|Beitragstitel||Low grade pelvic chondrosarcoma treated by wide excision with custom-made osteotomy guides and reconstruction with the extracorporeally irradiated tumour as autologous osteocartilaginous graft. A case report.|
Primary tumours of the pelvis, especially around the acetabulum are difficult to treat, mainly because of the complexity of local anatomy. Custom made cutting guides have gained popularity in orthopaedic surgery, thank to their accuracy, ease of use and reproducibility. Their use, however, has rarely been described for the treatment of malignant pelvic bone tumours. We présent the case of a patient with a low grade chondrosarcoma of the iliopubic ramus and acetabulum treated with this technique.
A 30 year old pregnant patient was referred to our sarcoma centre with left hip pain after a low energy trauma. MRI and surgical biopsy revealed a chondrogenic tumour of the left iliopubic ramus, infiltrating the anterior acetabular wall, compatible with a low-grade chondrosarcoma. The patient was followed up closely by MRI and definitive treatment was postponed to after delivery.
Surgery was performed 3 months after uncomplicated childbirth by C-section. Thoraco-abdominal CT did not reveal distant metastases. Wide excision was performed using a double incision with a modified Smith-Petersen approach and anterior dislocation of the hip for exposure of the iliopubic eminence and the acetabulum. The C-section incision was used to expose the medial aspect of the iliopubic ramus. CT and MRI based custom made osteotomy guides (Materialise, Leuven, Belgium) were used to perform the osteotomies through the iliopubic ramus and the anterior acetabular wall. Debulking of the tumour was performed on the back table and the specimen was irradiated with 10MV photons at a dose of 50 Gy. It was then reimplanted in its anatomical position and fixed with plates and screws and the hip was then reduced. Postoperative evolution was uneventful and the patient was discharged home ten days after surgery.
The use of custom made guides allowed close but safe margins, and maximal sparing of joint surface. The autologous osteocartilaginous graft after extracorporeal suppressive irradiation of the specimen allowed anatomical reconstruction of the pelvis and hip, with preserved function and potentially delayed secondary degenerative changes. This technique may represent a viable alternative for the treatment of some sélecte malignant tumours of the pelvis.