Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors.
BACKGROUND
The saddle prosthesis originally was developed to reconstruct large acetabular defects in revision hip arthroplasty and was used primarily for hip reconstruction after periacetabular tumor resections. The long-term survival of these reconstructions is unclear.


OBJECTIVE
We therefore examined the long-term function, complications, and survival in patients treated with saddle prostheses after periacetabular tumor resection.


METHODS
Between 1987 and 2003 we treated 17 patients with a saddle prosthesis after periacetabular tumor resection (12 chondrosarcomas, three osteosarcomas, one malignant fibrous histiocytoma, one metastasis). During followup, 11 patients died, resulting in a median overall survival of 49 months (95% CI, 30-68 months). The remaining six patients were alive without disease (mean followup, 12.1 years; range, 8.3-16.8 years). In one patient the saddle prosthesis was removed after 3 months owing to dislocation and infection. We obtained SF-36 questionnaires, Toronto Extremity Salvage Scores (TESS), and Musculoskeletal Tumor Society (MSTS) scores.


RESULTS
Thirteen of 17 patients used walking assists for mobilization at last followup: eight patients required two crutches, five needed one crutch, and one did not use any walking aids. The other three patients were not able to mobilize independently and only made bed to chair transfers. The mean hip flexion in the six surviving patients was 60° (range, 40°-100°) at last followup. Local complications were seen in 14 of the 17 patients: nine wound infections, seven dislocations, and two leg-length discrepancies requiring additional surgery. In the five surviving patients with their index prosthesis still in situ, the mean MSTS score at long-term followup was 47% (range, 20%-77%), the mean TESS score was 53% (range, 41%-67%), and the mean composite SF-36 physical and mental component summaries were 43.9 and 50.6, respectively.


CONCLUSIONS
Reconstruction with saddle prostheses after periacetabular tumor surgery has a high risk of complications and poor long-term function with limited hip flexion; therefore, we no longer use the saddle prosthesis for reconstruction after periacetabular tumor resections.
Department of Orthopaedics & Trauma, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. jorisajansen@yahoo.com
J A
JA
Jansen
M A J
MA
van de Sande
P D S
PD
Dijkstra
D000077:Acetabulum / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome