Periacetabular Reconstruction with a New Endoprosthesis

Reconstruction of the Type II pelvic resection is challenging. Currently available reconstructive options have inherent problems including graft and implant failure, pain, poor function, and high major complication rates. The periacetabular reconstruction (PAR) endoprosthesis was designed to be secured with internal fixation and bone cement to the remaining ilium and support a reconstructed acetabulum. This construct potentially avoids the complications of graft or hardware failure, while maintaining early mobilization, comfort, limb lengths, and function. We retrospectively reviewed 25 patients who underwent Type II pelvic resection and reconstruction with the PAR endoprosthesis, analyzing function, complications, and survivorship. The minimum followup was 13 months (mean, 29.4 months; range, 13 to 108 months). We compared the PAR data with the literature for the Mark II saddle endoprosthesis. The PAR's average MSTS score was 20.8 (67%), major complications occurred in 14 (56%), and implant survivorship was 84% at 2 years and 60% at 5 years. The rate of failure at the ilium-saddle interface was lower and implant survivorship higher than those in the published literature for the Mark II saddle. We recommend use of the PAR endoprosthesis for reconstruction of large defects following Type II pelvic resection. The modified saddle design provides greater inherent stability, allowing for faster rehabilitation and improved longevity without increased complications and is an improvement over the currently available saddle prostheses. Level of Evidence: Level III, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence.