Acetabular reconstruction after pelvic tumor resection: are biological methods justified?

Acetabular reconstruction after pelvic tumor resection represents one of the most demanding challenges in orthopedic oncology. While non-biological methods are widely applied, their long-term durability and complication profiles remain concerning. Biological reconstruction using recycled bone offers the potential for durable and stable outcomes, though its role in the acetabulum remains debated. This study aimed to evaluate the radiological, functional, and oncological outcomes of biological acetabular reconstruction and to analyze associated complications in a single-center cohort.

We retrospectively reviewed 14 consecutive patients (mean age, 20 years; range, 5-61 years) who underwent biological acetabular reconstruction following pelvic tumor resections between 2000 and 2022. Reconstruction methods included liquid nitrogen-treated autografts, vascularized or non-vascularized autografts, and cement augmentation. Radiological outcomes were assessed using the ISOLS system, functional outcomes with the MSTS and Harris Hip Score (HHS), and oncological status according to the ISOLS criteria. Complications were systematically analyzed.

The mean follow-up was 64 months (range, 24-148). The mean MSTS score was 74%, and mean HHS was 81.9, with no significant differences between partial and total acetabular resections. The mean ISOLS radiographic score was 20.6. No local recurrences occurred, while three patients developed distant metastases. Major complications included coxo-femoral arthrosis (42%) and avascular necrosis (43%). Only one case required conversion to non-biological reconstruction. Graft retrieval was necessary in one case due to infection.

Biological acetabular reconstruction is feasible and provides durable functional and oncological outcomes, with manageable complication rates. Establishing a stable biological foundation simplifies complication management and preserves the possibility of future revisions. This strategy should be considered a reliable reconstructive option, particularly in young patients requiring long-term solutions.