Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation

Reconstruction after the resection of pelvic tumors is a major challenge. It depends on many factors such as age, activity level, type of tumor, its adjuvant treatment, and the extent of the disease. The purpose of the current study was to analyze the functional and oncologic outcomes of patients who had an iliofemoral arthrodesis after resection of a pelvic sarcoma. Between 1981 and 1999, 20 males and 12 females with a mean age of 39.9 years (range, 10-71 years) had an iliofemoral arthrodesis, either as a solid fusion or primary pseudarthrosis, at one institution. The functional outcome was evaluated using the Musculoskeletal Tumor Society and the Toronto Extremity Salvage scores. At a mean followup of 97 months (range, 14-226 months), 15 of 32 patients were alive, all without disease. The radiographic union rate was 86%. The mean overall Musculoskeletal Tumor Society and Toronto Extremity Salvage scores were 64% and 48%, respectively. Patients with a primary solid fusion did functionally better compared with patients who had pseudarthrosis (Toronto Extremity Salvage Score, 76%; Musculoskeletal Tumor Society Score, 71% versus Toronto Extremity Salvage Score, 52%; Musculoskeletal Tumor Society Score, 25%). Biomechanical analysis showed that the loss of motion in the hip is well-compensated. The authors conclude from this series that iliofemoral reconstruction after resection of a pelvic sarcoma provides acceptable and durable long-term results, not only from the oncologic, but also from the functional perspective.