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

The Notch Osteotomy^1,15

The notch that the prosthesis fits into needs to be close to the thickest part of the ilium. The dashed line in the image (above left) are proposed levels of ilium resection depending on lesion location.¹ Illustration on above right courtesy of Malawer et al.¹⁵

Benevenia et al.¹ found that improper notch prep can lead to instability.

The Mark II saddle prosthesis articulates with the ilium and is allowed to have some movement to help with the overall functionality of the prosthesis. Although, this is a controversial issue. Some authors claim that this saddle-notch articulation can cause pressure erosions, superior saddle migration and premature failure.

Menendez et al., claim that their custom saddle prosthesis (PAR) is less likely to move as it is fixed with three screws (see photo)

ª For stability some surgeons attach Gore-tex artificial ligament around saddle to maintain stability for the Mark II design (see below right).³

      Intraoperative notch prep⁴          Gore-Tex loop³

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