Long-term results of hemipelvis reconstruction with allografts

Thirteen patients underwent pelvic reconstruction by massive allografts after resection of a malignant tumor (primary in 10 patients and metastatic in three patients). In 10 patients, the tumor involved the acetabulum and iliac wing and was reconstructed by a hemipelvic allograft; this was accompanied by a hip arthroplasty in nine of the patients. In three patients, a femoral metaphyseal tumor extending to the acetabulum was reconstructed by a total acetabular allograft and a composite proximal femoral allograft prosthesis. Two patients (20%) had a local recurrence, and one patient died of massive pulmonary embolism. Postoperative complications were one infection and two dislocations. At 3 years, one cup loosening and one acetabular fatigue fracture required surgery. The functional result was excellent in two patients whose gluteal muscles could be spared, good (allowing a normal family life) in six patients, fair in two patients, and poor in two patients. Seven patients had a Musculoskeletal Tumor Society rating greater than 60% of normal (the mean rating in 12 patients was 56.4%). No evidence of long-term deterioration was seen in the patients with the longest followups (7, 8, 10, and 14 years). Reconstruction of the hemipelvis with massive allografts and arthroplasty is a rewarding but demanding procedure and should be reserved for physically active patients who are in good general health and are expected to have a response to anticancer therapy. The procedure is particularly suitable for patients with primary tumors.