Pelvic Reconstruction
The Client
Orthopaedic Surgeon
The Case Report
A 39 year old female patient presented with left hip pain. An x-ray was taken showing a large lesion involving the roof of the acetabulum, extending into the proximal ischium and right through into the wing of the ilium involving both the sciatic notch extending back towards the acroiliac joint. This had the characteristic appearances of a chondrosarcoma and was biopsied. This confirmed this diagnosis. This was Grade I -II.
The patients options were to have a hind quarter amputation or to have a custom prosthesis to replace the area of bone requiring resection. The lesion was fortunately contained within the bone without soft tissue extension.
The Implant Development
A custom prosthesis was designed and manufactured by Enztec using CT Scan data to incorporate an acetabulum into which would be cemented an acetabular component of the surgeons choice. The prosthesis was designed so that intra operative adjustment could be undertaken if needed by the surgeon.
Secure fixation to the residual pelvis was provided by a combination of fixed angle spikes, bolts, and orthopaedic screws. The whole prosthesis was manufactured using an endoskeleton technique, welded to an aerospace standard with TIG welding, heat treated, crack tested and then passivated.
The whole manufacturing process took less than two weeks and the surgery less than five hours, and incorporated a total hip replacement. The patient was kept in hospital to allow early healing of soft tissue to the implant and to gain stability of the hip joint which was devoid of all its hip capsule.
Clinical Outcome
The patient has remained tumour free with adequate margins, and can walk without a stick with only a slight limp. For long walks she uses a single walking stick in the opposite hand. She is able to swim, has no pain, and follow-up x-rays have shown no evidence of complication, either in the implant loosening or recurrence of the tumour.
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