Introduction and Aims: The management of bone defects created by Type 1 pelvic resections of large iliac bone tumors remains controversial. We reviewed the functional and oncologic outcome following Type I resection with and without bone reconstruction. Method: A retrospective review of our prospectively collected database was undertaken analysing functional and oncological outcome of 16 patients with Type I pelvic resections. Minimum follow-up was 12 months (range 12–96 months). Outcome data was available on eight of 10 patients managed without reconstruction (WOR), with the residual ilium allowed to collapse back onto the sacrum, and on five of six patients with bone graft reconstruction (WR). Functional outcome was assessed by the Toronto Extremity Salvage score (TESS) and the Musculoskeletal Tumor Society scores (MSTS87 and MSTS93). Results: Average age at surgery was 33 years (WOR) and 48 years (WR), (p=0.04), with average maximal tumor dimensions of 12cm and 9cm respectively (p=0.1). The most frequent diagnosis was chondrosarcoma. The WOR group average TESS, MSTS 87 and MSTS 93 scores were respectively 73%, 18/35 and 58% at an average of 50 months (range 24–96 months) compared to 69%, 21/35 and 51% at an average of 37 months (range 12–60 months) for the WR group. Thirty-three percent of WOR and 20% of WR patients did not require walking aids. Infection or wound necrosis occurred in 40% of WOR patients and 50% of WR patients. No local recurrences were identified. Conclusion: Similar functional and oncologic outcome was achieved in both groups suggesting that bone reconstruction is not justified following Type I pelvic resection

A retrospective review of our prospectively collected database was undertaken and the functional and oncologic outcomes after Type One pelvic resections for bone tumours of the ilium and sacrum were analyzed. Seventeen patients were identified with a minimum followup after resection of twelve months. In seven patients the bone defect was reconstructed, with no reconstruction in the remaining ten patients. The functional/oncologic outcomes of the two groups are similar, however patients without reconstruction had fewer complications and less dependence on walking aids suggesting that reconstruction may not be justified. Management of defects created by Type One pelvic resections of large iliac bone tumours remains controversial. We reviewed the functional/oncologic outcome following resection with and without reconstruction. Similar functional/oncologic outcome was achieved in both groups suggesting that reconstruction is not justified. A retrospective review of our prospectively collected database was undertaken analyzing functional/oncological outcome of seventeen patients with Type One pelvic resection. Minimum follow up was twelve months (12–96). Outcome data was available on 8/10 patients managed without reconstruction (WOR), with residual ilium collapsing back onto sacrum, and on 5/7 patients with bone graft reconstruction (WR). Average age thirty-three years (WOR) and 48yrs (WR), (p=0.04), with average maximal tumour dimensions of 12cm and 9cm (p=0.1). The most frequent diagnosis was chondrosarcoma. The WOR group average TESS, MSTS 87 and MSTS 93 scores were respectively 73%, 18/35 and 58% at an average of 50 months (24–96) compared to 69%, 21/35 and 51% at an average of 37 months (12–60) for the WR group. 33% of WOR and 20% of WR patients did not require walking aids. Infection or wound necrosis occurred in 40% of WOR patients and 57% of WR patients. No local recurrences. The perceived advantages of no reconstruction are shorter operating times, reduced incidence of complications and improved functional outcome due to medialization of the weightbearing axis in the absence of hip abductors. The oncologic/functional outcomes of both groups were similar but in those not reconstructed there was a lower incidence of complications and walking aids

We evaluate the outcome (Functional, Oncological, and complications) after resection of pelvic sarcoma and reconstruction with the saddle prosthesis. Twenty-seven patients with a mean follow up of forty-five months. Fourteen patients were free of disease, eleven patients were deceased, and two patients were alive with disease. MSTS 93 was 51 %, MSTS 87 was15%, and TESS was 64 %. Infection occurred in ten, fracture in six, and dislocation in six patients. Vertical migration stabilized after two years. Five patients were retired, five had full-time employment, six were disabled, and eleven were deceased. Reconstruction with saddle prosthesis following resection for pelvic sarcoma is associated with significant morbidity. Treatment of pelvic sarcoma is difficult. Of many techniques described for reconstruction of the pelvis following tumor resection, limited data exists to compare functional results. To evaluate the outcome after resection of pelvic sarcoma and reconstruction with the saddle prosthesis. This retrospective study includes twenty-seven patients who underwent saddle prosthetic reconstruction for pelvic sarcoma. Functional outcome was assessed with MSTS 1987 & 1993 and the Toronto Extremity Salvage Score (TESS). Oncological outcome parameters and complications were recorded. We reviewed twenty-seven patients with a mean follow up of forty-five months. Seven (26%) patients underwent type II (periacetabular) pelvic resection, twenty had type II & III (periacetabular and pubis). Eleven patients received chemotherapy. None received radiation. Fourteen patients were free of disease, eleven patients were deceased, and two patients were alive with disease. The survival rate was 60%, 22% had local recurrence, and 22% had metastasis. Functional evaluation was completed in seventeen patients and the mean for MSTS 93 was 50.8 %, the MSTS 87 was15.3%, and the TESS was 64.4 %. Infection occurred in ten cases, and there were five nerve palsies. Heterotopic ossification occurred in ten, fracture in six, and dislocation in six patients. Limb shortening was initially progressive but stabilized after two years and ultimately ranged between one and six centimeters. Five patients were retired, five had full-time employment, six were disabled, and eleven were deceased. Reconstruction with saddle prosthesis following resection for pelvic sarcoma is associated with significant morbidity. However the functional results appear to confer an advantage when compared to the significant disability following hemipelvectomy

Reconstruction of pelvic bone defect after resection for bone tumours is a challenging procedure especially when the hip joint is involved due to the anatomy and the complex biomechanical and structural function of the pelvic ring. This surgery is associated to high complication rate. The additive 3D printing technology allows us to produce trabecular titanium custom based implants with an accurate planning of resection using bone cutting jigs.

From August 2013 to January 2017, we treated 8 patients for bone pelvic sarcoma with custom-made osteotomy jigs (Nylon) and custom-made trabecular titanium prosthesis produced through rapid prototyping technology based on mirroring of the contralateral hemipelvis. Mean follow up time was 18 months (range 2–30) Wide margins were obtained in all cases, in one a local recurrence developed. Surgical time was 4 hours average (from 180 to 250 mins). No postoperative complications were reported.

Rapid prototyping is a promising technique in order to achieve wide surgical margins and restore the anatomy in pelvic bone tumour resection as well as reducing complications.

Abstract. Background. Conventional periacetabular pelvic resections are associated with poor functional outcomes. Resections through surgical corridors beyond the conventional margins may be helpful in retaining greater function without compromising the oncological margins. Methods. The study included a retrospective review of 82 cases of pelvic resections for pelvic tumors. Outcomes of acetabulum preservation (Group A) were compared with complete acetabular resection (Group B). Also, we compared outcomes of Type I+half resections (Group 1) with Type I+II resections (Group 2), and Type III+half resections (Group 3) with Type II+III resections (Group 4). Results. Group A (n=44) had significantly better functional outcome than Group B(n=38) with average MSTS93 score 22.3 vs 20.1 and average HHS 91.3 vs 82.5 (p<0.001). Group 1(n=14) and Group 2(n=12) had similar functional outcomes (mean MSTS93 score 22.07 vs 21.58 (p=0.597) and mean HHS 90.37 vs 86.51 (p=0.205)). Group 3(n=11) had significantly better functional outcome than Group 4(n=17), with mean MSTS93 score 22.8 vs 19.7 (p<0.001) and mean HHS 92.3 vs 80.1 (p<0.001). Oncological outcomes were similar among the groups. Conclusion. Trans-acetabular pelvic resections provide functional benefit over conventional resections without compromising oncological margins. There is a need to revisit and revise the pelvic resection planes

The reconstruction of peri-acetabular defects after severe bone loss or pelvic resection for tumor is among the most challenging surgical intervention. The Lumic® prosthesis (Implantcast, Buxtehude, Germany) was first introduced in 2008 in an effort to reduce the mechanical complications encountered with the classic peri-acetabular reconstruction techniques and to improve functional outcomes. Few have evaluated the results associated with the use of this recent implant. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. Every patient in whom a Lumic® endoprosthesis was used for reconstruction after peri-acetabular resection or severe bone loss with a minimal follow-up of three months was included. The charts were reviewed and data concerning patients’ demographics, peri-operative characteristics and post-operative complications was collected. Surgical and functional outcomes were also assessed. Sixteen patients, 11 males and five females, were included and were followed for 28 months [3 – 60]. Mean age was 55 [17–86], and mean BMI reached 28 [19.6 – 44]. Twelve patients (75%) had a Lumic® after a resection of a primary sarcoma, two following pelvic metastasis, one for a benign tumor and one after a comminuted acetabular fracture with bone loss. Twelve patients (75%) had their surgery performed in one stage whereas four had a planned two-stage procedure. Mean surgical time was 555 minutes [173-1230] and blood loss averaged 2100 mL [500-5000]. MSTS score mean was 60.3 preoperatively [37.1 – 97] and 54.3 postoperatively [17.1-88.6]. Five patients (31.3%) had a cemented Lumic® stem. All patients got the dual mobility bearing, and 10 patients (62.5%) had the largest acetabular cup implanted (60 mm). In seven of these 10 patients the silver coated implant was used to minimize risk of infection. Five patients (31.3%) underwent capsular reconstruction using a synthetic fabric aiming to reduce the dislocation risk. Five patients had per-operative complications (31.3%), four were minor and one was serious (comminuted iliac bone fracture requiring internal fixation). Four patients dislocated within a month post-operatively and one additional patient sustained a dislocation one year post-operatively. Eight patients (50%) had a post-operative surgical site infection. All four patients who had a two-stage surgery had an infection. Ten patients (62.5%) needed a reoperation (two for fabric insertion, five for wash-outs, and three for implant exchange/removal). One patient (6.3%) had a septic loosening three years after surgery. At the time of data collection, 13 patients (81.3%) were alive with nine free of disease. Silver coating was not found to reduce infection risk (p=0.2) and capsuloplasty did not prevent dislocation (p=1). These results are comparable to the sparse data published. Lumic® endoprosthesis is therefore shown to provide good functional outcomes and low rates of loosening on short to medium term follow-up. Infection and dislocation are common complications but we were unable to show benefits of capsuloplasty and of the use of silver coated implants. Larger series and longer follow-ups are needed

The reconstruction of peri-acetabular defects after severe bone loss or pelvic resection for tumor is among the most challenging surgical intervention. The Lumic® prosthesis (Implantcast, Buxtehude, Germany) was first introduced in 2008 in an effort to reduce the mechanical complications encountered with the classic peri-acetabular reconstruction techniques and to improve functional outcomes. Few have evaluated the results associated with the use of this recent implant. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. Every patient in whom a Lumic® endoprosthesis was used for reconstruction after peri-acetabular resection or severe bone loss with a minimal follow-up of three months was included. The charts were reviewed and data concerning patients’ demographics, peri-operative characteristics and post-operative complications was collected. Surgical and functional outcomes were also assessed. Sixteen patients, 11 males and five females, were included and were followed for 28 months [3 – 60]. Mean age was 55 [17-86], and mean BMI reached 28 [19.6 – 44]. Twelve patients (75%) had a Lumic® after a resection of a primary sarcoma, two following pelvic metastasis, one for a benign tumor and one after a comminuted acetabular fracture with bone loss. Twelve patients (75%) had their surgery performed in one stage whereas four had a planned two-stage procedure. Mean surgical time was 555 minutes [173-1230] and blood loss averaged 2100 mL [500-5000]. MSTS score mean was 60.3 preoperatively [37.1 – 97] and 54.3 postoperatively [17.1-88.6]. Five patients (31.3%) had a cemented Lumic® stem. All patients got the dual mobility bearing, and 10 patients (62.5%) had the largest acetabular cup implanted (60 mm). In seven of these 10 patients the silver coated implant was used to minimize risk of infection. Five patients (31.3%) underwent capsular reconstruction using a synthetic fabric aiming to reduce the dislocation risk. Five patients had per-operative complications (31.3%), four were minor and one was serious (comminuted iliac bone fracture requiring internal fixation). Four patients dislocated within a month post-operatively and one additional patient sustained a dislocation one year post-operatively. Eight patients (50%) had a post-operative surgical site infection. All four patients who had a two-stage surgery had an infection. Ten patients (62.5%) needed a reoperation (two for fabric insertion, five for wash-outs, and three for implant exchange/removal). One patient (6.3%) had a septic loosening three years after surgery. At the time of data collection, 13 patients (81.3%) were alive with nine free of disease. Silver coating was not found to reduce infection risk (p=0.2) and capsuloplasty did not prevent dislocation (p=1). These results are comparable to the sparse data published. Lumic® endoprosthesis is therefore shown to provide good functional outcomes and low rates of loosening on short to medium term follow-up. Infection and dislocation are common complications but we were unable to show benefits of capsuloplasty and of the use of silver coated implants. Larger series and longer follow-ups are needed

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. Methods. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival. Cite this article: Bone Jt Open 2024;5(4):260–268

Objectives. To assess the accuracy of patient-specific instruments (PSIs) versus standard manual technique and the precision of computer-assisted planning and PSI-guided osteotomies in pelvic tumour resection. Methods. CT scans were obtained from five female cadaveric pelvises. Five osteotomies were designed using Mimics software: sacroiliac, biplanar supra-acetabular, two parallel iliopubic and ischial. For cases of the left hemipelvis, PSIs were designed to guide standard oscillating saw osteotomies and later manufactured using 3D printing. Osteotomies were performed using the standard manual technique in cases of the right hemipelvis. Post-resection CT scans were quantitatively analysed. Student’s t-test and Mann–Whitney U test were used. Results. Compared with the manual technique, PSI-guided osteotomies improved accuracy by a mean 9.6 mm (p < 0.008) in the sacroiliac osteotomies, 6.2 mm (p < 0.008) and 5.8 mm (p < 0.032) in the biplanar supra-acetabular, 3 mm (p < 0.016) in the ischial and 2.2 mm (p < 0.032) and 2.6 mm (p < 0.008) in the parallel iliopubic osteotomies, with a mean linear deviation of 4.9 mm (p < 0.001) for all osteotomies. Of the manual osteotomies, 53% (n = 16) had a linear deviation > 5 mm and 27% (n = 8) were > 10 mm. In the PSI cases, deviations were 10% (n = 3) and 0 % (n = 0), respectively. For angular deviation from pre-operative plans, we observed a mean improvement of 7.06° (p < 0.001) in pitch and 2.94° (p < 0.001) in roll, comparing PSI and the standard manual technique. Conclusion. In an experimental study, computer-assisted planning and PSIs improved accuracy in pelvic tumour resections, bringing osteotomy results closer to the parameters set in pre-operative planning, as compared with standard manual techniques. Cite this article: A. Sallent, M. Vicente, M. M. Reverté, A. Lopez, A. Rodríguez-Baeza, M. Pérez-Domínguez, R. Velez. How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study. Bone Joint Res 2017;6:577–583. DOI: 10.1302/2046-3758.610.BJR-2017-0094.R1

Introduction and Aims: Improved survival has motivated aggressive surgery with musculoskeletal tumors. Pelvic resection is challenging because of the constraints of adjacent vital anatomy, and the considerable impact on limb and visceral function. The aims of this study was to assess the functional, oncologic and surgical outcomes following resections of the bony pelvis. Method: Between 1996 and 2003, 49 patients underwent tumor resections of the pelvic ring. The mean age was 43 (range 15–72) years. There were 44 primary (36 bone, nine soft tissue) and five secondary tumors. Of the bone tumors, there were six osteosarcomas, five Ewings sarcomas, 12 chondrosarcomas and 13 others. Of the soft tissue tumors, nine were of neural origin. Tumor locations included the ilium, periacetabulum, pubic bones, sacrum or combinations of these. Neoadjuvant chemotherapy (seven patients) and pre-operative radiotherapy (eight patients) were also used. Function was assessed using the American Musculoskeletal Tumor Society Functional scoring system. No patient had metastases at presentation. Results: Surgery – There were 40 limb sparing resections and nine hindquarter amputations. The surgical margins were intralesional (four), marginal (12), wide (28) and radical (five). Of the limb sparing surgery, prosthetic reconstructions were used in nine patients, biologic reconstructions in seven patients a combination of biologic and prosthetic reconstructions in three cases and no reconstructions in the others. The mean operating time was five (range 1.5–10) hours. The mean intra-operative blood loss was 10 (range 2–26) units. The average length of stay was 22 (range 2–110) days. Fifty percent of patients developed acute complications. Survival – There was one intra-operative death. There were nine local recurrences and 16 metastases. Death from disease occurred at a mean time of 13 (range 1–51) months. Mean follow-up was 28 (range 1–90) months. Functional assessment – Hind quarter amputation and periacetabular resections had the worse functional outcome. These accounted for almost 40% of all cases. Surprisingly, patients with periacetabular resections had the best score for emotional acceptance. Conclusion: Pelvic resections are complex, demanding and accompanied by a high complication rate. Surgery significantly affects functional outcome. Disease control is similar to limb tumors and medium to long-term survival is possible. Emotional acceptance of surgery in survivors was surprisingly high. Major pelvic resection for malignancy appears justifiable

Background. In certain clinical situations, complex local anatomy and limitations of surgical exposure can make adequate and bone tumor ablation, resection and reconstruction very challenging. We wished to review our clinical experience and accuracy achieved with entirely virtually planned single stage tumor ablation/resection and reconstructions. Methods. We report 6 cases of bone tumors in which tumor removal (by radio-frequency (RF) ablation and/or resection) and subsequent reconstruction were based entirely on pre-operative virtual analysis and planning. All interventions were accomplished with specifically designed and pre-operatively manufactured 3D-printed drill & resection guides. Immediate subsequent defect reconstruction was either performed with a precisely matching allograft (n=1) or composite metal implant (n=5) consisting of a defect specific titanium scaffold and multiple integrated fixation features to provide optimal immediate stability as well as subsequent opportunity for osseointegration. We reviewed the sequence of all procedural steps as well as the accuracy of each saw blade or drill trajectory by direct intra-operative measurement, post-operative margin status and virtual comparison of pre- and post-operative CT scans. Results. Intra-operative application/assembly of the resection guides could be accomplished with relative ease in all cases, permitting quick and efficient reproduction of the planned osteotomies as well as RF-probe trajectories with a high degree of accuracy. Histologically all resection margins were negative as planned except in one case where one pelvic resection was extended due to intraoperative concern of possible local tumor progression. All implants could be placed as planned, with post-operative imaging demonstrating satisfactory implant position. Virtual analysis of post-operative CT scans confirmeded minimal deviation of final implant position from the pre-operative plan. Conclusion. Reliable, accurate placement of tumor biopsy/ablation tracts and resection planes and their optimal alignment with respect to critical structures, tumor extent and desired preservation of unaffected bone is the most challenging and time consuming step during the analysis and planning phase. However it is also the crucial step with regard to subsequent design and production of clinically and oncologically meaningful case-specific drill/resection guides and implants. If these prerequisites are met, computer assisted virtual planning along with 3Dprinting-technology can afford high intraoperative accuracy, contribute to increased intra-operative surgeon confidence and decreased operative time

Aims

Ilium is the most common site of pelvic Ewing’s sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients’ outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft.

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

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

Aim. To identify factors leading to the success or failure of extracorporeal irradiation and re-implantation of bone (ECIR). Method. Review of experience of this technique since 1996 documenting successes and failures. Results. 35 patients with a variety of malignant bone tumours underwent ECIR from 1996 up to 2007. The most common diagnosis was Ewings' sarcoma (15) followed by osteosarcoma (9) and chondrosarcoma (5) with the most common sites being the pelvis (15) followed by the tibia (10) and humerus (3). The age range was from 7 to 66 and 8 were skeletally immature at the time of surgery. The bones were sterilised with a dose of 90Gy before reimplantation. The overall patient survival was 69% at 5 years and 62% at 10 years. Local recurrence arose in 4 cases, 3 of whom already had metastatic disease. None of the LR arose in the irradiated bone. The rate of non union was 9% at the 58 osteotomies, the greatest risk being in the tibia. There were four graft fractures of which 3 needed fixation and all united. There is one case of convincing graft resorbtion after 12 years. Two patients developed infections but there have been none since the bone was routinely immersed in antibiotics whilst being irradiated. Conclusion. ECIR is a useful technique with very limited indications. In the majority of cases it works well. It appears particularly useful in pelvic resections and diaphyseal resections. Distal tibial reconstructions do worst. The irradiated bone needs reinforcing with either cement or a bone graft for best results

Aim: To identify factors leading to the success or failure of extracorporeal irradiation and reimplantation of bone (ECIR). Method: Review of experience of this technique since 1996 documenting successes and failures. Results: 35 patients with a variety of malignant bone tumours underwent ECIR from 1996 up to 2007. The most common diagnosis was Ewings’ sarcoma (15) followed by osteosarcoma (9) and chondrosarcoma (5) with the most common sites being the pelvis (15) followed by the tibia (10) and humerus (3). The age range was from 7 to 66 and 8 were skeletally immature at the time of surgery. The bones were sterilised with a dose of 90Gy before reimplantation. The overall patient survival was 69% at 5 years and 62% at 10 years. Local recurrence arose in 4 cases, 3 of whom already had metastatic disease. None of the LR arose in the irradiated bone. The rate of non union was 9% at the 58 osteotomies, the greatest risk being in the tibia. There were four graft fractures of which 3 needed fixation and all united. There is one case of convincing graft resorbtion after 12 years. Two patients developed infections but there have been none since the done was routinely immersed in antibiotics whilst being irradiated. Conclusion: ECIR is a useful technique with very limited indications. In the majority of cases it works well. It appears particularly useful in pelvic resections and diaphyseal resections. Distal tibial reconstructions do worst. The irradiated bone needs reinforcing with either cement or a bone graft for best results

Purpose. Durable fixation may be difficult to achieve when significant bone loss is present, as it occurs in pelvic sarcoma resection and revision surgery of tumor implants. Purpose of this study was to review clinical results of primary and revision surgery of the pelvis and lower extremity in the setting of severe bone loss following limb salvage procedures for bone sarcoma using modular porous tantalum implants. Method. Retrospective study of 15 patients (nine females, six males) undergoing primary or revision pelvic reconstruction (five patients) or revision surgery of a tumor implant of the hip (five patients), knee (four patients), and ankle (one patient) using porous tantalum implants was undertaken. Reason for the tumor implant was resection of bone sarcoma in 13 cases and tumor-like massive bone loss in the remaining two cases. Cause for revision was aseptic failure (nine patients) or deep infection (six patients); average age at the time of surgery was 31 years (16–61 yrs). Revision was managed in a staged fashion in all the six infected cases. All patients presented severe combined segmental and cavitary bone defects. Bone loss was managed in all patients using porous tantalum implants as augmentation of residual bone stock and associated with a megaprosthesis in eight cases (five proximal femur, two distal femur, one proximal tibia). Average follow-up was 4.5 years for hip/knee implants and 2.5 yrs for pelvic reconstructions (range 1–6.8 yrs). Minimum follow-up of two years was available in 11 cases. Results. Infection recurred in one of the six cases managed for infection, requiring further treatment but allowing retention of the porous tantalum implant. All the patients showed well-fixed and functioning implants at latest follow-up. Conclusion. Porous tantalum has been very successful at early follow-up in patients with severe bone loss following primary and revision tumor-related surgery of the pelvis and lower extremity. Longer follow-up is required to appreciate long-term shortcomings

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

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