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Ipsilateral Femoral Autograft Reconstruction After Resection of a Pelvic Tumor
David J. Biau, MD1; Fabrice Thévenin, MD1; Valérie Dumaine, MD1; Antoine Babinet, MD1; Bernard Tomeno, MD1; Philippe Anract, MD1
1 Departments of Orthopaedic Surgery (D.J.B., V.D., A.B., B.T., and P.A.) and Radiology (F.T.), Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75679 Paris CEDEX 14 France. E-mail address for D.J. Biau: djmbiau@yahoo.fr
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, Paris, France

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jan 01;91(1):142-151. doi: 10.2106/JBJS.G.01061
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Abstract

Background: Reconstruction of bone after the resection of a pelvic tumor is challenging. The purpose of the present study was to evaluate the use of the ipsilateral femur as the graft material for reconstruction.

Methods: We performed a retrospective review of thirteen patients with a malignant pelvic lesion who underwent resection followed by reconstruction with an ipsilateral femoral autograft and insertion of a total hip replacement. The study group included nine men and four women with a median age of fifty-one years at the time of the reconstruction. The diagnosis was chondrosarcoma in eight patients, metastasis in three, and myeloma and radiation-induced malignant disease in one each. The surviving patients were assessed functionally and radiographically; the cumulative probability of revision was estimated while taking into account competing risks.

Results: The median duration of follow-up was forty-nine months. At the time of the latest follow-up, seven patients were alive and disease-free and six had died from metastatic disease. Four patients had had revision of the reconstruction, two for the treatment of mechanical complications and two for the treatment of infection. Three other patients had mechanical complications but had not had a revision. The cumulative probability of revision of the reconstruction for mechanical failure was 8% (95% confidence interval, 0% to 23%), 8% (95% confidence interval, 0% to 23%), and 16% (95% confidence interval, 0% to 39%) at one, two, and four years, respectively.

Conclusions: Although it has attendant complications consistent with pelvic tumor surgery, an ipsilateral femoral autograft reconstruction may be an option for reconstruction of pelvic discontinuity in a subgroup of patients following tumor resection. This innovative procedure requires longer-term follow-up studies.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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