Endoprosthesis in the operative treatment of bone tumours of the pelvis

Aim: Limb salvage procedures in cases of bone tumours of the pelvis are established. In this retrospective study the clinical results after implantation of megaprostheses of the pelvis are reported. Methods: Between November 1994 and September 2004 an endoprosthetic replacement of the pelvis was performed in 24 consecutive patients, fourteen females and ten males. The mean age was 49.3 years (range: 17 - 64 years). In ten cases a complete and in fourteen an incomplete internal hemipelvectomy was done. Thirteen patients presented with a primary bone tumour and eleven with a bone metastasis. The tumour volume ranged between 50 and 1315 ml (median: 352 ml). The mean follow-up was 98 months. Results: In 23 of the 24 patients an R0 resection was achieved. Local recurrences were observed in five patients (20.8%). Deep infections developed in ten patients (41.7%) postoperatively. In two of these ten patients a secondary external hemipelvectomy was necessary. Eight patients (33.3%) developed a paralysis of the femoral and/or sciatic nerve, and a loosening of the endoprosthesis was observed in four cases (16.7%). Two patients died within 30 days postoperatively (pulmonary embolism, dissection of the abdominal aorta). Eight of the 24 patients are still alive, two of them after secondary hernipelvectomy and another after removal of the endoprosthesis due to infection. The functional results of the five surviving patients with an endoprosthesis, according to the MSTS scoring system, are good in two and poor in three patients. Conclusion: Internal hernipelvectomy and reconstruction of the pelvic girdle with endoprostheses is associated with a high rate of complications. Each single case should be critically evaluated and alternative procedures should be considered.