Background

While extra-articular resection (EAR) of the knee and shoulder joint is associated with poorer clinical outcomes, the oncological and functional risks of EAR of the hip joint are unknown. We aimed to compare these risks between EAR of the hip joint and intra-articular resection (IAR).

Methods

We conducted a comparative study of 75 patients who underwent en-bloc tumour resection and limb-salvage reconstruction for bone sarcomas of the peri-acetabulum between 1996 and 2016. We divided patients into two groups for analyses; EAR (n = 21) and IAR (n = 54).

Results

There was no statistical difference in oncological outcomes; the 5-year cumulative incidence of disease-specific death was 34% and 35% in the EAR and IAR groups, respectively (p = 0.943), and the 5-year cumulative incidence of LR was 26% and 34%, respectively (p = 0.482). The most common complications were dislocation (28%) and deep infection (28%); there was equally no difference between the groups. The mean Musculoskeletal Tumour Society score was 66% and 65% in the EAR and IAR groups, respectively (p = 0.795), and were significantly lower in patients with deep infection (52% vs. 69%; p = 0.013). In a sub-analysis on the outcomes in patients who underwent PI-uninvolved PII-resection for chondrosarcoma, no major differences in oncologic and functional outcomes were confirmed.

Conclusion

Patients undergoing EAR and limb-salvage reconstructions of the hip joint have undistinguishable oncological, clinical and functional outcomes compared to those undergoing IAR and reconstructions. If preoperative imaging suggests articular tumour involvement, there appears to be no detrimental effect of undertaking EAR to optimise local control.

中文翻译：

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骨盆肉瘤髋关节外切除术：与关节内切除术相比，是否存在任何肿瘤学和功能风险？

背景

虽然膝关节和肩关节的关节外切除 (EAR) 与较差的临床结果相关，但髋关节 EAR 的肿瘤学和功能风险尚不清楚。我们旨在比较髋关节 EAR 和关节内切除术 (IAR) 之间的这些风险。

方法

我们对 1996 年至 2016 年期间接受整块肿瘤切除和保肢重建髋臼周围骨肉瘤的 75 名患者进行了比较研究。我们将患者分为两组进行分析；EAR (n = 21) 和 IAR (n = 54)。

结果

肿瘤学结果没有统计学差异；EAR 组和 IAR 组 5 年疾病特异性死亡累积发生率分别为 34% 和 35%（p  = 0.943），LR 组 5 年累积发生率分别为 26% 和 34%（p  = 0.482)。最常见的并发症是脱位（28%）和深部感染（28%）；两组之间同样没有差异。EAR 组和 IAR 组的平均肌肉骨骼肿瘤协会评分分别为 66% 和 65%（p  = 0.795），并且在深部感染患者中显着降低（52% 对 69%；p = 0.013)。在对接受 PI 未受累的 PII 切除软骨肉瘤患者的结果进行亚分析时，证实肿瘤学和功能结果没有重大差异。

结论

与接受 IAR 和重建的患者相比，接受 EAR 和髋关节保肢重建的患者具有无法区分的肿瘤学、临床和功能结果。如果术前影像显示关节肿瘤受累，则进行 EAR 以优化局部控制似乎没有不利影响。