PMC8035037_01
Axial (a) and coronal (b) T2 STIR weighted views on initial MRI of the pelvis showing a chondrogenic lesion of the left iliopubic ramus extending in the anterior acetabular wall.
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While the MRI showed no traumatic lesion, it revealed a tumor of her left iliopubic ramus infiltrating the anterior acetabular wall, evoking a chondrogenic tumor (Figure 1).
Computer-generated images demonstrating the resection lines (a) and the positioned cutting guides (b) based on MRI- and CT-based reconstructions of the patients' hemipelvis. (Images are courtesy of Materialise , Leuven, Belgium).
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The surgical team planned the resection margins and the cutting guides based on MRI- and CT-based reconstructions of the patients' hemipelvis were fabricated by a company specialized in medical 3D printing (Materialise , Leuven, Belgium) (Figure 2).
Intraoperative picture showing the planning of the incisions for the dual approach: Pfannenstiel and Smith-Petersen, respectively.
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A modified Smith-Petersen (Figure 3) approach was used for anterior dislocation of the hip (Figure 4) and exposure of the iliopubic eminence and the acetabulum.
Intraoperative view of the anteriorly dislocated femoral head through the Smith-Petersen approach (a) and the acetabular cavity (b) after femoral head dislocation, demonstrating the integrity of the labrum (arrow).
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A modified Smith-Petersen (Figure 3) approach was used for anterior dislocation of the hip (Figure 4) and exposure of the iliopubic eminence and the acetabulum.
Intraoperative picture showing the verification of the position of the cutting guide on the 3D-printed model of the patient's hemipelvis.
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C-section (Pfannenstiel) incision was then used to expose the iliopubic ramus. CT- and MRI-based patient-specific osteotomy guides (Figure 5) were used to perform the osteotomies through the iliopubic ramus, anterior acetabular wall, and teardrop (Figure 6).
Intraoperative pictures showing the positioned cutting guide for the osteotomy of the iliopubic ramus (a) and the anterior-superior portion of the acetabulum (b).
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C-section (Pfannenstiel) incision was then used to expose the iliopubic ramus. CT- and MRI-based patient-specific osteotomy guides (Figure 5) were used to perform the osteotomies through the iliopubic ramus, anterior acetabular wall, and teardrop (Figure 6).
Picture of the resected bone. The tumor on the iliopubic ramus infiltrating the anterosuperior portion of the acetabulum is visible.
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The specimen (Figure 7) was then dived in a serum-filled box and sterile packed (Figure 8).
Picture of the specimen after curettage and placement in a physiologic serum filled sterile container ready to be wrapped and transported to the radio-oncology department for irradiation.
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The specimen (Figure 7) was then dived in a serum-filled box and sterile packed (Figure 8).
Intraoperative picture showing the plate fixation of the recycled autograft at the level of the iliopubic ramus.
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Finally, the irradiated bone was reimplanted in its anatomical position and fixed with plates and screws (Figure 9).
Plain film at 4 years of follow-up showing healed osteotomy sites without signs of femoral head avascular necrosis or osteoarthritis. Note the presence of heterotopic ossification.
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Plain films revealed healed osteotomy sites and no signs of femoral head avascular necrosis or osteoarthritis (Figure 10).
PMC8035037_02
AP pelvic plain film showing a lytic lesion of the left iliopubic ramus.
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A plain film of the left hip showed a lytic lesion of the iliopubic ramus (Figure 11).
Axial (a) and coronal (b) T1 TSE sequence views on initial MRI of the pelvis showing a tumor of the left iliopubic ramus.
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MRI of the pelvis revealed a chondrogenic lesion of the left iliopubic ramus extending in the anterior acetabular wall (Figure 12).
Plain film at 30 months of follow-up showing a mild thinning of the joint line.
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Radiological workup at six months of follow-up revealed arthritic changes of the hip in its anterior portion (Figures 13 and 14(a)).
Axial view of a CT scan at 6 months (a) and at 30 months of follow-up (b) showing the healing of the osteotomy and the progression of osteoarthritis in the articular portion of the recycled autograft.
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Radiological workup at six months of follow-up revealed arthritic changes of the hip in its anterior portion (Figures 13 and 14(a)). At 30 months of follow-up, plain films showed complete healing at the osteotomy sites and mild progression of the osteoarthritic changes (Figure 14(b)).