TY - JOUR
TI - Acetabular reconstruction in oncological surgery: A systematic review
and meta-analysis of implant survivorship and patient outcomes
AU - Kostakos, Thomas A.
AU - Nayar, Sandeep Krishan
AU - Alcock, Harry and
AU - Savvidou, Olga
AU - Vlasis, Konstantinos
AU - Papagelopoulos, Panayiotis
AU - J.
JO - SURGICAL ONCOLOGY-OXFORD
PY - 2021
VL - 38
TODO - null
SP - null
PB - Elsevier Sci Ltd, Exeter, United Kingdom
SN - null
TODO - 10.1016/j.suronc.2021.101635
TODO - Oncology; Oncological surgery; Acetabular reconstruction; Malignant
acetabular tumor; Modular acetabular implant; Custom-made acetabular
implant
TODO - Background: Reconstruction of the hip for peri-acetabular oncological
disease remains a challenge. The objective of this study was to
summarize the evidence and identify techniques utilized for primary and
metastatic tumors of the acetabulum and hemipelvis. Methods: A
systematic review of the published literature was carried out in
accordance with PRISMA guidelines. MEDLINE, EMBASE and Cochrane
databases identified relevant articles. Quality was assessed using the
Newcastle-Ottawa Scale. The study was registered on PROSPERO. Results:
53 papers were included, 16 were suitable for meta-analysis. 909
patients had primary and 1140 metastatic disease. 1094 patients
underwent reconstruction with conventional total hip arthroplasty (with
or without cup-cage or cement augmentation) or modifications of the
Harrington procedure, collectively termed ‘noncomplex’. 928 patients
underwent ‘complex’ reconstructions with either a modular hemipelvic,
saddle, reverse snow-cone, custom-made or 3D-printed endoprosthesis. The
most common complication was deep infection (11%) followed by
dislocation (5%). Mean MSTS scores were 61.9% for ‘non-complex’ versus
63.2% for ‘complex’ reconstruction. Meta-analysis suggested increased
mortality for primary (OR 3.14; 95% CI 1.15-8.54) and trends toward
reduced mortality for metastatic disease (OR 0.93; 95% CI 0.26-3.29)
following ‘complex’ versus ‘non-complex’ reconstruction. Reoperation
rates were higher following ‘complex’ reconstruction for metastatic
disease (OR 1.90; 95% CI 0.66-5.46) and similar for primary disease (OR
0.98; 95% CI 0.45-2.14). Conclusions: Peri-acetabular tumors are
associated with high rates of morbidity and mortality. Decisions
regarding implant selection are multi-factorial with recent increase in
the use of custom-made and 3D-printing technologies. Multiple factors
contribute to the oncological outcome and patient function. Further
research is required in order to guide optimal practice.
ER -