Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint

With the development of surgical techniques and improvements in hemi-pelvic prosthesis systems, extra-articular resection can be performed as a limb-salvage procedure in selected patients whose hip joint is invaded by a sarcoma. The aim of this study was to describe the indications for and the technical details, post-operative complications, and oncologic and functional outcomes of this procedure.

Eighteen patients with Enneking IIB or IB sarcoma who underwent extra-articular resection of the hip joint were enrolled. A modular pelvic endoprosthesis combined with a femoral endoprosthesis was used to reconstruct the bone and joint defect. Pathological diagnoses included osteosarcoma (7 patients), chondrosarcoma (7), undifferentiated high-grade pleomorphic sarcoma (3), and malignant peripheral nerve-sheath tumour (1).

Wide, marginal and intralesional surgical margin was achieved in 13, four and one patients, respectively. There was one peri-operative death and the other 17 patients were followed up for 35.0 months (range, 10-75 months). Three patients had early-stage dislocations. One had a traumatic dislocation three years later. Two patients had wound complications. The average MSTS 93 score was 63.5% ± 10.8%. Four patients had local recurrence. The estimated three-year disease-free survival and overall survival for the 18 patients were both 50.0%.

Although technically demanding, extra-articular resection of hip is a limb-salvage procedure that is worth considering for carefully selected patients.