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Ipsilateral Femoral Autograft Reconstruction After Resection of a Pelvic Tumor

Biau, David J. MD; Thévenin, Fabrice MD; Dumaine, Valérie MD; Babinet, Antoine MD; Tomeno, Bernard MD; Anract, Philippe MD

Journal of Bone & Joint Surgery - American Volume: 01 January 2009 - Volume 91 - Issue 1 - p 142–151
doi: 10.2106/JBJS.G.01061
Scientific Articles

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.

1Departments 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

Copyright 2009 by The Journal of Bone and Joint Surgery, Incorporated
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