Periacetabular reconstruction with a new endoprosthesis.
Reconstruction of the Type II pelvic resection is challenging. Currently available reconstructive options have inherent problems including graft and implant failure, pain, poor function, and high major complication rates. The periacetabular reconstruction (PAR) endoprosthesis was designed to be secured with internal fixation and bone cement to the remaining ilium and support a reconstructed acetabulum. This construct potentially avoids the complications of graft or hardware failure, while maintaining early mobilization, comfort, limb lengths, and function. We retrospectively reviewed 25 patients who underwent Type II pelvic resection and reconstruction with the PAR endoprosthesis, analyzing function, complications, and survivorship. The minimum followup was 13 months (mean, 29.4 months; range, 13 to 108 months). We compared the PAR data with the literature for the Mark II saddle endoprosthesis. The PAR's average MSTS score was 20.8 (67%), major complications occurred in 14 (56%), and implant survivorship was 84% at 2 years and 60% at 5 years. The rate of failure at the ilium-saddle interface was lower and implant survivorship higher than those in the published literature for the Mark II saddle. We recommend use of the PAR endoprosthesis for reconstruction of large defects following Type II pelvic resection. The modified saddle design provides greater inherent stability, allowing for faster rehabilitation and improved longevity without increased complications and is an improvement over the currently available saddle prostheses.


METHODS
Level III, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence.
Menendez
Lawrence R
LR
Department of Orthopedics, Keck School of Medicine, University of Southern California + Los Angeles County Medical Center, USC University Hospital, 1510 San Pablo Street, Suite 634, Los Angeles, CA, 90033, USA.
Ahlmann
Elke R
ER
Falkinstein
Yuri
Y
Allison
Daniel C
DC
D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
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