Pelvic reconstruction using pedestal endoprosthesis—experience from Europe

Background: Reconstructive techniques following acetabular reconstruction for pelvic primary and metastatic malignancy are technically difficult and are known to have high complication rates. Previous studies of outcomes following pedestal acetabular prosthesis have shown that the most common complications were dislocation and infection with rates ranging from 10–26% and 11–47% respectively. Methods: A case series review of all acetabular reconstructions performed between 2003 and 2016 using a pedestal prosthesis was performed using data from the Royal Orthopaedic Hospital oncology database. Patient demographics and primary diagnoses were recorded, as was length of follow up, complications rate, patient and implant survivorship. Results: We identified 52 cases of acetabular reconstruction for pelvic malignancy between 2003 and 2016. The average follow-up was 4 ½ years with a 27% complication rate. The deep infection rate was 8% with half of these requiring removal of implants. The dislocation rate was 12%. The use of intra-operative computer navigation reduced the rate of dislocation by half when compared to cases where navigation was not used. Conclusions: The complication rates associated with a stemmed acetabular endoprosthesis are to other reconstructive techniques for acetabular defects. There was a significant decrease in dislocation rate when intra-operative navigation was used. Similarly, the rate of deep infection was also one of the lowest reported in literature. When used for metastatic pelvic disease there was a 100% implant survivorship.