Does Extracorporeal Irradiation and Reimplantation After Acetabular Resections Result in Adequate Hip Function? A Preliminary Report

Pelvic resections are challenging, and reconstruction of the resected acetabulum to restore mobility and stability is even more difficult. Extracorporeal radiation therapy (ECRT or extracorporeal irradiation) of autograft bone and reimplantation allows for a perfect size match and has been used with some success in the extremities. Although the risk of wound complications in pelvic surgery has discouraged surgeons from using ECRT of autografts in that anatomic site, we believe it may be a reasonable option. In a small series, we asked: (1) What was the median surgical time and blood loss for these procedures, and what early complications were observed? (2) Is there evidence of osteonecrosis or cartilage loss at a minimum of 2 years after ECRT of acetabular autografts, and what functional scores were achieved? (3) What were the oncologic outcomes after ECRT? Between March 2007 and September 2016, one surgeon performed 12 ECRT acetabular autografts and reimplantations after resections of pelvic or acetabular tumors. Of those, 10 with minimum 2-year followup are reported on here with respect to oncologic, functional, and radiographic assessment; all 12 are reported on for purposes of surgical parameters and early complications. During that period, we generally performed this approach when we judged it possible to achieve a tumor-free margin, adequate bone stock, and sufficient remaining hip musculature to allow use of the bone as an autograft with restoration of hip mobility. We generally did not use this approach when we anticipated a difficult resection with uncertain margins or where remaining bone was judged of poor strength for use as a graft or if both iliopsoas and abductors were sacrificed. Since 2010, this series represents seven of the 21 pelvic resections with reconstruction that we performed (five patients in this series had the procedure performed before 2010). Followup was at a median of 65 months (range, 33-114 months) for nine patients whose functional outcomes were evaluated. The median patient age was 30 years (range, 10-64 years). Clinical parameters were recorded from chart review; radiographic analysis for assessment of cartilage was performed by looking for any obvious loss of joint space when compared with the opposite side. Functional scoring was done using the Musculoskeletal Tumor Society score, which was obtained from chart review. Oncologic assessment was determined for local recurrence as well as metastases. Median surgical time w