Malignant pelvic tumors: Limb-sparing resection and reconstruction

Limb salvage of malignant pelvic tumors should be considered when the tumor can be resected with a satisfactory surgical margin or when tumor location is such that amputation would not provide a better margin. Local recurrence rates approximate 17% with higher recurrence rates in patients with positive microscopic resection margins. Skeletal reconstruction is not necessary following resection of the anterior pelvis or incomplete removal of the ilium because pelvic stability is maintained. In patients with resection of the ilium and loss of pelvic stability, iliosacral arthrodesis provides good function. Reconstruction following periacetabular resections remains extremely challenging. Options include iliofemoral arthrodesis or pseudarthrosis, massive allograft or autoclaved allograft with hip arthroplasty, and pelvic or saddle prosthesis. We favor iliofemoral arthrodesis in the young, active patient because it provides good function with a durable, stable limb.