Pelvic reconstruction with bone cement and total hip prosthesis after resection of chondrosarcoma. Case Report

Open access

Abstract

Introduction. Chondrosarcoma is a malignant tumor of cartilaginous origin representing approximately 20-30% of all bone malignant tumors and occupying the second place in terms of their incidence. It usually affects adults between 40 and 60 years old, but can be encountered at older ages as well.

Materials and methods. We report the case of a 55-year-old male patient who presented to our department with 2 weeks-long right hip pain and partial loss of functionality in right limb. We performed X-rays, magnetic resonance imaging, computed tomography, bone scintigraphy, and angiography, which established the diagnosis of pelvic tumor. Biopsy of the tumor was performed by iliofemoral approach and its result showed moderately differentiated chondrosarcoma. Orthopaedic surgery was performed, with tumoral removal within oncological limits, pelvic reconstruction using acrylic bone cement impregnated with Vancomycin and total hip arthroplasty.

Results were assessed using the Musculoskeletal Tumor Rating Scale and a score of 23 out of 35 was obtained (the higher the better). Postoperative complications consisted in flap-skin necrosis that resolved within 2 months after surgery.

Conclusion. Bone defects repair using antibiotic impregnated cement drastically reduced the rate of postoperative infections, thus decreasing both morbidity and mortality. In spite of technological advancement, long-term prognosis remains reserved in chondrosarcoma, due to its specific aggressivity, resistance to chemo- and radiotherapy and high rate of recurrence.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Mottard S Sumathi VP Jeys L. Chondrosarcomas Orthopaedics and Trauma. 2010.

  • 2. Santini-Araujo E Kalil RK Bertoni F Park YK. Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists. Orthopedic Surgeons and Radiologists. 2015 Springer-Verlag London.

  • 3. Campanacci MD. Bone and Soft Tissue Tumors - Clinical Features Imaging Pathology and Treatment. 1999 Springer Vienna.

  • 4. Pring ME Weber KL Unni KK Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001; 83A:1630-42.

  • 5. Lee FY Mankin HJ Fondren G et al. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999; 81:326-38.

  • 6. Angelini A Guerra G Mavrogenis AF Pala E Picci P Ruggieri P. Clinical outcome of central conventional chondrosarcoma. J Surg Oncol. 2012; 106:929-37.

  • 7. Enneking WF Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Jt Surg Am. 1978; 60(6):731–46.

  • 8. Kollender Y Shabat S Bickels J Flusser G Isakov J Neuman Y et al. Internal hemipelvectomy for bone sarcomas in children and young adults: surgical considerations. Eur J Surg Oncol. 2000; 26(4):398–404.

  • 9. Puri A Pruthi M Gulia A. Outcomes after limb sparing resection in primary malignant pelvic tumors. Eur J Surg Oncol. 2014; 40:27-33.

  • 10. Rodl RW Hoffmann C Gosheger G Leidinger B Jurgens H Winkelmann W. Ewing’s sarcoma of the pelvis: combined surgery and radiotherapy treatment. J Surg Oncol. 2003; 83:154–60.

  • 11. Satcher RL Jr. O’Donnell RJ Johnston JO. Reconstruction of the pelvis after resection of tumors about the acetabulum. Clin Orthop Relat Res. 2003; 409:209–217.

  • 12. Guo W Sun X Ji T Tang X. Outcome of surgical treatment of pelvic osteosarcoma. J Surg Oncol. 2012; 106:406–410.

  • 13. Asavamongkolkul A Waikakul S. Using polypropylene mesh graft for soft tissue reconstruction in internal hemipelvectomy: a case report. World J Surg Oncol. 2012; 28(10):12410.

  • 14. Zheng G Jing L Guo-Xian P Xiang-Dong L Zhen W. Pelvic reconstruction with a combined hemipelvic prostheses after resection of primary malignant tumor. Surgical Oncology. 2010; 19:95-105.

  • 15. Buchholz HW Gartmann HD. Infection prevention and surgical management of deep insidious infection in total endoprosthesis. Chirurg. 1972; 43:446-53.

  • 16. Wahlig H Dingeldein E Buchholz HW Buchholz M Bach-mann F. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg Br. 1984; 66:175-9.

  • 17. Donati D Biscaglia R. The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours. J Bone Joint Surg Br. 1998; 80:1045-50.

  • 18. Mavrogenis AF Soultanis K Patapis P et al. Pelvic resections. Orthopedics. 2012; 35:e232–e243.

  • 19. Welkerling H Kratz S Ewerbeck V Delling G. A reproducible and simple grading system for classical chondrosarcomas. Analysis of 35 chondrosarcomas and 16 enchondromas with emphasis on recurrence rate and radiological and clinical data. Virchows Arch. 2003; 443:725e33.

  • 20. Shin KH Rougraff BT Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994; 304:207e17.

  • 21. Deloin X Dumaine V Biau D Karoubi M Babinet A Tomeno B Anract P. Pelvic chondrosarcomas: Surgical treatment options. Orthopaedics & Traumatology: Surgery & Research. 2009; 95:393-401.

  • 22. Salunkea AA Shaha J Warikooa V Chakrabortya A Sahijwania H Sharmaa M Jhaa R Dhangea A Pathakb S Pandita J Pruthic M Pandyad S Jaina A. Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes. Journal of Clinical Orthopaedic and Trauma. 2017; 8:249-253.

  • 23. Johnston JO Gray RM. Hip reconstruction following internal hemipelvectomy for primary periacetabular sarcomas. Chir Organi Mov. 1990; 75:249-52.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 408 202 3
PDF Downloads 245 155 3