GIF89aì>³™

INTRODUCTION

PELVIC BONE ANATOMY

CLASSIFICATION OF PELVIC RESECTIONS

SURGICAL OPTIONS FOR THE PERIACETABULAR RESECTION

Hemipelvectomy

Arthrodesis

Megaprosthesis

THE SADDLE PROSTHESIS

Historical Perspectives: The Mark I

Mark II Prosthesis

Periacetabular Reconstruction Prosthesis (PAR)

INDICATIONS

SURGICAL TECHNIQUES AND CONSIDERATIONS

The Notch Osteotomy

Soft Tissue Tension

NORMAL POSTOPERATIVE IMAGING

COMPLICATIONS AND IMAGING

Mark I

Mark II

PAR Page 1

PAR Page 2

RECOVERY AND FUNCTIONALITY

CONCLUSION

REFERENCES

Surgical Technique:^1,3,6,11

The patient is placed in the lateral decubitus position and the pelvis is approached via a long anterolateral or posterolateral incision (see below) or in some cases, both. Nerves and vasculature must be carefully dissected.

ª Median operative time is close to 7 hours

ª Blood loss ranges from 450-5000cc in most cases^{1,3,6,8,11,16}

The Incision (black dotted line)¹¹

When the pelvis is exposed and depending on whether the lesion is primary or metastatic usually determines the margins of the osteotomy. Wide margins can be curative in primary neoplasia, whereas in metastatic disease, margins are not as important.

Diagram: Malawer⁶

How much resected bone is too much?

The stated range of native ilium bone stock needed for insertion of a saddle prosthesis varies per surgeon. Most commonly, at least 2-4cm of native bone stock is needed. Rarely, the region may need to be stabilized with bone graft and screws.^1,3,6,11

The PAR prosthesis needs more native bone stock that the traditional saddle prosthesis to accommodate the large wings.

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  Intraoperative resection of periacetabular tumor⁴

Resected acetabular tumor⁴