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Bernese Periacetabular Osteotomy in a Hip Extra-Articular Resection Followed by Reconstruction Using an Extracorporeal Irradiated Acetabulum Autograft with Megaprosthesis, for Proximal Femur Osteosarcoma in a Pediatric Patient.

Barro V, Velez R, Pacha D, Giralt J, Roca I, Aguirre M - Case Rep Med (2015)

Bottom Line: Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability.Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority.We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Surgery Department, Vall d'Hebron Hospital, 08035 Barcelona, Spain.

ABSTRACT
Osteosarcoma is the most common primary malignant tumour of bone. The oncologic surgery of a proximal femur osteosarcoma affecting the hip joint can be very challenging. We present an 8-year-old boy with a 5-month history of right hip pain. Radiographs and magnetic resonance imaging (MRI) showed a lytic lesion of the proximal femur extending 13 cm to the diaphysis. Histological evaluation was consistent with high-grade osteoblastic osteosarcoma. After completing chemotherapy we performed an extra-articular resection of the hip. Reconstruction was accomplished by reimplanting the acetabulum after irradiation and modular proximal femur megaprosthesis. Endoprosthetic reconstruction following proximal femur resection is a good treatment alternative achieving good postoperative function. Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability. Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority. We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

No MeSH data available.


Related in: MedlinePlus

Following the Bernese periacetabular osteotomy, an en bloc extra-articular resection of the acetabulum was performed; the resected specimen was then transferred to a separate sterile trolley. A capsulectomy was made through the acetabular rim, and the articular fluid and proximal femur were sent for histological examination. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation.
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fig2: Following the Bernese periacetabular osteotomy, an en bloc extra-articular resection of the acetabulum was performed; the resected specimen was then transferred to a separate sterile trolley. A capsulectomy was made through the acetabular rim, and the articular fluid and proximal femur were sent for histological examination. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation.

Mentions: A femoral osteotomy was made 16 cm distally from the tip of the greater trochanter, giving 3 cm of wide margin. The insertions of the adductors were transected from the proximal femur, followed by release of the gluteus medius and minimus. Subsequently an en bloc extra-articular resection of the acetabulum was performed, following the standard steps in a Bernese periacetabular osteotomy; the resected specimen was then transferred to a separate sterile trolley and moved away from the main operative field to avoid any contamination. Under aseptic precautions, a capsulectomy was made through the acetabulum rim, and samples of articular fluid and the proximal femur were sent for histological examination. Head size was measured for bipolar reconstruction. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation (Figure 2). The acetabulum segment, enclosed in a sterile pack, was irradiated to a dose of 50 Gy/1 fraction. Meanwhile we implanted a bipolar femoral modular megaprosthesis (Biomet OSS Compress) for proximal femoral reconstruction. Upon return to the operating room, the excised acetabulum was reimplanted and fixed with two reconstruction plates, achieving perfect geometric anatomic fit.


Bernese Periacetabular Osteotomy in a Hip Extra-Articular Resection Followed by Reconstruction Using an Extracorporeal Irradiated Acetabulum Autograft with Megaprosthesis, for Proximal Femur Osteosarcoma in a Pediatric Patient.

Barro V, Velez R, Pacha D, Giralt J, Roca I, Aguirre M - Case Rep Med (2015)

Following the Bernese periacetabular osteotomy, an en bloc extra-articular resection of the acetabulum was performed; the resected specimen was then transferred to a separate sterile trolley. A capsulectomy was made through the acetabular rim, and the articular fluid and proximal femur were sent for histological examination. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4496472&req=5

fig2: Following the Bernese periacetabular osteotomy, an en bloc extra-articular resection of the acetabulum was performed; the resected specimen was then transferred to a separate sterile trolley. A capsulectomy was made through the acetabular rim, and the articular fluid and proximal femur were sent for histological examination. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation.
Mentions: A femoral osteotomy was made 16 cm distally from the tip of the greater trochanter, giving 3 cm of wide margin. The insertions of the adductors were transected from the proximal femur, followed by release of the gluteus medius and minimus. Subsequently an en bloc extra-articular resection of the acetabulum was performed, following the standard steps in a Bernese periacetabular osteotomy; the resected specimen was then transferred to a separate sterile trolley and moved away from the main operative field to avoid any contamination. Under aseptic precautions, a capsulectomy was made through the acetabulum rim, and samples of articular fluid and the proximal femur were sent for histological examination. Head size was measured for bipolar reconstruction. The acetabulum was placed in a sterile container and sent to the radiotherapy department for extracorporeal irradiation (Figure 2). The acetabulum segment, enclosed in a sterile pack, was irradiated to a dose of 50 Gy/1 fraction. Meanwhile we implanted a bipolar femoral modular megaprosthesis (Biomet OSS Compress) for proximal femoral reconstruction. Upon return to the operating room, the excised acetabulum was reimplanted and fixed with two reconstruction plates, achieving perfect geometric anatomic fit.

Bottom Line: Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability.Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority.We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Surgery Department, Vall d'Hebron Hospital, 08035 Barcelona, Spain.

ABSTRACT
Osteosarcoma is the most common primary malignant tumour of bone. The oncologic surgery of a proximal femur osteosarcoma affecting the hip joint can be very challenging. We present an 8-year-old boy with a 5-month history of right hip pain. Radiographs and magnetic resonance imaging (MRI) showed a lytic lesion of the proximal femur extending 13 cm to the diaphysis. Histological evaluation was consistent with high-grade osteoblastic osteosarcoma. After completing chemotherapy we performed an extra-articular resection of the hip. Reconstruction was accomplished by reimplanting the acetabulum after irradiation and modular proximal femur megaprosthesis. Endoprosthetic reconstruction following proximal femur resection is a good treatment alternative achieving good postoperative function. Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability. Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority. We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

No MeSH data available.


Related in: MedlinePlus