title: Surgical technique: Porous tantalum reconstruction for destructive nonprimary periacetabular tumors.
abstract: BACKGROUND
  Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail.
  
  
  METHODS
  After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium.
  
  
  METHODS
  We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months).
  
  
  RESULTS
  Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation.
  
  
  CONCLUSIONS
  Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. sim.franklin@mayo.edu
authors: Fazel A
authors: FA
authors: Khan
authors: Peter S
authors: PS
authors: Rose
authors: Michiro
authors: M
authors: Yanagisawa
authors: David G
authors: DG
authors: Lewallen
authors: Franklin H
authors: FH
authors: Sim
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D001863:Bone Screws; D003475:Curettage; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D016062:Porosity; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D013635:Tantalum; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013635:Tantalum