Internal Hemipelvectomy and Pelvic Reconstruction With Non-Vascularized Fibular Graft for Chondrosarcoma Ilium

Reconstruction of Type I-II Internal Hemipelvectomy in a Patient With Pelvic Myxoid Chondrosarcoma: A Case Report

Pelvic chondrosarcomas are a major clinical challenge since the only therapeutic approach available is surgical resection. Reconstruction after partial resection of the pelvis including the acetabulum or the hip joint is a laborious and rigorous surgical procedure. Numerous complications are associated with different reparative methods. Moreover, due to the anatomical complexities of the area, adequate surgical margins are difficult to achieve in many cases, which are closely related to the advent of local recurrence of the tumor. Several techniques for hip function restoration and skeletal reconstruction have been reported. The purpose of this report is to describe a novel pelvic reconstruction technique for PI-II resection that required a custom-designed implant. We present the case of a 61-year-old female patient with chronic pain in the gluteal region. The pelvis’s magnetic resonance imaging (MRI) showed an osteolytic tumor in the right iliac wing that compromises the acetabular roof. The diagnosis was a grade 2 central chondrosarcoma. Surgery included the reconstruction of the acetabulum by inserting two Schanz pins coated with hydroxyapatite, one in the iliopubic corridor and the other in the ischium. A supporting “pyramid” was built, unitizing both Schanz with cement, onto which an acetabular cage was inserted. The procedure was completed with a conventional total hip prosthesis. The patient presented an acute prosthesis infection, which positively responded to prompt surgical lavage and antibiotic treatment. After 10 months of follow-up, the patient remains free of infection, with weight-bearing as tolerated, without pain, and with excellent hip motion. No tumor recurrence has occurred. Medialization of the construct has occurred as expected, with no evidence of implant loosening. The technique used in this patient is novel, could be considered cost-effective, and has allowed the reconstruction of a functional hip. For resections of the acetabular area and preservation of the ischium and pelvic zones, this technique may be an acceptable option.