Resection and Reconstruction of Acetabular Tumors involving Ischium and Inferior pubic bone with a Total Hip Replacement Using Posterior K-L Approach

Abstract

\n Background: To explore the feasibility and short-term effect of posterior K-L (Kocher Langenbeek) approach in treating pelvic acetabular tumors involving ishium, inferior ramus of pubis. Methods: We retrospectively reviewed patients with acetabular tumors involving ishium, inferior ramus of pubis underwent surgery in Shanghai General Hospital from January 2016 to June 2020 with modified K-L approach, including 8 women and 12 men, patients aged from 19-76 years, including 6 chondrosarcomas, 6 osteosarcomas, 3 metastatic pelvic tumors, 2 epithelioid sarcomas, 3 giant cell tumor of bone. 20 patients were defined as pelvic Ennecking zone II + pelvic zone III involvement. All patients were followed up regularly in clinic, operation time, intraoperative bleeding, methods of reconstruction, duration of hospitalization, perioperative complications were recorded, and MSTS functional score was used to evaluate the patients functional status.Results: All patients were followed up regularly in clinic with a mean 32 months (20-48 months). No patient died in the perioperative period, the average intraoperative bleeding was 1250 ml (800-2400 ml) in 10 patients, the mean operation duration was 2.6 hours (2-3.5 hours), no wound infection and delayed healing, the average duration of hospital stay was 12 days (10-16 days), the main complications during the follow-up included nervus cutaneus femoris posterior paralysis, 2 tumor recurrence, MSTS score was 22.5 points. 4 patients died during follow-up. Conclusions: The posterior K-L approach can be employed to effectively resect and reconstruction pelvic acetabular tumors invoving ishium, inferior ramus of pubis and reconstruct them properly. It is mainly suitable for malignant pelvic tumors involving the pelvic III and II + III regions. It also can often be available for biological reconstruction by using the acetabulum tantalum metal block, acetabulum reinforcing ring or autograft femur head. It is of highly safety and few perioperative complications, which is worth popularizing.