title: Extracorporeal Irradiation and Reimplantation with Total Hip Arthroplasty for Periacetabular Pelvic Resections: A Review of 9 Cases.
abstract: We report the early results of nine patients with periacetabular malignancies treated with Enneking and Dunham type 2 resection and reconstruction using extracorporeally irradiated (ECI) tumour bone combined with total hip arthroplasty (THA). Diagnosis was chondrosarcoma in six patients, osteosarcoma in two patients, and metastatic renal cell carcinoma in one patient. All patients underwent surgical resection and the resected specimen was irradiated with 50 Gy in a single fraction before being prepared for reimplantation as a composite autograft. The mean follow-up was 21 months (range, 3-59). All patients were alive at latest follow-up. No local recurrence was observed. One patient serially developed three pulmonary metastases, all of which were resected. One experienced hip dislocation due to incorrect seating of an acetabular liner. This was successfully treated with revision of the liner with no further episodes of instability. There were no cases of deep infection or loss of graft. The average Musculoskeletal Tumor Society (MSTS) score was 75% (range, 57-87%). Type 2 pelvic reconstruction with ECI and THA has shown excellent early oncological and functional results in our series. Preservation of the gluteus maximus and hip abductors is important for joint stability and prevention of infection.
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC 3065, Australia; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Lester Wai Mon
authors.initials: LW
authors.lastname: Chan
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC 3065, Australia.
authors.forename: Jungo
authors.initials: J
authors.lastname: Imanishi
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Samuel Y
authors.initials: SY
authors.lastname: Ngan
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Sarat
authors.initials: S
authors.lastname: Chander
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Chu
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Renae
authors.initials: R
authors.lastname: Thorson
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC 3065, Australia; Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Pang
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC 3065, Australia; Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia; Department of Surgery, University of Melbourne, St. Vincent's Hospital, Fitzroy, VIC 3065, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Choong