and 120 malignant tumors. Of the 65 benign tumors most were only biopsied or resected. Reconstructive methods were needed 16 cases, mostly they were cysts in the acetabular region that were þlled with cancellous bone. 48 of the malignant bone tumors were more than just biopsied. 32 were only resected, four hemipelvectomies were performed. 12 resections with reconstruction were done, þve times with endoprostheses, three times with PMMA, three times with bone grafting and once with osteosynthesis. The endoprosthetic solutions included two large pelvic reconstructions. Two large defects in the posterior pelvic ring were reconstructed with autogenous þbular grafts. Pelvic rings left open after resection were susceptible to fatigue fractures, these cases were all treated conservatively. Large anterior reconstructions were reinforced with meshes to prevent herniation. Conclusion: In selected cases good function and stability is possible after large pelvic ring resections

Frequent imaging after a completed multimodal therapy of osteosarcoma is recommended by therapy optimization studies to detect local or systemic tumor recurrence. Considering the low rates of local recurrence, regular local imaging has to be questioned. 150 patients with osteosarcoma were treated in our department between 1991 and 2005. The median age of patients with osteosarcoma was 17 years with a range of 4 – 79 years and a female:male ratio of 1:1.1. The primary tumors of 147 patients were treated surgically, while 3 patients refused to be operated. After a wide resection, a tumor endoprosthesis was implanted in 103 (70.1%) of the 147 patients, 16 (10.9%) patients underwent a Borggreve rotationplasty, a resection and biological reconstruction was implemented in 10 (6.8%) patients, while further 18 (12.2%) patients were amputated. The median follow up was 95 months. Local recurrences appeared in 2 (1.4%) patients which had been treated with a hemipelvectomy. After implantation of a tumor endoprosthesis, local recurrences were not observed. Postoperative complications observed after the implantation of a tumor endoprosthesis included infections (n=14; 13.6%), loosening, fractures and wearing of endoprotheses (n=7; 4.8%), luxation (n=1; 0.7%) as well as traumatic shaft fractures of involved bones (n=5; 3.4%). All complications included specific symptoms and were diagnosed outside the routine follow up. In conclusion, local radiological imaging after resection of an osteosarcoma and reconstruction with a tumor endoprosthesis as a routine examination should be questioned, however it is definitely indicated in patients with specific symptoms

Survival of patients with high-grade osteosarcoma has significantly improved with combined multi-agent chemotherapy and aggressive local surgical control. However, despite modern therapy, approximately one-third recur and those that do recur are difficult to treat successfully. The recurrence of osteosarcoma is rare. Local recurrence occurs in 4–10% of patients following effective treatment. This report details a lady with local recurrence of osteosarcoma seventeen years following initial presentation. She was diagnosed with an osteosarcoma with both chondroblastic and osteoblastic differentiation of the right ilium in November 1989 (aged 41). There were no distant metastases. She received one cycle of neo-adjuvant chemotherapy (PIA) prior to a right hemipelvectomy in April 1990. Six weeks post excision, she underwent a hemipelvic and proximal femoral replacement. She received 5 cycles of adjuvant (PIA) chemotherapy. Post-operative recovery was complicated by infection leading to formation of a discharging sinus. Despite exploration and an external oblique rotation graft, the sinus continued to discharge and the femoral and pelvic prostheses were removed in March 1994. She mobilised with the use of two crutches and functioned extremely well. She was not keen for reinsertion of a prosthesis and remained on yearly follow-up until 2000. In June 2007, she presented to her general practitioner with dull right iliac fossa pain. She was referred back to our service and examination revealed a mass in the right iliac fossa. This was biopsied and demonstrated locally recurrent osteosarcoma. Staging investigations revealed no metastatic disease. She had excision of the osteosarcoma in September 2007 followed by re-excision local re-recurrence within psoas in April 2008. To our knowledge, this is the first time that locally recurrent intramedullary osteosarcoma, 17 years from initial diagnosis and treatment, is described in the literature. This case serves as a useful clinical reminder