Kantonsspital St.Gallen
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Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours

Boris Michael Holzapfel, Hakan Pilge, Peter Michael Prodinger, Andreas Toepfer, Susanne Mayer-Wagner, Dietmar Werner Hutmacher, Ruediger Von Eisenhart-Rothe, Maximilian Rudert, Reiner Gradinger & Hans Rechl

abstract

PURPOSE
We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect.

METHODS
From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1-22.5, standard deviation ± 5.3). Kaplan-Meier analysis was used to estimate survival rates.

RESULTS
Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %).

CONCLUSION
The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes.
   
citation Holzapfel B M, Pilge H, Prodinger P M, Toepfer A, Mayer-Wagner S, Hutmacher D W, von Eisenhart-Rothe R, Rudert M, Gradinger R, Rechl H. Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours. Int Orthop 2014; 38:1435-42.
   
type journal paper/review (English)
date of publishing 7-2014
journal title Int Orthop (38/7)
ISSN electronic 1432-5195
pages 1435-42
PubMed 24658873
DOI 10.1007/s00264-014-2314-1