Iliosacral resection for primary bone tumors: is pelvic reconstruction necessary?

UNLABELLED: Iliosacral resection for primary bone tumors creates a large unstable pelvic ring defect, the treatment of which remains controversial. We did this study to determine if skeletal reconstruction of such defects is necessary. Sixteen patients whose data were collected prospectively had iliosacral resection with a minimum followup of 12 months. The surgical and functional results of patients who had skeletal reconstruction (n = 4) were compared with the results of patients who did not have iliosacral repair (n = 12) using a case-control design. Function was evaluated by assessing impairment using the Musculoskeletal Tumor Society 1987 and 1993 rating scales, and disability was measured using the Toronto Extremity Salvage Score. Although all four iliosacral arthrodeses initially healed, one allograft used for reconstruction fractured and another was removed because of progressive lumbosacral spinal instability. Patients treated without pelvic reconstruction had fewer operative complications. Although the Toronto Extremity Salvage Score and the Musculoskeletal Tumor Society 1987 and 1993 scores were similar for both patient groups, those patients who were treated without reconstruction were less likely to require the use of an ambulatory assistive device, less likely to require narcotics or have chronic pain, and more likely to return to work. These results suggest that reconstruction of the skeletal defect to restore pelvic stability after iliosacral resection is not mandatory. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.