Hand-modelled composite prostheses after resection of peri-acetabular bone malignancies.
OBJECTIVE
To improve function after pelvic resection involving the acetabulum, using an anatomic composite implant built with screws and cement.


METHODS
Since 1990, 66 patients with peri-acetabular bone malignancies have been treated by extensive resection followed by hand-modelled innominate prosthesis with partially constrained total hip prosthesis. The hand-modelled innominate prosthesis was made of a titanium cup, a set of long titanium screws and two or three packs of gentamycine-loaded cement.


RESULTS
Many postoperative complications were observed: deep infection (14%), hip prosthesis dislocation (25%) and local recurrence (15%). Sixteen patients (25%) had to be reoperated. Nevertheless, at last follow-up, 62 patients still had composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 80% with unlimited walking without support, average hip flexion 100 degrees , length discrepancy less than 1 cm.


CONCLUSIONS
These results were similar to those described in the literature for custom-made innominate prostheses and much better than those of alternative reconstructive procedures. Hand-modelled composite prostheses are cheaper, easier, more adaptable and enables better anchorage than custom-made prostheses. Such a procedure can be used even after total iliac wing resection.


CONCLUSIONS
The advantages of such a procedure plead for its extensive use after acetabular resection. But long-term follow-up is necessary to validate indications.
Unité dOncologie Pédiatrique-Adultes Jeunes HôpitalAvicenne 125 Rue de Stalingrad Bobigny Cedex 93009 France.
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Sokolov
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