LIMB SALVAGE IN PERIACETABULAR SARCOMAS - REVIEW OF 21 CONSECUTIVE CASES

The oncologic and functional outcome was reviewed in 21 consecutive pa tients who underwent limb salvaging surgery for periacetabular sarcoma using a new surgical approach and different types of reconstruction b etween 1972 and 1990. Histologic diagnosis in 86% showed osteosarcomas , chondrosarcomas, and Ewing's tumors, Age ranged from 10.0 to 61.5 ye ars (mean age, 32.9 years), The resection margin was wide in 15 patien ts but marginal in 2 patients and intralesional in 4 patients, All of the latter patients died of their disease, In all cases where 3-dimens ional imaging was used, wide resection margins could be achieved, wher eas this was possible only in 50% of the cases with conventional imagi ng techniques, Seven patients died of their disease 3 to 15 months aft er surgery, 2 died of chemotherapy induced sepsis, and 2 patients died perioperatively, At followup, 8 patients had no evidence of disease ( mean, 57.6 months; range, 12-190 months), and 2 patients were alive wi th disease, Fourteen patients could be observed for at least 12 months (mean, 41.1 months) and were functionally evaluated according to Enne king's criteria. If extensive resection was necessary, the best result s were found if the defect had been reconstructed with a custom made p rosthesis, The results were only satisfactory after implantation of sa ddle prostheses and poor with allografts or when no reconstruction of the bone defect was done.