Periacetabular limb salvage for malignant bone tumours.
OBJECTIVE
To evaluate treatment outcomes in primary malignant periacetabular bone tumour removal and limb salvage with or without bone-graft reconstruction.


METHODS
A total of 13 patients were treated for malignant periacetabular bone tumours at Siriraj Hospital, Bangkok, Thailand. The diagnoses were chondrosarcoma (n=8), Ewing's sarcoma (n=2), osteosarcoma (n=1), well-differentiated osteosarcoma (n=1), and malignant giant cell tumour (n=1). 11 patients did not undergo reconstruction following tumour resection; 2 patients received fibular bone grafts bridging the periacetabulum to the remaining sacrum. Adjuvant chemotherapy was administered for high-grade malignant tumours, and postoperative radiation therapy was performed on patients with a closed surgical margin.


RESULTS
At a mean follow-up of 24.3 months (range, 8.9-43.9 months), 9 patients remained disease-free, 3 had died of the disease, and one was alive with disease. According to the Musculoskeletal Tumor Society classification system, the mean functional analysis at final follow-up was 68.7%. Patients who underwent internal hemipelvectomy experienced a subsequent leg-length discrepancy ranging from 3 to 10 cm. Four patients had complications (one each for deep wound infection, skin necrosis, seroma, and vascular spasms) and were successfully treated with multiple debridements and appropriate antibiotics. Three patients had local recurrences; one required a classic hemipelvectomy.


CONCLUSIONS
Malignant periacetabular tumours are difficult to manage. Functional results of our patients with no reconstruction or with bone-graft bridging were fair. Patients undergoing internal hemipelvectomy may experience leg-length discrepancies, which can be balanced with shoe lifts.
Asavamongkolkul
A
A
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siaas@mahidol.ac.th
Pimolsanti
R
R
Waikakul
S
S
Kiatsevee
P
P
D000328:Adult; D001859:Bone Neoplasms / Q000628:therapy*; D016025:Bone Transplantation; D017024:Chemotherapy, Adjuvant; D002648:Child; D002813:Chondrosarcoma / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000628:therapy; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000628:therapy; D010384:Pelvic Bones; D012512:Sarcoma, Ewing / Q000628:therapy; D016896:Treatment Outcome