Reconstruction of Periacetabular Bone Tumor by Vascularized Fibula Graft and Irradiated Autograft

Background: Periacetabular reconstruction following malignant bone tumor resection for limb saving is extremely challenging. We attempted a new reconstruction method in two patients by combining a free vascularized fibula graft with an extracorporeally irradiated autograft. Patients: A 14-year-old boy with osteosarcoma and a 44-year-old man with chondrosarcoma were treated with wide excision of the tumor, followed by periacetabular reconstruction with an autogenous, extracorporeally irradiated osteoarticular graft combined with a free vascularized fibula graft. Results: Incorporation of the irradiated pelvic bone was achieved without any complications and the resulting limb function was good. Osteoarthritic changes were seen in one patient. Conclusion: This reconstruction method was safe and reliable for primary, limb-sparing surgery. It is best indicated when the femoral head can be preserved and the mechanical strength of the affected acetabulum is maintained.