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CLASSIFICATION OF PELVIC RESECTIONS
SURGICAL OPTIONS FOR THE PERIACETABULAR RESECTION
THE SADDLE PROSTHESIS
Historical Perspectives: The Mark I
Periacetabular Reconstruction Prosthesis (PAR)
SURGICAL TECHNIQUES AND CONSIDERATIONS
COMPLICATIONS AND IMAGING
PAR Page 1
PAR Page 2
Megaprosthesis
From 1990 to 1997, Muller et al. treated 9 patients with hemipelvectomy and insertion of a megaprosthesis (Howmedica, Kiel, Germany) that had computer aided design.
He reported very high complication rates(8/9 patients), mainly deep infections, dislocations, hematomas. Seven of those patients required surgical intervention. Functionality was not discussed.9
Custom Made Hemipelvis
Windhager et al. treated periacetabular sarcomas with a custom prosthesis (Howmedica, Germany). The size of the prosthesis was generated from 3-D CT reconstructions with resection margins defined by the surgeon.
He reported satisfactory results with less complications than with arthrodesis, pseudoarthrosis, or saddle prosthesis.
Major surgical drawback: prosthesis needs to be exact fit as it is pre-ordered and made of precise measurements from 3-D Computed Tomography models (see page 2).
Other options include:
Massive allografts/autografts and composite allografts.
Some proponents have had success with these techniques, but major complications are somewhere in the 25-35% range.
The most common complication being infection, loosening, dislocation and in autografts, patients sustain fractures11
And finally, this leads us to the saddle prosthesis
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