From OT Europe

19th EFORT Annual Congress: The essentials of orthopaedic reconstruction in pelvic oncology

EFORT

Besides the prevailing aim of any orthopaedic surgery to preserve the anatomical functions of the treated limb, surgeons specialized in management of musculoskeletal tumors face an extra challenge in their daily practice: making a choice that avoids tumor recurrence.

To address the medical options regarding tumor treatment specifically around the pelvis, our upcoming EFORT Congress in Barcelona will provide a concise 2-hour overview of this difficult problem via the Interactive Expert Exchange (IEE) session led by Prof. Reinhard Windhager, chair of the department of orthopaedics and trauma surgery at the Medical University of Vienna.

The numerous challenges associated to resection of pelvic tumors will be explored by a group of highly experienced reconstruction surgeons who will outline all available reconstructive techniques and discuss their current preferred strategies. Indeed, factors that affect the results of reconstruction after pelvic tumor resection can be diverse, despite often being patient-related or linked to the tumor amplitude and functional status of the limb. An interactive clinical case discussion, which includes two provocateurs, complements the IEE content and reviews tangible examples of each option discussed.

Barcelona banner

As malignant bone and soft-tissue tumors can spread cancer cells to the rest of the body, several decades ago, doctors removed tumors by directly amputating the affected limb. Nowadays, as limb-sparing surgery in the pelvic region has become the standard of care in around 90% of the cases, orthopaedic surgeons are constantly defied to find the best reconstructive solution for each patient. Once the tumor and surrounding tissues are removed, an allograft bone transplant or an orthopaedic implant, such as an artificial joint, replace the bone excised. Advances in imaging techniques and improvement in prosthetic design have changed the prognosis for patients with a non-metastatic disease, justifying major surgical resections of pelvic malignancies. However, the limits of reconstruction, in terms of the time invested by the medical multi-disciplinary teams and in terms of the patient’s quality of life, remain inconstant. In addition, due to a large list of defects encountered in practice, reconstructive surgery after resection of pelvic tumors has always been in the spotlight with many experimental attempts out of which only a few have been selected for wider use.

Reconstructive Surgery in Pelvic Tumors
Thursday 31 May 2018 | 10:00 – 12:15

Introduction & Conclusions
Reinhard Windhager (Austria)

Questions & Presentations

  • Long-term Results of Endoprosthetic Replacement in The Pelvis – Robert Grimer (United Kingdom)
  • The Role of Pedestal Cup After Tumor Resection – Sander Dijkstra (Netherlands)
  • 3D Printing in Pelvic Oncology – Pietro Ruggieri (Italy)
  • Hip Transposition: Do We Need Endoprosthetic Replacement? – Jendrik Hardes (Germany)

Discussion on Clinical Cases
Mikel San Julián Aranguren (Spain) & David Biau (France)

Clinical results for pelvic reconstruction based on allografts have high rates of wound complications, mechanical failures, and often imply a long-term exposure to infections, and need for revision. Therefore, this medical approach has been abandoned early. It is also the case of endoprosthetic reconstruction, initially introduced in the oncologic field by customized pelvic implants. Infection rates as high as 40% were reported in the literature and caused huge concerns regarding the usage of those implants, especially in patients with local irradiation and chemotherapy. The failure of these two treatment options, gradually led to the development of alternative reconstructive techniques that avoid metal implants as much as possible. Despite this new path in the research profession of pelvic oncology, the innovative introduction of silver coating as a protection against infection and the increased precision of MRI and CT imaging, resettled the endoprosthetic replacement as a reliable option. Indeed, advanced imaging and 3D printing allow a more rapid and concise preoperative production of custom tumor prostheses. Modern navigation tools and patient-specific instruments not only allow a more accurate resection, but also give the possibility to design and tailor an implant based on the exact level of resection and the anticipated bone stock that will remain.

IEE banner

The highly interactive format of these sessions will combine current knowledge on pelvic reconstruction strategies with intense discussions highlighting difficult cases where surgical execution does not adhere preoperative planning. Specialists and practitioners attending this IEE will benefit from the deep analysis of complex situations by renowned experts to improve their skills and ease their daily practice within the field of pelvic reconstruction.

IEEs are paying sessions and pre-registration is mandatory on a first-come, first-serve basis (maximum of 200 participants). Only participants with a full registration for the congress can attend the IEE sessions. All details to sign-up are available on our registration platform. Visit our Barcelona congress website regularly.

EFORT

Besides the prevailing aim of any orthopaedic surgery to preserve the anatomical functions of the treated limb, surgeons specialized in management of musculoskeletal tumors face an extra challenge in their daily practice: making a choice that avoids tumor recurrence.

To address the medical options regarding tumor treatment specifically around the pelvis, our upcoming EFORT Congress in Barcelona will provide a concise 2-hour overview of this difficult problem via the Interactive Expert Exchange (IEE) session led by Prof. Reinhard Windhager, chair of the department of orthopaedics and trauma surgery at the Medical University of Vienna.

The numerous challenges associated to resection of pelvic tumors will be explored by a group of highly experienced reconstruction surgeons who will outline all available reconstructive techniques and discuss their current preferred strategies. Indeed, factors that affect the results of reconstruction after pelvic tumor resection can be diverse, despite often being patient-related or linked to the tumor amplitude and functional status of the limb. An interactive clinical case discussion, which includes two provocateurs, complements the IEE content and reviews tangible examples of each option discussed.

Barcelona banner

As malignant bone and soft-tissue tumors can spread cancer cells to the rest of the body, several decades ago, doctors removed tumors by directly amputating the affected limb. Nowadays, as limb-sparing surgery in the pelvic region has become the standard of care in around 90% of the cases, orthopaedic surgeons are constantly defied to find the best reconstructive solution for each patient. Once the tumor and surrounding tissues are removed, an allograft bone transplant or an orthopaedic implant, such as an artificial joint, replace the bone excised. Advances in imaging techniques and improvement in prosthetic design have changed the prognosis for patients with a non-metastatic disease, justifying major surgical resections of pelvic malignancies. However, the limits of reconstruction, in terms of the time invested by the medical multi-disciplinary teams and in terms of the patient’s quality of life, remain inconstant. In addition, due to a large list of defects encountered in practice, reconstructive surgery after resection of pelvic tumors has always been in the spotlight with many experimental attempts out of which only a few have been selected for wider use.

Reconstructive Surgery in Pelvic Tumors
Thursday 31 May 2018 | 10:00 – 12:15

Introduction & Conclusions
Reinhard Windhager (Austria)

Questions & Presentations

  • Long-term Results of Endoprosthetic Replacement in The Pelvis – Robert Grimer (United Kingdom)
  • The Role of Pedestal Cup After Tumor Resection – Sander Dijkstra (Netherlands)
  • 3D Printing in Pelvic Oncology – Pietro Ruggieri (Italy)
  • Hip Transposition: Do We Need Endoprosthetic Replacement? – Jendrik Hardes (Germany)

Discussion on Clinical Cases
Mikel San Julián Aranguren (Spain) & David Biau (France)

PAGE BREAK

Clinical results for pelvic reconstruction based on allografts have high rates of wound complications, mechanical failures, and often imply a long-term exposure to infections, and need for revision. Therefore, this medical approach has been abandoned early. It is also the case of endoprosthetic reconstruction, initially introduced in the oncologic field by customized pelvic implants. Infection rates as high as 40% were reported in the literature and caused huge concerns regarding the usage of those implants, especially in patients with local irradiation and chemotherapy. The failure of these two treatment options, gradually led to the development of alternative reconstructive techniques that avoid metal implants as much as possible. Despite this new path in the research profession of pelvic oncology, the innovative introduction of silver coating as a protection against infection and the increased precision of MRI and CT imaging, resettled the endoprosthetic replacement as a reliable option. Indeed, advanced imaging and 3D printing allow a more rapid and concise preoperative production of custom tumor prostheses. Modern navigation tools and patient-specific instruments not only allow a more accurate resection, but also give the possibility to design and tailor an implant based on the exact level of resection and the anticipated bone stock that will remain.

IEE banner

The highly interactive format of these sessions will combine current knowledge on pelvic reconstruction strategies with intense discussions highlighting difficult cases where surgical execution does not adhere preoperative planning. Specialists and practitioners attending this IEE will benefit from the deep analysis of complex situations by renowned experts to improve their skills and ease their daily practice within the field of pelvic reconstruction.

IEEs are paying sessions and pre-registration is mandatory on a first-come, first-serve basis (maximum of 200 participants). Only participants with a full registration for the congress can attend the IEE sessions. All details to sign-up are available on our registration platform. Visit our Barcelona congress website regularly.