engleski

Acetabular transplantation in a girl with Ewing sarcoma: Case report

INTRODUCTION: Pelvic tumors remain the major challenge in orthopedic oncology. We present the first case of acetabular reconstruction with bone graft in Croatia. CASE REPORT: A 15 year old girl with Ewing sarcoma reported to our department due to three months history of upper thigh pain. The diagnosis of Ewing sarcoma was done according to X ray, MRI, bone scan and biopsy. Preoperative chemotherapy was administrated. PROCEDURE: Bone graft (homotransplant) was obtained from cadaver a few weeks before the operation, and stored in Bone bank. All microbiological tests were negative for obtained cadaveric specimen. Acetabular transplantation was done as a single procedure: acetabulum was resected en bloc through the illium, upper ischium, and upper ramus of pubic bone, with clear margins. Homotransplant was prepared to fit resected part of pelvis. Fixation of homotransplant to remnant pelvis was done by plates and screws. Hip joint was reconstructed with total hip replacement: cemented acetabular part fixed into bone graft, and uncemented femoral component. Operating time was 7 hours with total blood loss of 1.5 L. Immediate postoperative period was without complications. Antibiotics and thromboprofilaxis were administrated according to guidelines. Fourth postoperative day the patient presented with high fewer, elevated C-reactive protein and erythrocyte sedimentation rate, and fistula in operative scar. Swab revealed deep bacterial infection. Antibiotics were given, and negative pressure pump was placed in the wound, but without success. Finally, bone graft was removed from patient 32 days after primary operation. One month after operation patient can walk with two cruches and coxofemoral brace. DISCUSSION: Imunocompromised patients due to chemotherapy, relatively long operation time, and proximity of possible contaminated pelvic and abdominal region predispose high risk for infection. In literature, infection rate is up to 30–40%, and other complications in more than 2/3 of patients with reconstruction of pelvic tumors.

acetabulum; tumor; Ewing sarcoma; transplantation

Liječ Vjesn 134, Supplement 6, Zagreb, November 2012