EXTRA-ARTICULAR RESECTION OF THE HIP WITH A POSTERIOR COLUMN-PRESERVING TECHNIQUE FOR TREATMENT OF AN INTRA-ARTICULAR MALIGNANT LESION

A malignant lesion extending into the hip may necessitate en bloc resection of the joint, which may result in substantial loss of pelvic bone stock and compromise pelvic stability. Few reports have dealt specifically with the technical aspects of extra-articular resection of the hip1-4. In this report, we present a technique that allows en bloc resection of the hip with use of a periacetabular osteotomy, reconstruction of the acetabulum with an acetabular allograft, and total hip arthroplasty through a combined ilioinguinal and iliofemoral approach. Fig. 1 The utilitarian incision described by Enneking is used. This incision is well suited for a combination of a modified Smith-Petersen approach, representing the standard approach for the Bernese periacetabular osteotomy, and the ilioinguinal approach described by Judet et al., allowing plate application along the anterior column of the pelvis. We present the cases of two patients in whom we performed an extra-articular resection of the hip for the treatment of intra-articular extension of a proximal femoral malignant lesion. By employing the principles of the Bernese periacetabular osteotomy, we preserved the posterior acetabular column and maintained the continuity and stability of the pelvic ring5. Both patients were informed that data concerning the cases would be submitted for publication. Fig. 2 En bloc resection of the hip was performed with use of a periacetabular osteotomy, as described by Ganz et al., leaving the posterior column intact. The osteotomies were performed in the following order: ischial (a), pubic (b), anterior aspect of the ilium (c), and posterior aspect of the ilium (d). Fig. 3 An acetabular allograft (hatched area) is used for reconstruction of the acetabular bone stock. The graft is fixed with screws (not shown in the diagram but can be seen in Figures 4-B and 5-C) augmented with an anterior reconstruction plate. Fig. 4-A Figs. 4-A and …