Pelvic massive allograft reconstruction after bone tumour resection

Purpose

The purpose of this report was to retrospectively review a series treated with pelvic tumour resection and massive allograft reconstruction, and determine survival of patients and implants, functional results and morbidity of surgical technique.

Methods

From 1999, 33 patients underwent pelvic tumour resection and massive allograft reconstruction. The mean age was 40 years (range, 14–72) and 29 patients had a primary malignant tumour. The resection involved the acetabular area in all but three patients.

Results

At a median follow-up of 33 months (range, two–143) four patients had local recurrence. The morbidity was high: five deep infections (15 %), requiring two allograft removal, six hip dislocations (18 %), eight sciatic nerve palsy (24 %), persistent in six cases, and two loosening of the acetabular component. Implant survival was 87.3 % at last follow up. The cumulative overall patient’s survival was 41.5 % at five and ten years. The average MSTS functional score was 70 % (range, 54–100 %) when the acetabulum was preserved while it was 61 % (30–100 %) in patients with acetabular resection.

Conclusion

In conclusion, pelvic allografts represent a valid option for reconstruction after resection of pelvic tumours but due to the associated morbidity, patients should be carefully selected.     

Pelvic tilt compensates for increased acetabular anteversion

Purpose

Pelvic tilt determines functional orientation of the acetabulum. In this study, we investigated the interaction of pelvic tilt and functional acetabular anteversion (AA) in supine position.

Methods

Pelvic tilt and AA of 138 individuals were measured by computed tomography (CT). AA was calculated in relation to the anterior pelvic plane (APP) and relative to the table plane. We analysed these parameters for gender-specific and age-related differences.

Results

The mean pelvic tilt was -0.1?±?5.5°. Pelvic sagittal rotation displayed no gender nor age related differences. Females showed higher angles of AA compared with males (20.0° vs 17.2°, p?<?0.001; AA relative to the APP). Anterior tilting of the pelvis positively correlated with AA and individuals with high AA had a higher anterior pelvic tilt compared with those with low AA (p?<?0.0001; AA relative to the APP).

Conclusions

AA has to be calculated regarding pelvic sagittal rotation for correct acetabular orientation. Pelvic tilt is dependent on acetabular orientation and compensates for increased AA.

     

Guest editorial - Pelvic osteotomy for acetabular dysplasia

No Abstract available.     

Guest editorial - Pelvic osteotomy for acetabular dysplasia

No Abstract available.     

Complex acetabular reconstruction for metastatic tumor

Twenty-six hips were reconstructed in 25 patients with periacetabular metastatic lesions. Twelve hip reconstructions were performed using a modified Harrington technique with polymethyl methacrylate, cancellous screws, and reinforcement rings (type I). Fourteen hip reconstructions were performed using bulk bone—graft and reinforcement rings (type II). According to the Musculoskeletal Tumor Society functional rating score, there was no appreciable difference between the two types of reconstructions. Either technique can give satisfactory results depending on the anatomic location and extent of bone loss. Careful patient selection is the prime determinant of a successful outcome.     

Cementless acetabular reconstruction after acetabular fracture.

BACKGROUND: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture. METHODS: Thirty total hip arthroplasties were performed with use of a cementless hemispheric, fiber-metal-mesh-coated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture. The median interval between the fracture and the arthroplasty was thirty-seven months (range, eight to 444 months). The average age at the time of the arthroplasty was fifty-one years (range, twenty-six to eighty-six years), and the average duration of follow-up was sixty-three months (range, twenty-four to 140 months). Fifteen patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and fifteen patients had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis. RESULTS: Operative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis. Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods. Eight of the fifteen patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the fifteen patients who had been treated by closed means (p = 0.005). Two of the fifteen patients with a previous open reduction and internal fixation required bone-grafting of acetabular defects compared with seven of the fifteen patients treated by closed means (p = 0.04). The thirty patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 points at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39). Twenty-seven patients (90%) had a good or excellent result. There were no dislocations or deep infections. The Kaplan-Meier ten-year survival rate, with revision or radiographic loosening as the end point, was 97%. These results were similar to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis. CONCLUSIONS: The intermediate-term clinical results of total hip arthroplasty with cementless acetabular reconstruction for posttraumatic osteoarthritis after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especially in patients with previous open reduction and internal fixation. Previous open reduction and internal fixation predisposed the hip to more intraoperative instability but less bone deficiency.     

Pelvic and acetabular fractures in childhood

In pediatric pelvic fractures and acetabular fractures, the treating physician is confronted with a unique pattern of injuries. Throughout the literature, pediatric pelvic fractures are rare, but acetabular fractures are even rarer. The lack of experience with this type of fracture, due to their infrequency, leads to unavailability of standardized protocols for specific diagnosis and therapy. Anatomical differences and various stages of skeletal maturation between children and adults lead to different causes, patterns, and associated injuries. In this article, we review the epidemiology and pathophysiology of this entity of fractures and provide current algorithms for diagnosis and therapy. Both operative and nonoperative treatments have been advocated in the literature, and in this article we define indications for both approaches and review the current literature.     

Techniques of acetabular reconstruction

Acetabular reconstruction and revision can be a complex and demanding procedure. This article reviews the essential components of preoperative planning and surgical technique. In addition, there are several unsolved issues that will be addressed along the author's current prejudice on these issues.     

Pelvic reconstruction techniques

Partial resection of the pelvis or sacrum is an uncommon procedure, typically performed in the setting of tumors, severe infections, or trauma. The resultant defects, depending on the size and location, may cause significant postoperative morbidity or functional impairment. It is therefore essential that the surgeon be aware of all reconstructive options available and implement the most appropriate option for each individual patient. The purpose of this article is to review the functional consequences of the various pelvic resections and discuss the options available for reconstruction.     

结构性骨移植修复髋臼骨缺损研究进展

结构性骨移植是目前临床上修复髋臼严重骨缺损的主要方法之一,不仅有利于恢复缺损处解剖结构和髋关节生物力学结构,也有利于恢复髋臼骨量,为将来再翻修提供条件.早期临床研究认为移植骨移植后存在相应的并发症,故翻修假体失败率较高.近年来,随着手术技巧的不断完善、植骨适应证的严格把握、金属加强杯和骨小梁结构型金属杯等手段的应用,假体生存率和使用时间均明显提高.该文就结构性骨移植在髋臼骨缺损中的应用作一综述.     

髋臼内壁截骨术在发育不良髋关节全髋置换髋臼重建中的应用

目的探讨髋臼内壁截骨术在发育不良髋关节髋臼重建中的应用。方法2001年5月至2002年12月,采用结合髋臼内壁截骨术的全髋关节置换术治疗髋关节发育不良患者17例18髋,男1例1髋,女16例17髋,年龄35～70岁,平均51.4岁。其中CroweⅠ期4髋,Ⅱ期7髋,Ⅲ期4髋,Ⅳ期3髋。通过在手术前、后X线片上绘制Ranawat三角,对照手术前、后髋关节旋转中心与理想旋转中心的距离,测量术后臼杯穹顶与Kohler线的距离、臼杯直径等研究髋关节旋转中心重建与臼杯固定的效果。结果所有人工臼杯均安置于真臼位置,臼杯直径44～56mm,平均50.78mm。术前股骨头中心距理想旋转中心水平距离为12～40mm,平均21.09mm;术后股骨头中心距理想旋转中心水平距离为-3～10.1mm,平均3.73mm;手术前、后比较差异有统计学意义(t=7.95,P<0.01)。术前股骨头中心距理想旋转中心垂直距离为5～32mm,平均15.39mm;术后股骨头中心距理想旋转中心垂直距离为-18～26.3m m,平均4.98mm;手术前、后比较差异有统计学意义(t=3.42,P<0.01)。随访3个月以上者,截骨部位均骨性愈合。结论内壁截骨术有助于将发育不良髋关节的髋臼安置于真臼位置,保留髋臼底部的骨量,避免髋臼外上方植骨的并发症。     

Pelvic tilt makes acetabular cup navigation inaccurate

Background Modern navigation techniques allow precise positioning of the acetabular cup relative to the anterior pelvic plane. Variations in pelvic tilt will affect the resulting spatial orientation of the cup.

Methods We measured pelvic tilt in 30 volunteers with an inclinometer combined with an ultrasonographic position measurement system. A mathematical algorithm was developed to calculate the resulting cup position measured on standard radiographs, depending on pelvic tilt.

Results Average pelvic tilt at rest was -4° in the lying position and -8° in the standing position, and ranged from -27° to +3°. Pelvic reclination of 1° will lead to functional anteversion of the cup of approximately 0.7°.

Interpretation Pelvic tilt makes navigation systems referring to the anterior plane inaccurate.     

Pelvic tilt makes acetabular cup navigation inaccurate

Background Modern navigation techniques allow precise positioning of the acetabular cup relative to the anterior pelvic plane. Variations in pelvic tilt will affect the resulting spatial orientation of the cup.

Methods We measured pelvic tilt in 30 volunteers with an inclinometer combined with an ultrasonographic position measurement system. A mathematical algorithm was developed to calculate the resulting cup position measured on standard radiographs, depending on pelvic tilt.

Results Average pelvic tilt at rest was ?4° in the lying position and ?8° in the standing position, and ranged from ?27° to +3°. Pelvic reclination of 1° will lead to functional anteversion of the cup of approximately 0.7°.

Interpretation Pelvic tilt makes navigation systems referring to the anterior plane inaccurate.     

骨盆或髋臼骨折儿童与成人患者死亡率的比较

Three registry studies of pediatric versus adult patients with pelvic fractures report on the mortality rates of these patient populations.While pelvic fractures occur in the context of severe traumati...     

Midterm results of uncemented acetabular reconstruction for posttraumatic arthritis secondary to acetabular fracture

At an average of 6.3 years after surgery, we evaluated midterm results of uncemented acetabular reconstruction in 31 hips with posttraumatic arthritis that developed after acetabular fracture. Patients were categorized by previous fracture treatments (open-reduction group and conservative-treatment group) and fracture patterns (simple group and complex group). Surgery duration and blood loss were greater in the open-reduction and complex groups than in the conservative-treatment and simple groups (P < .05). The mean Harris Hip Score increased from 49 before surgery to 89 after surgery. Survival with revision or radiographic acetabular loosening as an end point was 100%. Fracture treatments and patterns were associated with increased surgery duration and increased blood loss. Open reduction and internal fixation of a fracture favor anatomical restoration of the hip's rotational center.