Surgical Techniques and Considerations

Surgical Techniques1, 3, 6,11

The patient is placed in the lateral decubitus position and the pelvis is approached via a long anterolateral or posterolateral incision (see below) or in some cases, both. Nerves and vasculature must be carefully dissected.

  • Median operative time is close to 7 hours
  • Blood loss ranges from 450-5000cc in most cases1, 3, 6, 8, 11, 16

When the pelvis is exposed and depending on whether the lesion is primary or metastatic usually determines the margins of the osteotomy. Wide margins can be curative in primary neoplasia, whereas in metastatic disease, margins are not as important.

The incision, black dotted line.

How much resected bone is too much? 

The stated range of native ilium bone stock needed for insertion of a saddle prosthesis varies per surgeon. Most commonly, at least 2-4cm of native bone stock is needed. Rarely, the region may need to be stabilized with bone graft and screws.1, 3, 6, 11

The PAR prosthesis needs more native bone stock that the traditional saddle prosthesis to accommodate the large wings.

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