Clinical and functional outcomes of the saddle prosthesis

BACKGROUND:The implantation of a saddle prosthesis after resection of a pelvic tumor has been proposed as a simple method of reconstruction that provides good stability and reduces the surgical time, thus limits the onset of intraoperative complications. There are no studies in the literature of patients evaluated using gait analysis after being implanted with a saddle prosthesis. The present study is a retrospective case review aimed at illustrating long-term clinical and functional findings in tumor patients reconstructed with a saddle prosthesis. MATERIALS AND METHODS:A series of 15 patients who received pelvic reconstruction with a saddle prosthesis were retrospectively reviewed in terms of clinical, radiographic, and functional evaluations. Two patients were additionally assessed by gait analysis. RESULTS:Long-term functional follow-up was achieved in only 6 patients, and ranged from 97 to 167 months. Function was found to be rather impaired, as a mean of only 57 % of normal activity was restored. Gait analysis demonstrated that the implant had poor biomechanics, as characterized by very limited hip motion. CONCLUSIONS: Though the saddle prosthesis was proposed as advance in tumor-related pelvic surgery, the present study indicates that it yields unsatisfactory clinical and functional results due to both clinical complications and the poor biomechanics of the device. The use of a saddle prosthesis in tumor surgery did not provide satisfactory results in long-term follow-up. It is no longer implanted at our institute, and is currently considered a "salvage technique.

The effect of preoperative status and timing on outcome following total hip arthroplasty /

Introduction. Total hip arthroplasty (THA) has been well documented to enhance patient function, but patient outcome is dependent on preoperative status. The exact timing of surgery to optimize patient outcome after THA remains unknown. This study determines the ideal timing for surgery to obtain the best possible functional outcome.Methods. Prospective, multicenter, cohort studies of 175 hybrid THAs. General health (SF-36) and disease specific (WOMAC and Harris Hip Score (HHS)) questionnaires were used to determine preoperative and 2 year final outcomes. Student's t-test, 95% confidence intervals, receiver operator characteristic curves, simple regression analysis and probability were measured.Results. All functional scores were improved significantly postoperatively (p<0.001). Patients with a HHS ≥ 65 preoperatively had a 100% probability of having an excellent result postoperatively. A preoperative HHS value of 34 and preoperative WOMAC (physical function) value of 50 were the best cutoff points to attain a significantly better postoperative functional outcome

Resection of Periacetabular Lesions

Peri-acetabular pelvic resections are demanding operations with complex indications, anatomy, and postoperative rehabilitation. Sir Gordon Gordon-Taylor of Britain in 1935 called hindquarter amputations “one of the most colossal mutilations practiced on the human frame.” [1] It was attempted with and without success prior to the turn of the twentieth century with Girard of Berne documenting the first nonfatal pelvic resection for sarcoma in 1895 [2]. As the knowledge base of pelvic anatomy, oncology, and imaging technology grew, more attempts at hemipelvectomy were made, and various techniques were developed. The application of cross-sectional imaging as well as the rise of metallurgy and implant development in the 1970s expanded the indications of this operation