ALLOGENEIC BONE TRANSPLANTATION FOR PELVIC RECONSTRUCTION OF LARGE SKELETAL DEFECTS AFTER TUMOR RESECTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGWei ¹ ,  WANGYan ¹ , BIWenzhi ¹ , YANGJing ² , HANGang ¹ , JIAJinpeng ¹ , XUMeng ¹ , LIUGuiqi ¹

1. Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. Department of Anesthesiology, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

WANGYan, Email: yanwang301@yahoo.com

Keywords：

Pelvic tumor; Allogeneic bone transplantation; Pelvic repair and reconstruction

DOI：

10.7507/1002-1892.20140074

Video：

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Objective To investigate the short-term effectiveness of allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection. Methods Between January 2008 and November 2009, 9 patients with pelvic tumor were treated, and the clinical data were retrospectively analyzed. There were 1 male and 8 females with an average age of 36.1 years (range, 18-44 years). There were 5 cases of giant cell tumor of bone, 2 cases of chondrosarcoma, 1 case of malignant giant cell tumor of bone, and 1 case of Ewing sarcoma. According to the Enneking system for staging musculoskeletal tumors, the lesion involved ilium (region I) in 4 cases, acetabulum (region II) in 6 cases, pubis and ischium (region III) in 3 cases, and sacrum (region IV) in 1 case. The average disease duration was 6.8 months (range, 1-36 months). After accurate resection of the tumor, allograft ilium with or without acetabulum was used in 6 cases and 2 cases respectively, and allogenous bone plate in 1 case for pelvic reconstruction; total hip arthroplasty was performed in 6 cases; sacrum screw was used in 1 case. Results Infection of incision and abdominal distention occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other cases, without infection, lower limb deep venous thrombosis, or dislocation. The average follow-up was 11.8 months (range, 8-15 months). The X-ray films showed breakage of plate in 1 case at 8 months after operation and partial bone resorption in 2 cases; good position of the prosthesis, plate, and transplanted bone was observed in the other cases. No local recurrence was found. At last follow-up, the average musculoskeletal tumor score (MSTS) was 23 (range, 18-29). Conclusion Allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection can achieve satisfactory short-term surgical and functional effectiveness.

Citation： WANGWei, WANGYan, BIWenzhi, YANGJing, HANGang, JIAJinpeng, XUMeng, LIUGuiqi. ALLOGENEIC BONE TRANSPLANTATION FOR PELVIC RECONSTRUCTION OF LARGE SKELETAL DEFECTS AFTER TUMOR RESECTION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 331-334. doi: 10.7507/1002-1892.20140074 Copy

1.	Enneking WF. Local resection of malignant lesions of the hip and pelvis. Clin Orthop Relat Res, 2002, (397):3-11.
2.	Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasm involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6):731-746.
3.	Erikson U, Hjelmstedt A. Limb-saving radical resection of chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1976, 58(4):568-570.
4.	Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1978, 60(6):719-730.
5.	Bell RS, Davis AM, Wunder JS, et al. Allograft reconstruction of the acetabulum after resection of stage-IIB sarcoma. Intermediate-term results. J Bone Joint Surg (Am), 1997, 79(11):1663-1674.
6.	Langlais F, Lambotte JC, Thomazeau H. Long-term results of hemipelvis reconstruction with allografts. Clin Orthop Relat Res, 2001, (388):178-186.
7.	Delloye C, Banse X, Brichard B, et al. Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg (Am), 2007, 89(3):579-587.
8.	Donati D, Di Bella C, Frisoni T, et al. Alloprosthetic composite is a suitable reconstruction after periacetabular tumor resection. Clin Orthop Relat Res, 2011, 469(5):1450-1458.
9.	Satcher Jr RL, O'Donnell RJ, Johnston JO. Reconstruction of the pelvis after resection of tumors about the acetabulum. Clin Orthop Relat Res, 2003, (409):209-217.
10.	Hugate R Jr, Sim FH. Pelvic reconstruction techniques. Orthop Clin North Am, 2006, 37(1):85-97.
11.	Hoffmann C, Gosheger G, Gebert C, et al. Functional results and quality of life after treatment of pelvic sarcomas involving the acetabulum. J Bone Joint Surg (Am), 2006, 88(3):575-582.
12.	Schwameis E, Dominkus M, Krepler P, et al. Reconstruction of the pelvis after tumor resection in children and adolescents. Clin Orthop Relat Res, 2002, (402):220-235.
13.	Harrington KD. The use of hemipelvic allografts or autoclaved grafts for reconstruction after wide resections of malignant tumors of the pelvis. J Bone Joint Surg (Am), 1992, 74(3):331-341.
14.	Gebert C, Wessling M, Gosheger G, et al. Pelvic reconstruction with compound osteosynthesis following hemipelvectomy:A clinical study. Bone Joint J, 2013, 95-B(10):1410-1416.
15.	Campanacci D, Chacon S, Mondanelli N, et al. Pelvic massive allograft reconstruction after bone tumour resection. Int Orthop, 2012, 36(12):2529-2536.
16.	Han I, Lee YM, Cho HS, et al. Outcome after surgical treatment of pelvic sarcomas. Clin Orthop Surg, 2010, 2(3):160-166.
17.	Salom EM, Penalver MA. Pelvic exenteration and reconstruction. Cancer J, 2003, 9(5):415-424.
18.	Kitagawa Y, Ek ET, Choong PF. Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour. J Orthop Surg (Hong Kong), 2006, 14(2):155-162.
19.	Nazemi TM, Kobashi KC. Complications of grafts used in female pelvic floor reconstruction:Mesh erosion and extrusion. Indian J Urol, 2007, 23(2):153-160.
20.	Zeifang F, Buchner M, Zahlten-Hinguranage A, et al. Complications following operative treatment of primary malignant bone tumours in the pelvis. Eur J Surg Oncol, 2004, 30(8):893-899.
21.	Ozaki T, Hillmann A, Bettin D, et al. High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand, 1996, 67(4):333-338.
22.	Ozaki T, Hoffmann C, Hillmann A, et al. Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res, 2002, (396):197-205.
23.	Gebert C, Wessling M, Hoffmann C, et al. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol, 2011, 103(3):269-275.

1. Enneking WF. Local resection of malignant lesions of the hip and pelvis. Clin Orthop Relat Res, 2002, (397):3-11.
2. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasm involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6):731-746.
3. Erikson U, Hjelmstedt A. Limb-saving radical resection of chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1976, 58(4):568-570.
4. Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1978, 60(6):719-730.
5. Bell RS, Davis AM, Wunder JS, et al. Allograft reconstruction of the acetabulum after resection of stage-IIB sarcoma. Intermediate-term results. J Bone Joint Surg (Am), 1997, 79(11):1663-1674.
6. Langlais F, Lambotte JC, Thomazeau H. Long-term results of hemipelvis reconstruction with allografts. Clin Orthop Relat Res, 2001, (388):178-186.
7. Delloye C, Banse X, Brichard B, et al. Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg (Am), 2007, 89(3):579-587.
8. Donati D, Di Bella C, Frisoni T, et al. Alloprosthetic composite is a suitable reconstruction after periacetabular tumor resection. Clin Orthop Relat Res, 2011, 469(5):1450-1458.
9. Satcher Jr RL, O'Donnell RJ, Johnston JO. Reconstruction of the pelvis after resection of tumors about the acetabulum. Clin Orthop Relat Res, 2003, (409):209-217.
10. Hugate R Jr, Sim FH. Pelvic reconstruction techniques. Orthop Clin North Am, 2006, 37(1):85-97.
11. Hoffmann C, Gosheger G, Gebert C, et al. Functional results and quality of life after treatment of pelvic sarcomas involving the acetabulum. J Bone Joint Surg (Am), 2006, 88(3):575-582.
12. Schwameis E, Dominkus M, Krepler P, et al. Reconstruction of the pelvis after tumor resection in children and adolescents. Clin Orthop Relat Res, 2002, (402):220-235.
13. Harrington KD. The use of hemipelvic allografts or autoclaved grafts for reconstruction after wide resections of malignant tumors of the pelvis. J Bone Joint Surg (Am), 1992, 74(3):331-341.
14. Gebert C, Wessling M, Gosheger G, et al. Pelvic reconstruction with compound osteosynthesis following hemipelvectomy:A clinical study. Bone Joint J, 2013, 95-B(10):1410-1416.
15. Campanacci D, Chacon S, Mondanelli N, et al. Pelvic massive allograft reconstruction after bone tumour resection. Int Orthop, 2012, 36(12):2529-2536.
16. Han I, Lee YM, Cho HS, et al. Outcome after surgical treatment of pelvic sarcomas. Clin Orthop Surg, 2010, 2(3):160-166.
17. Salom EM, Penalver MA. Pelvic exenteration and reconstruction. Cancer J, 2003, 9(5):415-424.
18. Kitagawa Y, Ek ET, Choong PF. Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour. J Orthop Surg (Hong Kong), 2006, 14(2):155-162.
19. Nazemi TM, Kobashi KC. Complications of grafts used in female pelvic floor reconstruction:Mesh erosion and extrusion. Indian J Urol, 2007, 23(2):153-160.
20. Zeifang F, Buchner M, Zahlten-Hinguranage A, et al. Complications following operative treatment of primary malignant bone tumours in the pelvis. Eur J Surg Oncol, 2004, 30(8):893-899.
21. Ozaki T, Hillmann A, Bettin D, et al. High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand, 1996, 67(4):333-338.
22. Ozaki T, Hoffmann C, Hillmann A, et al. Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res, 2002, (396):197-205.
23. Gebert C, Wessling M, Hoffmann C, et al. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol, 2011, 103(3):269-275.

Chinese Journal of Reparative and Reconstructive Surgery

ALLOGENEIC BONE TRANSPLANTATION FOR PELVIC RECONSTRUCTION OF LARGE SKELETAL DEFECTS AFTER TUMOR RESECTION

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