Pelvis Model for Reconstruction with Autografted Long Bones following Hindquarter Amputation - Computational Biomechanics of the Musculoskeletal System - page 128

table 11.2
Finite element models of Pelvic reconstruction and applications

year author(s) resection location(s) reconstruction method(s)

2003 Kawahara et al. IV + S A modified Galveston; a triangular frame;

and a novel reconstruction

2008 Jia et al. I Fibular autograft with four different

rod-screw systems

2009 Niu et al. I + II + III Autograft long bones

2010 Ji et al. II + III Modular hemipelvic prosthesis

2012 Zhu et al. IV + S Sacral-rod; 4-rod; bilateral fibular flaps; and

improved compound Galveston techniques

2013 Zhou et al. I + II + III Modular hemipelvic prosthesis

2013 Hao et al. II + III Modular hemipelvic prosthesis

11.2 hemIPelvIC autograFt reConStruCtIon
After hemipelvic amputation, ipsilateral autogenous bones are harvested as native materials for
repairing wide bone defects. It is a purely biological reconstruction with perfect osteoinductive
properties and can avoid the loosening and breakage often seen with metal implants. Rejection and
potential for disease transmission can be ignored in this procedure. Because of the small number
of complications and good functionality, autograft implantation was recommended by Hillmann
et al. (2003).
Bramer and Taminiau (2005) reconstructed the pelvic ring and tuberosity of the ischium (TI)
with the ipsilateral femur or tibia in three patients, two of whom were alive one and four years
postoperatively. The authors believed that in selected cases with a wide defect in the hemipelvis
after resection, this method could improve function and quality of life, but they failed to report
on whether the femoral condyle (FC) used to replace TI was situated in the vacated space of the
original TI.
Wang et al (2012) recently studied the anatomy of proximal femoral autografts of 13 fresh-frozen
Chinese male cadavers. Based on their measurements, we calculated the diameter of the femoral head,
the distance from the apex of the greater trochanter perpendicular to the medial cortex edge of the
femoral neck, the length between the apex of the femoral head and the midpoint of the osteotomy line
under the lesser trochanter, and the width of the greater trochanter from anterior to posterior. These
parameters were 50.0 ± 2.7 mm, 56.9 ± 5.9 mm, 100.8 ± 5.7 mm, and 48.9 ± 2.7 mm, respectively.
There was a positive correlation between subject height and each of these parameters. The authors
thought that proximal femoral autograft reconstruction was a good option after hemipelvic resection.
Seventy cases have been investigated and measured retrospectively using radiographic data at the
Tongji University School of Medicine to determine the maximum diameter that could be contained
in the trochanter. Dual-energy x-ray absorptiometry was used to detect the bone mineral density
(BMD) of the natural acetabulum and trochanter of eight volunteers to reflect BMD differences and
determine whether postoperative protection was needed. The experiment was detailed by Gao et al.
(2011). It was found that the section of the greater trochanter was round and had a maximum diam-
eter of 44.2 ± 5.75 mm. The BMD was 1.224 ± 0.183 g·cm −3 in the natural acetabulum and 0.866 ±
0.132 g·cm −3 in the trochanter region. The hemipelvis and acetabulum could be reconstructed with
an autograft from the ipsilateral proximal femur. Therefore, it is feasible to reconstruct the hemipel-
vis and hip joint with an autografted ipsilateral proximal femur combined with a normal-sized total
hip replacement. Postoperative protection is mandatory for the new acetabulum as it would not be
able to replace the natural one in terms of BMD.