Effectiveness analysis of resection and reconstruction of primary bone tumor in pelvic zone <b>Ⅱ</b>_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Junqi ¹ , CHENG Jiajia ¹ , WANG Tao ¹ , XU Meng ² , HAN Gang ² , JIA Jinpeng ² , WANG Wei ² , TU Chongqi ³ ,  BI Wenzhi ²

1. Department of Orthopedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P. R. China;
2. Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100853, P. R. China;
3. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

BI Wenzhi, Email: 13011277676@163.com

Keywords：

Pelvis; acetabulum; bone tumor; reconstruction

DOI：

10.7507/1002-1892.202211016

Video：

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Objective To investigate the effectiveness of complete resection of bone tumor in pelvic zone Ⅱ and reconstruction with allogeneic pelvis, modular prosthesis, and three-dimensional (3D) printing prosthesis. Methods The clinical data of 13 patients with primary bone tumor in pelvic zone Ⅱ who underwent tumor resection and acetabular reconstruction between March 2011 and March 2022 were retrospectively analyzed. There were 4 males and 9 females with an average age of 39.0 years ranging from 16 to 59 years. There were 4 cases of giant cell tumor, 5 cases of chondrosarcoma, 2 cases of osteosarcoma, and 2 cases of Ewing sarcoma. The Enneking classification of pelvic tumors showed that 4 cases involved zone Ⅱ, 4 cases involved zone Ⅰ and zone Ⅱ, and 5 cases involved zone Ⅱ and zone Ⅲ. The disease duration ranged from 1 to 24 months, with an average of 9.5 months. The patients were followed up to observe the recurrence and metastasis of the tumor, and the imaging examination was performed to observe the status of implant in place, fracture, bone resorption, bone nonunion, and so on. The improvement of hip pain was evaluated by visual analogue scale (VAS) score before operation and at 1 week after operation, and the recovery of hip function was evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system after operation. Results The operation time was 4-7 hours, with an average of 4.6 hours; the intraoperative blood loss ranged from 800 to 1 600 mL, with an average of 1 200.0 mL. There was no reoperation or death after operation. All patients were followed up 9-60 months (mean, 33.5 months). No tumor metastasis was found in 4 patients receiving chemotherapy during follow-up. Postoperative wound infection occurred in 1 case, and prosthesis dislocation occurred in 1 case at 1 month after prosthesis replacement. One case of giant cell tumor recurred at 12 months after operation, and the puncture biopsy showed malignant transformation of giant cell tumor, and hemipelvic amputation was performed. The postoperative hip pain significantly relieved, and the VAS score was 6.1±0.9 at 1 week after operation, which was significantly different from the preoperative score (8.2±1.3) (t=9.699, P<0.001). At 12 months after operation, the MSTS score was 23.0±2.1, including 22.8±2.1 for patients with allogenic pelvis reconstruction and 23.3±2.3 for patients with prosthsis reconstruction. There was no significant difference in the MSTS score between the two reconstruction methods (t=0.450, P=0.516). At last follow-up, 5 patients could walk with cane assistance and 7 patients could walk without cane assistance. Conclusion The resection and reconstruction of primary bone tumor in pelvic zone Ⅱ can obtain satisfactory hip function, and the interface of allogeneic pelvis and 3D printing prosthesis have better bone ingrowth, which is more in line with the requirements of biomechanics and biological reconstruction. However, pelvis reconstruction is difficult, the patient’s condition should be evaluated comprehensively before operation, and the long-term effectiveness needs further follow-up.

Citation： HUANG Junqi, CHENG Jiajia, WANG Tao, XU Meng, HAN Gang, JIA Jinpeng, WANG Wei, TU Chongqi, BI Wenzhi. Effectiveness analysis of resection and reconstruction of primary bone tumor in pelvic zone Ⅱ. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 277-283. doi: 10.7507/1002-1892.202211016 Copy

1.	Hipfl C, Stihsen C, Puchner SE, et al. Pelvic reconstruction following resection of malignant bone tumours using a stemmed acetabular pedestal cup. Bone Joint J, 2017, 99-B(6): 841-848.
2.	Fujiwara T, Tsuda Y, Evans S, et al. Extra-articular resection for bone sarcomas involving the hip joint. J Surg Oncol, 2020, 121(2): 258-266.
3.	Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
4.	Sun W, Zan P, Ma X, et al. Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. BMC Cancer, 2019, 19(1): 969. doi: 10.1186/s12885-019-6196-x.
5.	Takami M, Ieguchi M, Aono M, et al. Flail hip joint following periacetabular tumor resection of the pelvis using upper surface of the femoral neck as a saddle: A case report. Oncol Lett, 2015, 10(6): 3529-3531.
6.	Baimagambetov SA, Balgazarov SS, Ramazanov ZK, et al. Paraprosthetic complications after endoprosthesis replacement of pelvis joint with implants. J Natl Med Assoc, 2018, 110(3): 231-241.
7.	Tang X, Guo W, Yang R, et al. Acetabular reconstruction with femoral head autograft after intraarticular resection of periacetabular tumors is durable at short-term followup. Clin Orthop Relat Res, 2017, 475(12): 3060-3070.
8.	Brown TS, Salib CG, Rose PS, et al. Reconstruction of the hip after resection of periacetabular oncological lesions: a systematic review. Bone Joint J, 2018, 100-B(1 Supple A): 22-30.
9.	Park JW, Kang HG, Kim JH, et al. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci, 2021, 26(2): 276-283.
10.	Zoccali C, Baldi J, Attala D, et al. 3D-printed titanium custom-made prostheses in reconstruction after pelvic tumor resection: Indications and results in a series of 14 patients at 42 months of average follow-up. J Clin Med, 2021, 10(16): 3539. doi: 10.3390/jcm10163539.
11.	Biscaccianti V, Fragnaud H, Hascoët JY, et al. Digital chain for pelvic tumor resection with 3D-printed surgical cutting guides. Front Bioeng Biotechnol, 2022, 10: 991676. doi: 10.3389/fbioe.2022.991676.
12.	Ji T, Guo W, Yang RL, et al. Clinical outcome and quality of life after surgery for peri-acetabular metastases. J Bone Joint Surg (Br), 2011, 93(8): 1104-1110.
13.	Barrientos-Ruiz I, Ortiz-Cruz EJ, Peleteiro-Pensado M. Reconstruction after hemipelvectomy with the ice-cream cone prosthesis: What are the short-term clinical results? Clin Orthop Relat Res, 2017, 475(3): 735-741.
14.	Thaunat M, Clowez G, Desseaux A, et al. Influence of muscle fatty degeneration on functional outcomes after endoscopic gluteus medius repair. Arthroscopy, 2018, 34(6): 1816-1824.
15.	闵理, 李隆卿, 虎鑫, 等. 改良Gibson和髂腹股沟联合入路在3D打印半骨盆假体置换术治疗EnnekingⅡ+Ⅲ区骨盆恶性肿瘤中的应用研究. 中国修复重建外科杂志, 2022, 36(7): 796-803.
16.	Xu S, Guo Z, Shen Q, et al. Reconstruction of tumor-induced pelvic defects with customized, three-dimensional printed prostheses. Front Oncol, 2022, 12: 935059. doi: 10.3389/fonc.2022.935059.
17.	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.
18.	Jansen JA, van de Sande MA, Dijkstra PD. Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors. Clin Orthop Relat Res, 2013, 471(1): 324-331.
19.	Guo X, Li X, Liu T, et al. Pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours. World J Surg Oncol, 2017, 15(1): 13. doi: 10.1186/s12957-016-1065-4.
20.	Angelini A, Drago G, Trovarelli G, et al. Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution. Clin Orthop Relat Res, 2014, 472(1): 349-359.
21.	Fujiwara T, Ogura K, Christ A, et al. Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas. J Bone Oncol, 2021, 31: 100396. doi: 10.1016/j.jbo.2021.100396.
22.	Xu L, Qin H, Tan J, et al. Clinical study of 3D printed personalized prosthesis in the treatment of bone defect after pelvic tumor resection. J Orthop Translat, 2021, 29: 163-169.
23.	Lu M, Wang J, Tang F, et al. A three-dimensional printed porous implant combined with bone grafting following curettage of a subchondral giant cell tumour of the proximal tibia: a case report. BMC Surg, 2019, 19(1): 29. doi: 10.1186/s12893-019-0491-y.
24.	García-Sevilla M, Moreta-Martinez R, García-Mato D, et al. Augmented reality as a tool to guide PSI placement in pelvic tumor resections. Sensors (Basel), 2021, 21(23): 7824. doi: 10.3390/s21237824.

1. Hipfl C, Stihsen C, Puchner SE, et al. Pelvic reconstruction following resection of malignant bone tumours using a stemmed acetabular pedestal cup. Bone Joint J, 2017, 99-B(6): 841-848.
2. Fujiwara T, Tsuda Y, Evans S, et al. Extra-articular resection for bone sarcomas involving the hip joint. J Surg Oncol, 2020, 121(2): 258-266.
3. Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
4. Sun W, Zan P, Ma X, et al. Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. BMC Cancer, 2019, 19(1): 969. doi: 10.1186/s12885-019-6196-x.
5. Takami M, Ieguchi M, Aono M, et al. Flail hip joint following periacetabular tumor resection of the pelvis using upper surface of the femoral neck as a saddle: A case report. Oncol Lett, 2015, 10(6): 3529-3531.
6. Baimagambetov SA, Balgazarov SS, Ramazanov ZK, et al. Paraprosthetic complications after endoprosthesis replacement of pelvis joint with implants. J Natl Med Assoc, 2018, 110(3): 231-241.
7. Tang X, Guo W, Yang R, et al. Acetabular reconstruction with femoral head autograft after intraarticular resection of periacetabular tumors is durable at short-term followup. Clin Orthop Relat Res, 2017, 475(12): 3060-3070.
8. Brown TS, Salib CG, Rose PS, et al. Reconstruction of the hip after resection of periacetabular oncological lesions: a systematic review. Bone Joint J, 2018, 100-B(1 Supple A): 22-30.
9. Park JW, Kang HG, Kim JH, et al. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci, 2021, 26(2): 276-283.
10. Zoccali C, Baldi J, Attala D, et al. 3D-printed titanium custom-made prostheses in reconstruction after pelvic tumor resection: Indications and results in a series of 14 patients at 42 months of average follow-up. J Clin Med, 2021, 10(16): 3539. doi: 10.3390/jcm10163539.
11. Biscaccianti V, Fragnaud H, Hascoët JY, et al. Digital chain for pelvic tumor resection with 3D-printed surgical cutting guides. Front Bioeng Biotechnol, 2022, 10: 991676. doi: 10.3389/fbioe.2022.991676.
12. Ji T, Guo W, Yang RL, et al. Clinical outcome and quality of life after surgery for peri-acetabular metastases. J Bone Joint Surg (Br), 2011, 93(8): 1104-1110.
13. Barrientos-Ruiz I, Ortiz-Cruz EJ, Peleteiro-Pensado M. Reconstruction after hemipelvectomy with the ice-cream cone prosthesis: What are the short-term clinical results? Clin Orthop Relat Res, 2017, 475(3): 735-741.
14. Thaunat M, Clowez G, Desseaux A, et al. Influence of muscle fatty degeneration on functional outcomes after endoscopic gluteus medius repair. Arthroscopy, 2018, 34(6): 1816-1824.
15. 闵理, 李隆卿, 虎鑫, 等. 改良Gibson和髂腹股沟联合入路在3D打印半骨盆假体置换术治疗EnnekingⅡ+Ⅲ区骨盆恶性肿瘤中的应用研究. 中国修复重建外科杂志, 2022, 36(7): 796-803.
16. Xu S, Guo Z, Shen Q, et al. Reconstruction of tumor-induced pelvic defects with customized, three-dimensional printed prostheses. Front Oncol, 2022, 12: 935059. doi: 10.3389/fonc.2022.935059.
17. 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.
18. Jansen JA, van de Sande MA, Dijkstra PD. Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors. Clin Orthop Relat Res, 2013, 471(1): 324-331.
19. Guo X, Li X, Liu T, et al. Pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours. World J Surg Oncol, 2017, 15(1): 13. doi: 10.1186/s12957-016-1065-4.
20. Angelini A, Drago G, Trovarelli G, et al. Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution. Clin Orthop Relat Res, 2014, 472(1): 349-359.
21. Fujiwara T, Ogura K, Christ A, et al. Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas. J Bone Oncol, 2021, 31: 100396. doi: 10.1016/j.jbo.2021.100396.
22. Xu L, Qin H, Tan J, et al. Clinical study of 3D printed personalized prosthesis in the treatment of bone defect after pelvic tumor resection. J Orthop Translat, 2021, 29: 163-169.
23. Lu M, Wang J, Tang F, et al. A three-dimensional printed porous implant combined with bone grafting following curettage of a subchondral giant cell tumour of the proximal tibia: a case report. BMC Surg, 2019, 19(1): 29. doi: 10.1186/s12893-019-0491-y.
24. García-Sevilla M, Moreta-Martinez R, García-Mato D, et al. Augmented reality as a tool to guide PSI placement in pelvic tumor resections. Sensors (Basel), 2021, 21(23): 7824. doi: 10.3390/s21237824.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of resection and reconstruction of primary bone tumor in pelvic zone Ⅱ

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