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Sarcoma
Volume 2016, Article ID 2549616, 7 pages
http://dx.doi.org/10.1155/2016/2549616
Clinical Study

Extracorporeal Irradiation and Reimplantation with Total Hip Arthroplasty for Periacetabular Pelvic Resections: A Review of 9 Cases

1Department of Orthopaedics, St. Vincent’s Hospital, Melbourne, VIC 3065, Australia
2Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
3Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia
4Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia
5Department of Surgery, University of Melbourne, St. Vincent’s Hospital, Fitzroy, VIC 3065, Australia

Received 29 January 2016; Accepted 31 March 2016

Academic Editor: R. Lor Randall

Copyright © 2016 Lester Wai Mon Chan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.