Periacetabular Resection for Bone Tumors: Is There Still a Role for Massive Allograft-prosthesis Composite...

Area of Science:

• Orthopedic oncology
• Reconstructive surgery
• Bone tumor treatment

Background:

• Allograft-prosthesis composite reconstruction offers bony union and preserves bone stock for revisions after periacetabular resections.
• Endoprosthetic reconstruction is common for periacetabular defects but compromises bone stock and has long manufacturing times.
• Few long-term results exist for allograft-prosthesis composite reconstruction in the pelvis following periacetabular resections for bone tumors.

Purpose of the Study:

• To determine the cumulative incidence of complications following allograft-prosthesis composite reconstruction for periacetabular tumors.
• To evaluate functional outcomes using the Musculoskeletal Tumor Society (MSTS) score at a minimum of 2 years post-surgery.
• To assess the 15-year survivorship of these reconstructions, free from revision or graft removal.

Main Methods:

• A retrospective study of 51 patients undergoing periacetabular resection and allograft-prosthesis composite reconstruction for pelvic bone tumors between 1994 and 2023.
• Analysis included 96% of patients with a minimum 24-month follow-up or earlier complications.
• Competing-risk methods were used to estimate cumulative incidence of major complications and graft removal; functional outcomes assessed via MSTS scores.

Main Results:

• The cumulative incidence of major complications reached 33% by 15 years post-reconstruction.
• The mean Musculoskeletal Tumor Society (MSTS) score was 23 ± 5, assessed approximately 10 years after surgery.
• The cumulative incidence of graft removal was 12% at 15 years.

Conclusions:

• Allograft-prosthesis composite reconstruction is an effective option for periacetabular resection, even with advancements in 3D-printed implants.
• This technique remains valuable for patients with long life expectancy, particularly when chemotherapy/radiotherapy are not primary treatments and the iliac wing is preserved.
• Further comparative studies are needed to evaluate allograft-prosthesis composites against other reconstructive methods like custom endoprostheses and recycled autografts.