PMC7607948_01
(a) In anteroposterior pelvic X-ray, there is an exophytic lesion containing a chondrogenic matrix that grows from right iliac wing. (b) In coronal T2 fat-suppressed sequences, an exophytic growing soft tissue mass from right iliac bone is invading lateral capsule of hip joint. (c) In axial T2 fat-suppressed sequences, T2 increased signal intensity in right iliac bone extends through bone marrow and subchondral area of sacroiliac joint while sacroiliac joint involvement is absent.
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MRI, tumoral tissues originating from destroyed cortex of the right iliac wing was extending to the right sacroiliac junction adjacent to the iliac crest accompanied by the soft tissue component. Moreover, hip joint involvement was also detected (Figure 1a-c).
(a) Preoperative wound planning. (b) Intraoperative tumor resection and reconstruction with prosthesis. (c) Postoperative wound closure.
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Surgery was performed in the lateral decubitus position under general anesthesia. "T" (extensive triradiate) incision was used to facilitate access to the posterior and anterior anatomical structures, which could also exclude the biopsy tract (Figure 2a). To avoid any length discrepancy at the lower extremity, the joint level was raised and the joint was reconstructed with a proximal femur modular tumor resection prosthesis (Figure 2b, c).
(a, b) Early postoperative anteroposterior X-rays (placement of pedestal cup, LUMiC , through sacrum and L5 vertebra). Balanced lower extremity length after reconstruction.
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No complications were seen clinically and radiologically in early postoperative period (Figure 3a, b).
(a) Postoperative 23rd month anteroposterior X-ray shows failure of LUMiC  after motorcycle accident. (b) After final operation, early anteroposterior pelvic X-ray (placement of LUMiC  and L5 corpus screw and rods). (c) Control anteroposterior pelvic X-ray at postoperative 36th month.
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Implant failure on the LUMiC  and limb discrepancy were detected and the decision was established for revision (Figure 4a). Additionally, axial stability of LUMiC  prosthesis was supported by a L5 polyaxial corpus screw and lateral connector rod from L5 vertebrae to LUMiC  prosthesis (Figures 4b and 5b).
(a) Intraoperative instability and malposition of LUMiC  prosthesis. (b) Placement of LUMiC  and L5 corpus polyaxial screw, lateral connector, and pre-bent rod. (c) Spinopelvic implants and Kirschner wires augmented with antibiotic loaded cement.
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LUMiC  stem were detected (Figure 5a). LUMiC  and cements were removed and signs of infection were not detected. Additionally, axial stability of LUMiC  prosthesis was supported by a L5 polyaxial corpus screw and lateral connector rod from L5 vertebrae to LUMiC  prosthesis (Figures 4b and 5b). Then, two Kirschner wires were placed to ala of sacrum and all implants were augmented by antibiotic loaded cement to support the stability of our reconstruction (Figure 5c).