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The Journal of Bone and Joint Surgery, Vol 60, Issue 6 731-746, Copyright © 1978 by Journal of Bone and Joint Surgery, Inc
Resection and reconstruction for primary neoplasms involving the innominate bone
WF Enneking and WK Dunham
Using described criteria for the selection of patients for excision or
resection of tumors involving various portions of the innominate bone, as
opposed to hemipelvectomy, fifty-seven out of the more than 200 patients
evaluated were judged to be candidates for a curative procedure. Of these,
twenty-five were selected for hemipelvectomy and thirty-two, for
non-amputative procedures. Depending on the location and extent of the
lesion as determined by complete preoperative work-ups, three types of
procedures were performed singly or in combination:(1) wide excision or
radical resection of the iliac wing; (2) periacetabular wide excision or
radical resection; or (3) wide excision or radical resection of the pubis.
Reconstruction was accomplished when the hip joint was excised by fusion or
the creation of a pseudarthrosis either medially in relation to the pubis
or laterally in relation to the ilium or wing of the sacrum. The results
after follow-ups of one to seventeen years were assessed in terms of the
immediate goals of surgery, control of the disease, and function. The
findings were as follows: With the preoperative assessment and operative
techniques described, an oncologically adequate procedure was performed in
two-thirds of the cases. In the remaining cases, the adequacy of the
procedure was compromised by poorly planned biopsies, occult
microextensions, and surgical errors. The recurrence rate was high after
the inadequate procedure (100 per cent) and low (4 per cent) after the
adequately accomplished procedures. Function was nearly normal when the hip
joint was preserved. If the hip joint was removed and fusion was obtained,
the results were good, but fusion was obtained in only 50 percent of the
cases in which it was attempted. If the hip joint was removed and
pseudarthrosis resulted, the results ranged from good to poor.
Sciatic-nerve involvement necessitating resection of the nerve was not a
contraindication to a non-amputative procedure.
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