Background: Reconstruction of the pelvic arch after resection of a
malignant pelvic tumor remains a major surgical challenge because of the high
rate of associated complications. The purpose of this investigation was to
assess the functional outcome and complication rate following treatment with a
bone allograft to reconstruct the pelvis.
Methods: Twenty-four consecutive patients underwent excision of a
malignant pelvic bone tumor and reconstruction with a pelvic bone allograft.
The living patients were followed for a minimum of twenty-four months. There
were nineteen primary malignant bone tumors, sixteen of which were high-grade
sarcomas, and there were five isolated metastases. Patients were examined
clinically and radiographically and were assessed functionally with the
Musculoskeletal Tumor Society score.
Results: The mean age of the patients at the time of the index
surgery was thirty-four years, and the mean duration of follow-up was
forty-one months. Eighteen of the twenty-four resections involved the
periacetabular area and were followed by reconstruction either with a hip
prosthesis (thirteen) or with an osteochondral allograft alone (five). The six
other resections involved the iliac bone. All patients received a massive bone
allograft that had been sterilely procured without secondary irradiation. At
the time of our last evaluation, eight patients were alive and free of
disease. Seven patients had a local recurrence. Neurological deficits were
present in six patients, and three had a deep infection. Nonunion of three of
the sixteen allografts that could be evaluated was observed. Neither graft
fracture nor lysis was observed. Eleven patients underwent surgical revision,
with nine of these revisions related to the reconstruction. The average
Musculoskeletal Tumor Society score at the time of the latest follow-up was
73% of the maximal possible score. The average score was 82% for the eleven
patients with an age of less than twenty years at the time of the index
procedure and 65% for the thirteen older patients. Ten patients walked without
any assistive device, and five of them had normal function with no or only a
Conclusions: Pelvic reconstruction after a limb-sparing resection is
associated with a high risk of surgical complications and usually should be
reserved for patients with a primary bone sarcoma. A pelvic allograft can
restore the anatomy and provide good functional results, especially in young
patients. Nonunion was the most common allograft-related complication.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.