Samir-Pierre Issa1,2, David Biau3,4,5, Antoine Babinet3,4, Valérie Dumaine3,4, Malo Le Hanneur4,6, Philippe Anract3,4,5. 1. Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 27 rue du Faubourg Saint Jacques, 75014, Paris, France. samir_p_issa@hotmail.com. 2. Paris-Descartes University, Sorbonne Paris Cité, Paris, France. samir_p_issa@hotmail.com. 3. Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 27 rue du Faubourg Saint Jacques, 75014, Paris, France. 4. Paris-Descartes University, Sorbonne Paris Cité, Paris, France. 5. INSERM, U1153 (ECaMO), Paris, France. 6. Department of Orthopedic Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), 20 rue Leblanc, 75015, Paris, France.
Abstract
PURPOSE: Despite numerous reconstructive techniques and prosthetic devices, pelvic reconstructions following peri-acetabular malignant tumours resections are highly challenging. In the present study, we describe our experience with the Integra® (Lépine, Genay, France) ice-cream cone prosthesis in such indications. The objective was to assess the mid-term outcomes of this device. METHODS: Twenty-four patients' chart with peri-acetabular malignant tumours, who underwent types II or II + III peri-acetabular resections according to Enneking and Dunham with subsequent reconstruction using the Integra® prosthesis between February 2009 and February 2015, were reviewed. Seventeen cases were primary surgeries and seven cases were revisions (i.e., failures of previous reconstructions for pelvic tumours). All living patients with the prosthesis implanted were functionally assessed, using the musculoskeletal tumour society (MSTS) and Postel-Merle d'Aubigné (PMA) scores. RESULTS: After a mean follow-up of 49 ± 26 months (range, 8 to 94 months), 21 patients were alive (88%), including 15 patients continuously disease-free (63%). MSTS and PMA scores averaged 72 ± 13% (range, 43 to 87%) and 14.6 ± 2.6 (range, 9 to 18), respectively. Fourteen patients (58%) presented at least one complication during follow-up, including four cases of deep infection (17%), four cases of dislocation (17%), and two mechanical failures (8%). At 5 years, the implant survival rate was 75%. CONCLUSIONS: In comparison to previous reconstructive techniques that we used in similar indications, functional and oncologic outcomes were improved with the Integra® implant. However, as commonly observed in pelvic bone tumour surgery, complication rates remain significant. LEVEL OF EVIDENCE: Therapeutic, Level IV-Retrospective Cases Series.
PURPOSE: Despite numerous reconstructive techniques and prosthetic devices, pelvic reconstructions following peri-acetabular malignant tumours resections are highly challenging. In the present study, we describe our experience with the Integra® (Lépine, Genay, France) ice-cream cone prosthesis in such indications. The objective was to assess the mid-term outcomes of this device. METHODS: Twenty-four patients' chart with peri-acetabular malignant tumours, who underwent types II or II + III peri-acetabular resections according to Enneking and Dunham with subsequent reconstruction using the Integra® prosthesis between February 2009 and February 2015, were reviewed. Seventeen cases were primary surgeries and seven cases were revisions (i.e., failures of previous reconstructions for pelvic tumours). All living patients with the prosthesis implanted were functionally assessed, using the musculoskeletal tumour society (MSTS) and Postel-Merle d'Aubigné (PMA) scores. RESULTS: After a mean follow-up of 49 ± 26 months (range, 8 to 94 months), 21 patients were alive (88%), including 15 patients continuously disease-free (63%). MSTS and PMA scores averaged 72 ± 13% (range, 43 to 87%) and 14.6 ± 2.6 (range, 9 to 18), respectively. Fourteen patients (58%) presented at least one complication during follow-up, including four cases of deep infection (17%), four cases of dislocation (17%), and two mechanical failures (8%). At 5 years, the implant survival rate was 75%. CONCLUSIONS: In comparison to previous reconstructive techniques that we used in similar indications, functional and oncologic outcomes were improved with the Integra® implant. However, as commonly observed in pelvic bone tumour surgery, complication rates remain significant. LEVEL OF EVIDENCE: Therapeutic, Level IV-Retrospective Cases Series.
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