Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis

We retrospectively reviewed 27 patients who had saddle prosthetic reconstruction for pelvic sarcoma from 1991 to 2001 with a mean followup of 45 months. Functional outcome was assessed with Musculoskeletal Tumor Society Scores of 1987 and 1993 and the Toronto Extremity Salvage score. Survival, recurrences, and complications were recorded. Seven (26%) patients had Type II (periacetabular) pelvic resection and 20 had Types II and III (periacetabular and pubis) pelvic resection. Eleven patients had chemotherapy treatment. None received radiation therapy. At final followup 14 patients were free of disease, 11 patients died, and two patients were alive with disease. The survival rate was 60%. Twenty-two percent had local recurrence, and 22% had metastasis. The mean Musculoskeletal Tumor Society Score 93 score in 17 patients was 50.8% +/- 21.7%, the mean Musculoskeletal Tumor Society Score 87 score was 15.3 +/- 6.1, and the mean Toronto Extremity Salvage score was 64.4% +/- 17.2%. Infection occurred in 10 patients; six were deep infections. There were five nerve palsies. Heterotopic ossification occurred in 10 patients, fracture occurred in six patients, and dislocation occurred in six patients. Limb shortening was progressive until it stabilized at 12 months, and ultimately ranged between I and 6 cm. Five patients were retired, five had full-time employment, and six were disabled. Reconstruction with the saddle prosthesis after resection for pelvic sarcoma is associated with substantial morbidity. However, the functional results seem to confer an advantage when compared with the considerable disability incurred after hemipelvectomy.