الفهرس 
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Abstract
P
eriacetabular oncological lesions may present in various areas of the acetabulum and be of varying size. Many types of reconstruction are available for their treatment to deal with defects after tumor resection but which technique is optimal remains controversial.
This systematic review and meta-analysis study included twenty five studies with a total of 846 cases to evaluate different methods of acetabular reconstruction after periacetabular tumor resection as regards surgical techniques, clinical, functional, oncological outcomes and possible complications.
Methods
We conducted a systematic review of literature in different databases and with pre-specified eligibility criteria and according to Cochrane’s handbook of systematic review guidelines in screening, we concluded sixteen different studies to be included in our study.
Data were obtained from text, tables, figures, and supplementary data. We focused on the following outcome measures: operative time, blood loss, postoperative complication, MSTS score, and implant survival rate. Risk of bias assessment was done according to GRADE guidelines to every study using Cochrane’s risk of bias tool.
Regarding operative time, the current study detected that hemipelvic endoprosthesis and ice-Cream Cone prosthesis had the longest operative time while Computer-Aided Custom-Made Prostheses had the shortest operative time.
Additionally, the present study revealed that extended ilioinguinal and Smith-Petersen approach had the longest operative time followed by iliofemoral approach with Smith-Petersen approach had the shortest operative time.
As regard blood loss, it was found that hemipelvic endoprosthesis had the largest amount of blood loss while rest of implants had nearly similar amounts of blood loss.
With reference to approaches, extended ilioinguinal and Smith-Petersen approach were associated with the largest amount of blood loss.
Concerning overall complications, saddle prosthesis (82%), LUMiC endoprosthetic (68%) and ice-cream cone prosthesis (60%) had the highest complication rates while 3D-printed pelvic endoprostheses had the lowest complication rates (29%).
Between the four approaches included; extended ilioinguinal and Smith-Petersen approach, Smith-Petersen, iliofemoral approach and Smith-Petersen (60%) had the highest complications rate while extended ilioinguinal approach had the lowest complications rate (39%).
With reference to deep infection, deep infection rates in extended ilioinguinal approach ranged between 0% and 23%. Additionally, in Smith-Petersen approach was 5%. Deep infection rate in extended ilioinguinal and Smith-Petersen approach was 15%. Finally, in iliofemoral approach it ranged between 20% and 26%.
Regarding delayed wound healing, delayed wound healing rate in Smith-Petersen approach was 31%. While delayed wound healing rates in extended ilioinguinal approach ranged between 10% and 20%. In compined extended ilioinguinal and Smith-Petersen approach, the delayed wound healing rate was 18%. Furthermore, Iliofemoral approach showed low rate of delayed wound healing (7%).
As regard tumor recurrence, The rates of tumor recurrence varied in Hemipelvic endoprosthesis ranged between 9 % and 30 %, other devices had recurrence rates as following LUMiC1 Endoprosthetic (12.7%), osteotomy guides and endoprosthetic reconstruction (17.8%), Constrained Total Hip Megaprosthesis (28%), modular prosthesis (35.8%) and Computer-Aided Custom-Made Prostheses (18.7%). as regard techniques, local recuurence in Smith-Petersen approach, extended ilioinguinal and Smith-Petersen approach and ilioinguinal approach were 5% to 18.7%, 18% to 32% and 11.1%.
Concerning MSTS score, two prosthesis reported highest scores of MSTS: Hemipelvic endoprosthesis and Ice-Cream Cone Prosthesis while 3D-printed pelvic endoprostheses and compound osteosynthesis reported lowest scores.
Regarding the approaches used, the range for MSTS score was variable between the studies as following; MSTS score in extended ilioinguinal ranged between 19.10% and 72%. Also, Smith-Petersen approach ranged between 19% and 72%. While, extended ilioinguinal and Smith-Petersen approach: MSTS score ranged between 48% and 61.40%. Finally, in iliofemoral approach: MSTS score ranged between 19% and 74%.
Regarding implant survival analysis, the current study detected that first year survival rate was as following; constrained-type hip tumor prosthesis was 91%, ice-cream cone prosthesis was 72% and for Iliac Stem prosthesis first year survival rate was 90%. 3-year survival rate, the present study pooled result for the odds of three year survival for hemipelvic endoprosthesis (OR= 0.78, 95%CI = [0.71, 0.88], I 2 =59.7%, P value=0.04), three year survival rate for the rest was as following; constrained-type hip tumor prosthesis was 62%, ice-cream cone prosthesis was 58% and for Iliac Stem prosthesis first year survival rate was 70%. 5 year survival, best results were achieved by Compound osteosynthesis 93.3 % followed by LUMiC Endoprosthetic 83%.
Study limitations
The present review has some limitations. While it has been possible to pool data from large number of interventions which were followed prospectively and retrospectively: (1) the lack of meta-regression analysis regarding surgeon and the comparison of the complications between different implants were small.; (2) individual studies had variations in exclusion/inclusion criteria; (3) surgeon skills varied between studies; (4) the background diseases of patients were various between studies; (5) the observed heterogeneity may be attributable to numerous other influential factors including size and other technical procedures; (6) some studies were not high-quality; (7) pooled data were analyzed, as individual patient data was not available, precluding more in-depth analyses.
Furthermore, the existence of publication bias, which was common to all meta-analyses, might have been unavoidable in our study.
Recommendations
Reconstruction of hip after peri-acetabular oncological disease remains a challenge for orthopedic surgeons. The combination of patient and tumor factors, as well as the surgical intervention proposed, whether curative or palliative, needs to be assessed for oncological outcomes, complications and implant survivorship free of revision surgery. Therefore, we recommend that:
Further prospective and comparative researches are needed to more accurately detect the outcomes in hip reconstruction for primary and metastatic tumor.
Surgeons should consider general condition of patient and tumor factors when making decision regard option of treatment.
The choice of treatment depend on activity level. In active patient, hemipelvic endoprosthesis and ice-Cream Cone Prosthesis may be the treatment of choice while in inactive patient, 3D-printed pelvic endoprostheses and compound osteosynthesis may be both options of treatment.