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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. - PowerPoint PPT Presentation
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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
Metastasis at diagnosis
1 (3.7%)
2 (7.4%)
4 (15%)
20 (74%)
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&IIINo16
imaging - crosses the si jointSI jointfrequencyremaining function of the abductorsfrequncyAWED2Metastasis at diagnosisll and lllBResection Margin.PreOp.6H.O10
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
GCT13.70%intact22MI1
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
Remaining function of abductors
17 (63%)
7 (26%)
3 (11%)
Site
number of patients
Metastasis at follow up.
5 (18.5%)
1 (3.7%)
14 (52%)
Number of cases
Type of pelvic resection
19 (70.3%)
7 (26%)
1(3.7%)
S.I Joint
2 (7.4%)
25 (92.6%)
Involvement of abductors by images
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
Usage Of Chemotherpy.
3(11.1%)
2 (7.4%)
6(22.2%)
16 (59.2%)
Marginns of Resection
Marginal(11) 41%
Wide(12) 44%
Intralesional(4) 15%
Number of cases
COMPLICATIONS
5 (18.5%)
6 (22.2%)
10 (37%)
10 (37%)
Site
Frequency
Metastasis at diagnosis
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
Type of pelvic resection
1(3.7%)
7 (26%)
19 (70.3%)
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)
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
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
Remaining function of abductors
17 (63%)
7 (26%)
3 (11%)
Site
Number of patients
Metastasis at diagnosis
4 (15%)
20(74%)
Site
number of patients
Metastasis at follow up.
5 (18.5%)
1 (3.7%)
14 (52%)
Number of cases
Type of pelvic resection
19 (70.3%)
7 (26%)
1(3.7%)
S.I Joint
2 (7.4%)
25 (92.6%)
Involvement of abductors by images
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
Intralesional(4) 15%
Wide(12) 44%
Marginal(11) 41%
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&IIINo16
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
Remaining function of abductors
17 (63%)
7 (26%)
3 (11%)
000
000
000
000
000
Site
Number of patients
Metastasis at diagnosis
4 (15%)
20(74%)
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
00
00
DIAGNOSIS
(3.7%)
(3.7%)
(3.7%)
(7.4%)
(11.1%)
(66.7%)
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%
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
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/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
Oncology statusfrequencyII&IIINo16
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
Osteosarcoma411.10%Female9minimus+portion of medius2Spine1contralateral ASIS1II&III
MFH27.40%local L.N1
hemangioendothelioma13.70%status of abductor originfrequency
GCT13.70%intact22
Ewing's13.70%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%)
000
000
000
000
000
Site
Number of patients
Metastasis at diagnosis
4 (15%)
20(74%)
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
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
Usage Of Chemotherpy.
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
Follow Up Visit (Months)
Mean Of Vertical Migration (MM)
Vertical Migration Of Saddle Prosthesis
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
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
GCT13.70%intact22MI1
Ewing's13.70%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%)
Site
number of patients
Metastasis at follow up.
5 (18.5%)
1 (3.7%)
14 (52%)
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
00
00
DIAGNOSIS
(3.7%)
(3.7%)
(3.7%)
(7.4%)
(11.1%)
(66.7%)
Number of Patients
Usage Of Chemotherpy.
3(11.1%)
2 (7.4%)
6(22.2%)
16 (59.2%)
Marginns of Resection
Marginal(11) 41%
Wide(12) 44%
Intralesional(4) 15%
Number of cases
COMPLICATIONS
5 (18.5%)
6 (22.2%)
10 (37%)
10 (37%)
Site
Frequency
Metastasis at diagnosis
20 (74%)
4 (15%)
2 (7.4%)
1 (3.7%)
Follow Up Visit (Months)
Mean Of Vertical Migration (MM)
Vertical Migration Of Saddle Prosthesis
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
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)
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
Ewing's13.70%repaired to abdominal wall5
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
Remaining function of abductors
17 (63%)
7 (26%)
3 (11%)
000
000
000
000
000
Site
Number of patients
Metastasis at diagnosis
4 (15%)
20(74%)
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
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
Metastasis at follow up.
14 (52%)
1 (3.7%)
5 (18.5%)
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)
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
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
Remaining function of abductors
17 (63%)
7 (26%)
3 (11%)
Site
Number of patients
Metastasis at diagnosis
4 (15%)
20(74%)
Site
number of patients
Metastasis at follow up.
5 (18.5%)
1 (3.7%)
14 (52%)
Number of cases
Type of pelvic resection
19 (70.3%)
7 (26%)
1(3.7%)
S.I Joint
2 (7.4%)
25 (92.6%)
Involvement of abductors by images
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.