Outcome Following Pelvic Sarcoma Resection Reconstructed With Saddle Prosthesis

Outcome Following Pelvic Sarcoma Resection Reconstructed With Saddle Prosthesis F.Aljassir MD, FRSCC.G.Beadel MB ChB.R.Turcotte MD, FRSCC.A.Griffin BSc.R.S.Bell MD, FRSCC . J.S.Wunder MD, FRSCC.M.H.Isler MD, FRSCC.

Introduction.Pelvic sarcomas remain a difficult problem.

Classically, hemipelvectomy was the primary means of surgical intervention.

With the advent of aggressive chemotherapy, better imaging studies and more advanced surgical techniques, limb-sparing resections have been increasingly used .

Techniques of surgical reconstruction include: 1- Ischiofemoral arthrodesis or pseudoarthrosis.

2-Iliofemoral arthrodesis or pseudoarthrosis. 3-Massive allograft or autoclaved autograft with hip arthroplasty. 4-Flail extremity.

5-Custom made metallic prostheses.

6-Saddle prosthesis.

The saddle is free to rotate on the body component. The entire prosthesis can abduct, adduct, flex, and extend through the saddle and iliac articulation.1-stem2-body3-Saddle

In the literatures there are few clinical studies of the saddle prosthesis

1-Nieder et al (seven:ISOLS, 313, 1993]. - 72 patients (failed of hip arthroplasty). -1 excellent , 14 good , 36 fair , and 21 poor. -Infection in 15 patients lead to poor results.

2-Aboulafia et al : ( Clin Orthop 314:203-213,1995). -17 patients, -mean follow up of (33 mon). -Favorable results: (excellent in 10, good in 2, fair in 1, and poor in 4.

3- Windhager et al (Clinical ortho (1996) 331:265-276.) -22 patients (6 had saddle prosthesis) -Custom-made pelvic had better functional results. -Eccentric new hip centre { limited motion}.4-Renard et al (Arch Orthop Trauma Surg(2000) 120:188-194) -15 patients. -Satisfactory results in short term follow up.5-Cottias et al (Journal of surgical oncology 2001;78:90-100.) -17 patients, with mean follow up of 42 months -early pain free weight bearing, -minimal limb shortening -functional results remained fair in most patients.

Objectives:To evaluate the outcome after resection of pelvic sarcoma and reconstruction with a saddle prosthesis.

Material & Methods.Retrospective study, 27 patients (1991 to 2001). (Maisonneuve- Rosemont Hospital (Montreal) and Mt Sinai Hospital (Toronto).

Functional outcome was assessed with MSTS 1987 & 1993 and the Toronto Extremity Salvage Score (TESS).

Oncological outcome parameters and complications were recorded.

Patients DemographicGender: 18 male (67%) / 9 female (33%).Age: ( 24 to 75 years ) , mean (SD) (53 (16)).Follow up: ( 12 to 120 months), mean (45 months). Operative time: ( 300 to 900 minutes ), mean (SD) ( 600 (98 )).Blood transfusions: from 4 to18 units, mean (SD) (10 (6)).

ChSAOSAEHEmGCTEWSAMFH

Chart6

18

4

2

1

1

1

frequency.

Diagnosis

18(66.7%)

4(14.8%)

2(7.4%)

1(3.7%)

Chart3

NONO18

minimusminimus7

minimus+portion of mediusminimus+portion of medius2

frequency

Soft tissue (abductors) involvement

Chart5

18

9

frequncy

Gender

Sheet1

patients#diagnosissexsiteimaging - soft tissue mass in abductorsimaging - crosses the si jointany functional abductor remainingonco statusmetastasis? (at diagnosis)resection marginschemo pre/postcomplications

1ChondrosarcomaMalesup pubic ramus, periacetabularnonoyes - partialAWEDyesmarginalnono

2OsteosarcomaMaleperiacetabular,iliumin minimusnoyes - glut mediusANEDnoType of Pelvic Resectionmarginalnoyes - infection

3ChondrosarcomaMalesupra acetabular iliumin minimusnoyes - glut mediusANEDnoII7marginalpre and postno

4MFHMaleProximal femurnononoDODyesII & III19intralesionalpreno

5ChondrosarcomaMaleperiacetabular, sup pubic ramus, hip jointnonoyes - most of itAWEDnoI, II & III1marginalnoyes - infection

6metastatic MFHFemaleperiacetabular, ischium, hip joint, skip met to femoral headin minimus + posterior portion of mediusnoyes - anterior glut mediusabductor origin intactANEDyeswidenoyes - dislocation of saddle, recurrent dislocation

7ChondrosarcomaFemaleleft sup pubic ramus, periacetabulum, hip joint,, pubisnonoyespartialDODnoresection typemarginalnoyes - infection

8ChondrosarcomaMaleProximal femur &periacetabular pelvis & hip jointnonono - resected with proximal femurno - repaired to abdo wallDODyestype 2 and 3marginalnoyes -infection

9OsteosarcomaMaleperiacetabular, ischium, inf pubic ramus, hip jointnonoyes - most of itpartialANEDnotype 2intralesionalpostno

10GCTFemaleperiacetabular, ischium, posterior columnnonoyes -most of itn/aANEDyestype 2wide contaminatednoyes

11ChondrosarcomaFemaleperiacteabulum, ilium, sup pubic ramus, hip joint, femoral head, necknonoyes - most of it, portion of minimus excised. Trochanteric osteotomy for exposure - reattachedpartialANEDnotype 2 - extraarticularwidenoyes - infection

12ChondrosarcomaFemaleperiacetabulum, ilium, ischium/posterior columnin minimusno (reaches within 1cm of SI joint inferiorly)yes - glut mediuspartialANEDnotype 2 and 3 - extra articularwidepreno

13OsteosarcomaMaleperiacetabulum, iliumnonoyes - most of itpartialDODyestype 2 - extraarticularwidenoyes - infection

14Chondrosarcomamposterior pelvisnonopartialnoAWODNEDnotype 2 and 3widenono

15ChondrosarcomamL. hipnonopartialpartialAWODNEDnotype 2 and 3 - extraarticularnegativepre &postopyes - fracture, femoral nerve palsy

16Ewing'smR. acetabulumnopartialpartialDCDnotype 2 and 3 - extraarticularNegativePostOpyes - femoral stem loosening, allograft saddle buttress fracture & saddle dislocation - recurred following revision

17ChondrosarcomafL.pelvisminimusnopartialDCDnotype 2 and 3 - extraarticularNegativeNoyes - ilium fracture with superomedial dislocation of prosthesis(7/5/02) & prosthesis dissociation (2/19/03)

18ChondrosarcomamL. acetabulumminimuspartialpartialDCDnotype 2- extraarticularNegativepreopyes- saddle unscrewed/dissociated

19ChondrosarcomamL. hemipelvisnonomost of itpartialAWODNEDnotype 2 - extraarticularmicro +veNoyes- dislocation , infection. DVT

20ChondrosarcomamR. hemipelvisnonopartialpartialDCDnotype 2 and 3micro +vePreOpyes- dislocation, DVT, MI

21ChondrosarcomamR. pelvisnonopartialpartialDCDnoII&IIINegativePreOpYES- fracture thru ilium with superior displacement of prosthesis

22ChondrosarcomamL. acetabulumnoyespartialDCDnoII&IIINegativeNoYes- dislocation of saddle, infection, sciatic nerve palsy

23Chondrosarcomafiliumminimus+ portion of mediuspartialDCDyesIIB, IIINegativePre0pyes- severe neuropathy from chemo. Proximal femur # at time of femoral osteotomy - cerclage wires

24ChondrosarcomafL acetabulumminimusmost of itNEDnoIINegativeNoyes - postop seroma percutaneously drained

25OsteosarcomafpelvisnonopartialpartialAWODNEDnoII&IIIMicro+Noyes - infection

26ChondrosarcomamL pubisminimusnopartialpartialNEDnowide resection (hemiplevis) I, II, IIImicro +veNoyes - fracture

27hemangioendotheliomampelvisnonopartialpartialAWODNEDnoII&IIInegativePreOp & PostOpyes - DVT

partialII&III

Oncology statusfrequencyII&IIINo16follow upV.M

imaging - crosses the si jointSI jointfrequencyremaining function of the abductorsfrequncyAWED2Metastasis at diagnosisll and lllBResection Margin.PreOp.6H.O1000

Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lllWide12PostOp.2Infec.1033.5

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&IIIMarginal11Pre.&Post Op3Dislo.668.3

Ch.SA1866.70%Male18minimus7most of it7partial5Ing. L.N.2Lung- Mets5ll&lllIntralesional4Frac.6129.5

O.SA411.10%Female9minimus+portion of medius2L.Spine1contralateral ASIS1II&IIIN.In.52410.5

MFH27.40%others63611

H.E13.70%status of abductor originfrequencyDisso.24812

GCT13.70%intact22MI1

Ew.13.70%repaired to abdominal wall5

Sheet1

00

00

00

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

0000

0000

0000

frequncy

number of patients

Remaining function of abductors

17 (63%)

7 (26%)

3 (11%)

00

00

00

Site

number of patients

Metastasis at follow up.

5 (18.5%)

1 (3.7%)

14 (52%)

0

0

0

Number of cases

Type of pelvic resection

19 (70.3%)

7 (26%)

1(3.7%)

000

000

S.I Joint

2 (7.4%)

25 (92.6%)

000

000

000

Involvement of abductors by images

2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

Number of Patients

Usage Of Chemotherpy.

3(11.1%)

2 (7.4%)

6(22.2%)

16 (59.2%)

0

0

0

Marginns of Resection

Marginal(11) 41%

Wide(12) 44%

Intralesional(4) 15%

0

0

0

0

0

0

0

0

Number of cases

COMPLICATIONS

5 (18.5%)

6 (22.2%)

10 (37%)

10 (37%)

000

000

000

000

Site

Frequency

Metastasis at diagnosis

20 (74%)

4 (15%)

2 (7.4%)

1 (3.7%)

0

0

0

0

0

0

0

Follow Up Visit (Months)

Mean Of Vertical Migration (MM)

Vertical Migration Of Saddle Prosthesis

0

0

0

0

0

0

number of cases

COMPLICATIONS

5(18.5%)

6(22.2%)

10(37%)

0

0

0

0

0

0

frequency.

Diagnosis

1(3.7%)

2(7.4%)

4(11.1%)

18(66.7%)

Chart2

NO- MetsNO- Mets20

Lung- MetsLung- Mets4

Ing. L.N.Ing. L.N.2

L.SpineL.Spine1

Site

Frequency


1 (3.7%)

2 (7.4%)

4 (15%)

20 (74%)

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1





























partialII&III

Oncology statusfrequencyII&IIINo16


Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lllWide12PostOp.2Infec.10

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&IIIMarginal11Pre.&Post Op3Dislo.6

Chondrosarcoma1866.70%Male18minimus7most of it7partial5Ing. L.N.2Lung- Mets5ll&lllIntralesional4Frac.6

Osteosarcoma411.10%Female9minimus+portion of medius2L.Spine1contralateral ASIS1II&IIIN.In.5

MFH27.40%DVT3

hemangioendothelioma13.70%status of abductor originfrequencyDisso.2


Ewing's13.70%repaired to abdominal wall5

Sheet1

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

S.I Joint

2 (7.4%)

25 (92.6%)


2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

00

00

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

Number of Patients


3(11.1%)

2 (7.4%)

6(22.2%)

16 (59.2%)


Marginal(11) 41%

Wide(12) 44%


Number of cases

COMPLICATIONS

5 (18.5%)

6 (22.2%)

10 (37%)

10 (37%)

Site

Frequency


20 (74%)

4 (15%)

2 (7.4%)

1 (3.7%)

Enneking WF. The anatomic considerations in tumor surgery: pelvis. In: Enneking WF, editor. Musculoskeletal Tumor Surgery, Vol. 2. New York: Churchill Livingstone.1983: 483529.TYPE I (ilium)TYPE II (periacetabular)TYPE III (pubis)Musculoskeletal Cancer Surgery(2001). Martin Malawar

Chart11

7

19

1

Number of cases


1(3.7%)

7 (26%)

19 (70.3%)

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1

patients#diagnosissexsiteimaging - soft tissue mass in abductorsimaging - crosses the si jointany functional abductor remainingonco statusmetastasis? (at diagnosis)

1ChondrosarcomaMalesup pubic ramus, periacetabularnonoyes - partialAWEDyes

2OsteosarcomaMaleperiacetabular,iliumin minimusnoyes - glut mediusANEDnoType of Pelvic Resection

3ChondrosarcomaMalesupra acetabular iliumin minimusnoyes - glut mediusANEDnoII7

4MFHMaleProximal femurnononoDODyesII & III19

5ChondrosarcomaMaleperiacetabular, sup pubic ramus, hip jointnonoyes - most of itAWEDnoI, II & III1

6metastatic MFHFemaleperiacetabular, ischium, hip joint, skip met to femoral headin minimus + posterior portion of mediusnoyes - anterior glut mediusabductor origin intactANEDyes

7ChondrosarcomaFemaleleft sup pubic ramus, periacetabulum, hip joint,, pubisnonoyespartialDODnoresection type

8ChondrosarcomaMaleProximal femur &periacetabular pelvis & hip jointnonono - resected with proximal femurno - repaired to abdo wallDODyestype 2 and 3

9OsteosarcomaMaleperiacetabular, ischium, inf pubic ramus, hip jointnonoyes - most of itpartialANEDnotype 2

10GCTFemaleperiacetabular, ischium, posterior columnnonoyes -most of itn/aANEDyestype 2

11ChondrosarcomaFemaleperiacteabulum, ilium, sup pubic ramus, hip joint, femoral head, necknonoyes - most of it, portion of minimus excised. Trochanteric osteotomy for exposure - reattachedpartialANEDnotype 2 - extraarticular

12ChondrosarcomaFemaleperiacetabulum, ilium, ischium/posterior columnin minimusno (reaches within 1cm of SI joint inferiorly)yes - glut mediuspartialANEDnotype 2 and 3 - extra articular

13OsteosarcomaMaleperiacetabulum, iliumnonoyes - most of itpartialDODyestype 2 - extraarticular

14Chondrosarcomamposterior pelvisnonopartialnoAWODNEDnotype 2 and 3

15ChondrosarcomamL. hipnonopartialpartialAWODNEDnotype 2 and 3 - extraarticular

16Ewing'smR. acetabulumnopartialpartialDCDnotype 2 and 3 - extraarticular

17ChondrosarcomafL.pelvisminimusnopartialDCDnotype 2 and 3 - extraarticular

18ChondrosarcomamL. acetabulumminimuspartialpartialDCDnotype 2- extraarticular

19ChondrosarcomamL. hemipelvisnonomost of itpartialAWODNEDnotype 2 - extraarticular

20ChondrosarcomamR. hemipelvisnonopartialpartialDCDnotype 2 and 3

21ChondrosarcomamR. pelvisnonopartialpartialDCDnoII&III

22ChondrosarcomamL. acetabulumnoyespartialDCDnoII&III

23Chondrosarcomafiliumminimus+ portion of mediuspartialDCDyesIIB, III

24ChondrosarcomafL acetabulumminimusmost of itNEDnoII

25OsteosarcomafpelvisnonopartialpartialAWODNEDnoII&III

26ChondrosarcomamL pubisminimusnopartialpartialNEDnowide resection (hemiplevis) I, II, III

27hemangioendotheliomampelvisnonopartialpartialAWODNEDnoII&III

partialII&III

Oncology statusfrequencyII&III

imaging - crosses the si jointSI jointfrequencyremaining function of the abductorsfrequncyAWED2Metastasis at diagnosisll and lllB

Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lll

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&III

Chondrosarcoma1866.70%Male18minimus7most of it7partial5Inguinal canal1Lung- Mets5ll&lll

Osteosarcoma411.10%Female9minimus+portion of medius2Spine1contralateral ASIS1II&III

MFH27.40%local L.N1

hemangioendothelioma13.70%status of abductor originfrequency

GCT13.70%intact22


Sheet1

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

Site

Number of patients


4 (15%)

20(74%)

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

S.I Joint

2 (7.4%)

25 (92.6%)


2 (7%)

7 (26%)

18 (67%)

Gender

Female33%(9)

Male(18)67%

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

(Enneking WF, Spanier SS, Goodman MA. Asystem for the surgical staging of musculoskeletal sarcoma: Clinical Orthop. 1980 Nov- Dec;(153): 106-20).

Chart6

12

11

4

Margins of Resection


Wide(12) 44%

Marginal(11) 41%

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1





























partialII&III


imaging - crosses the si jointSI jointfrequencyremaining function of the abductorsfrequncyAWED2Metastasis at diagnosisll and lllBResection Margin.PreOp.6No

Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lllWide12PostOp.2Infection

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&IIIMarginal11Pre.&Post Op3Dislocation

Chondrosarcoma1866.70%Male18minimus7most of it7partial5Inguinal canal1Lung- Mets5ll&lllIntralesional4Dissociated

Osteosarcoma411.10%Female9minimus+portion of medius2Spine1contralateral ASIS1II&IIINerve injury

MFH27.40%local L.N1DVT

hemangioendothelioma13.70%status of abductor originfrequencyMI

GCT13.70%intact22Seroma

Ewing's13.70%repaired to abdominal wall5Fracture

Sheet1

00

00

00

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

0000

0000

0000

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

000

000

000

000

000

Site

Number of patients


4 (15%)

20(74%)

00

00

00

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

0

0

0

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

000

000

S.I Joint

2 (7.4%)

25 (92.6%)

000

000

000


2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

00

00

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

00

00

00

00

Number of Patients


3(11.1%)

2 (7.4%)

6(22.2%)

16 (59.2%)

0

0

0


Marginal(11) 41%

Wide(12) 44%


No radiation therapy given to any patient

Chart2

No16

PreOp.6

PostOp.2

Pre.&Post Op3

Number of Patients

Chemotherapy.

16 (59.2%)

6(22.2%)

2 (7.4%)

3(11.1%)

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1

patients#diagnosissexsiteimaging - soft tissue mass in abductorsimaging - crosses the si jointany functional abductor remainingonco statusmetastasis? (at diagnosis)resection marginschemo pre/post

1ChondrosarcomaMalesup pubic ramus, periacetabularnonoyes - partialAWEDyesmarginalno

2OsteosarcomaMaleperiacetabular,iliumin minimusnoyes - glut mediusANEDnoType of Pelvic Resectionmarginalno

3ChondrosarcomaMalesupra acetabular iliumin minimusnoyes - glut mediusANEDnoII7marginalpre and post

4MFHMaleProximal femurnononoDODyesII & III19intralesionalpre

5ChondrosarcomaMaleperiacetabular, sup pubic ramus, hip jointnonoyes - most of itAWEDnoI, II & III1marginalno

6metastatic MFHFemaleperiacetabular, ischium, hip joint, skip met to femoral headin minimus + posterior portion of mediusnoyes - anterior glut mediusabductor origin intactANEDyeswideno

7ChondrosarcomaFemaleleft sup pubic ramus, periacetabulum, hip joint,, pubisnonoyespartialDODnoresection typemarginalno

8ChondrosarcomaMaleProximal femur &periacetabular pelvis & hip jointnonono - resected with proximal femurno - repaired to abdo wallDODyestype 2 and 3marginalno

9OsteosarcomaMaleperiacetabular, ischium, inf pubic ramus, hip jointnonoyes - most of itpartialANEDnotype 2intralesionalpost

10GCTFemaleperiacetabular, ischium, posterior columnnonoyes -most of itn/aANEDyestype 2wide contaminatedno

11ChondrosarcomaFemaleperiacteabulum, ilium, sup pubic ramus, hip joint, femoral head, necknonoyes - most of it, portion of minimus excised. Trochanteric osteotomy for exposure - reattachedpartialANEDnotype 2 - extraarticularwideno

12ChondrosarcomaFemaleperiacetabulum, ilium, ischium/posterior columnin minimusno (reaches within 1cm of SI joint inferiorly)yes - glut mediuspartialANEDnotype 2 and 3 - extra articularwidepre

13OsteosarcomaMaleperiacetabulum, iliumnonoyes - most of itpartialDODyestype 2 - extraarticularwideno

14Chondrosarcomamposterior pelvisnonopartialnoAWODNEDnotype 2 and 3wideno

15ChondrosarcomamL. hipnonopartialpartialAWODNEDnotype 2 and 3 - extraarticularnegativepre &postop

16Ewing'smR. acetabulumnopartialpartialDCDnotype 2 and 3 - extraarticularNegativePostOp

17ChondrosarcomafL.pelvisminimusnopartialDCDnotype 2 and 3 - extraarticularNegativeNo

18ChondrosarcomamL. acetabulumminimuspartialpartialDCDnotype 2- extraarticularNegativepreop

19ChondrosarcomamL. hemipelvisnonomost of itpartialAWODNEDnotype 2 - extraarticularmicro +veNo

20ChondrosarcomamR. hemipelvisnonopartialpartialDCDnotype 2 and 3micro +vePreOp

21ChondrosarcomamR. pelvisnonopartialpartialDCDnoII&IIINegativePreOp

22ChondrosarcomamL. acetabulumnoyespartialDCDnoII&IIINegativeNo

23Chondrosarcomafiliumminimus+ portion of mediuspartialDCDyesIIB, IIINegativePre0p

24ChondrosarcomafL acetabulumminimusmost of itNEDnoIINegativeNo

25OsteosarcomafpelvisnonopartialpartialAWODNEDnoII&IIIMicro+No

26ChondrosarcomamL pubisminimusnopartialpartialNEDnowide resection (hemiplevis) I, II, IIImicro +veNo

27hemangioendotheliomampelvisnonopartialpartialAWODNEDnoII&IIInegativePreOp & PostOp

partialII&III


imaging - crosses the si jointSI jointfrequencyremaining function of the abductorsfrequncyAWED2Metastasis at diagnosisll and lllBResection Margin.PreOp.6

Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lllWide14PostOp.2

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&IIIMarginal11Pre.&Post Op3

Chondrosarcoma1866.70%Male18minimus7most of it7partial5Inguinal canal1Lung- Mets5ll&lllIntralesional2


MFH27.40%local L.N1


GCT13.70%intact22


Sheet1

00

00

00

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

0000

0000

0000

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

000

000

000

000

000

Site

Number of patients


4 (15%)

20(74%)

00

00

00

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

0

0

0

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

000

000

S.I Joint

2 (7.4%)

25 (92.6%)

000

000

000


2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

00

00

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

0

0

0

Margins Of Resection.

Marginal(11) 41%

Intralesional(2)7%

Wide (14)52%

00

00

00

00

Number of Patients


3(11.1%)

2 (7.4%)

6(22.2%)

16 (59.2%)

Complications.Infection in 10 (37%) 4 were superficial and 6 (22%) were deep.Heterotropic ossification in 10 (37%).

One year post op.post op.

Complications.Dislocations in 6 (22.2%).

Fractures in 6 (22.2%)

Nerve Injuries in 5 (18.5%).

Others (2 dissociations, 3 DVT, and one MI).

Vertical migration12432

Chart1

0

3.5

8.3

9.5

10.5

11

12




Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1





























partialII&III

Oncology statusfrequencyII&IIINo16follow upV.M


Soft tissue mass in abductorsfrequencyyes2No3partialANED14NO- Mets20Metastasis at follow upllB,lllWide12PostOp.2Infec.1033.5

diagnosisfrequencysexfrequncyNO18no25partial17partialDOD11Lung- Mets4No- Mets14II&IIIMarginal11Pre.&Post Op3Dislo.668.3

Chondrosarcoma1866.70%Male18minimus7most of it7partial5Ing. L.N.2Lung- Mets5ll&lllIntralesional4Frac.6129.5

Osteosarcoma411.10%Female9minimus+portion of medius2L.Spine1contralateral ASIS1II&IIIN.In.52410.5

MFH27.40%DVT33611

hemangioendothelioma13.70%status of abductor originfrequencyDisso.24812



Sheet1

00

00

00

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

0000

0000

0000

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

000

000

S.I Joint

2 (7.4%)

25 (92.6%)

000

000

000


2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

00

00

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

Number of Patients


3(11.1%)

2 (7.4%)

6(22.2%)

16 (59.2%)


Marginal(11) 41%

Wide(12) 44%


Number of cases

COMPLICATIONS

5 (18.5%)

6 (22.2%)

10 (37%)

10 (37%)

Site

Frequency


20 (74%)

4 (15%)

2 (7.4%)

1 (3.7%)




Oncological Outcome.DCD At mean f/u (45 months).AWODAWD

Chart13

AWED2

ANED14

DOD11

frequency

number of patients

ONCOLOGY OUTCOME

2 (7.4%)

14 (52%)

11 (40.6%)

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1





























partialII&III







MFH27.40%local L.N1


GCT13.70%intact22


Sheet1

00

00

00

frequency

number of patients

ONCOLOGY OUTCOME

11 (40.6%)

14 (52%)

2 (7.4%)

0000

0000

0000

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

000

000

000

000

000

Site

Number of patients


4 (15%)

20(74%)

00

00

00

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

0

0

0

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

000

000

S.I Joint

2 (7.4%)

25 (92.6%)

000

000

000


2 (7%)

7 (26%)

18 (67%)

0

0

Gender

Female33%(9)

Male(18)67%

00

00

00

00

00

00

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

Oncological Outcome.At mean f/u (45 months).

Chart10

No- Mets14

Lung- Mets5

contralateral ASIS1

Site

number of patients


14 (52%)

1 (3.7%)

5 (18.5%)

Chart3

NONO18

minimusminimus7


frequency


Chart5

18

9

frequncy

Gender

Sheet1





























partialII&III







MFH27.40%local L.N1


GCT13.70%intact22


Sheet1

frequency

number of patients

ONCOLGY STATUS

11 (40.6%)

14 (52%)

2 (7.4%)

frequncy

number of patients


17 (63%)

7 (26%)

3 (11%)

Site

Number of patients


4 (15%)

20(74%)

Site

number of patients


5 (18.5%)

1 (3.7%)

14 (52%)

Number of cases


19 (70.3%)

7 (26%)

1(3.7%)

S.I Joint

2 (7.4%)

25 (92.6%)


2 (7%)

7 (26%)

18 (67%)

Gender

Female33%(9)

Male(18)67%

DIAGNOSIS

(3.7%)

(3.7%)

(3.7%)

(7.4%)

(11.1%)

(66.7%)

Oncological Outcome.Local recurrence in our study: 6/27 (22.2%) 4/6 (67%) had positive resectional margins.

Survival rate is (60%)At mean f/u (45 months).

Functional Outcomes.*is similar to other study : 1-mean =17, ( 11to 23).{ functional evaluation of 17 Saddle) Cottias et al Journal of surgical oncology 2001; 78:90-100.2-Mean=17.6, (13 to 26). (endoprosthetic pelvic replacement)Bruns et al (Arch Orthop Trauma Surg(1997)116:27-31).

*And lower compare to prox -imal femoral replacement: Mean =23.2 (13 to 33) Ogilivie et al clinical orthopedic and related research 2004;426:44-48

Mean (15)

Functional Outcomes.Custom made prosthetic reconstruction: mean( 70%) Abudu et al ( JBJS Br. 1997;79-B:773-9).

Endoprosthetic pelvic replacement , (51%). Bruns et al (Arch Orthop Trauma Surg(1997)116:27-31).

Proximal femoral replacement: Mean=67.7% (40-93%) Ogilivie et al clinical orthopedic and related research 2004;426:44-48

Mean (51%)

Functional Outcomes.TESS of limb sparing for lower limb sarcoma (distal thigh): mean (85%) Davis et al, Arch Phys Med Rehabbil. 1999 jun ;80960:615-8.

For proximal femoral replacement: Mean = 76% , (40-98) Ogilivie et al clinical orthopedic and related research 2004;426:44-48Mean = 58%, (39-95) { functional evaluation of 17 Saddle) Cottias et al (Journal of surgical oncology 2001; 78:90-100).

Mean (64%)

Functional OutcomeWork Status:*Full time 5 patients (18.5%).

*Early retirement 5 (18.5%).

*Disabled 6 (22.2%).

*Deceased 11(40.6%).Gait aids: L.L.D: range between 1 and 6 cm, with a mean of 3cm.A cane in 8 patients (30%).

Crutches in 5 (18.5%).

Walker in 3 patients (11.1%).

Shoe lift in 5 patients.

A.F.O in 3 patients.

Discussion.In pelvic sarcoma goals are to cure the patient and to preserve the best function and quality of life.

Treatment of pelvic sarcoma remains difficult.

Limited data exists to compare functional outcome.

The most common complications are infection and heterotopic ossification.

Conclusion.Like with other implants, the oncological and functional outcome in limb salvage procedures using a saddle prosthesis remain difficult to predict, and is associated with significant risk of morbidity and complications.

However, the functional results appear to confer an advantage compared to the expected disability following hemipelvectomy.

Documents

Outcome Following Pelvic Sarcoma Resection Reconstructed With Saddle Prosthesis