The patient was a 42-year-old male presenting with progressive right hip pain. Imaging studies revealed a lesion involving the right hemipelvis. Subsequent biopsy confirmed the diagnosis of chondrosarcoma affecting the ilium, pubis, and ischium. Due to the extensive involvement, a combined Type I + II pelvic resection was indicated. Preoperative management included a multidisciplinary oncologic evaluation to optimize planning for a wide resection, ensuring local tumor control while preserving maximal function.
Dr. Sadegh Saberi
- Orthopaedic Oncologist
- Associate Professor of Orthopaedic Surgery
- Tehran University of Medical Sciences (TUMS)
Pre-operative Planning
High-resolution 1-mm CT scans were obtained to create an accurate 3D reconstruction of the pelvis, and MRI was used to precisely delineate tumor margins and define planned osteotomy planes. Patient-specific cutting guides were designed to facilitate accurate bone resections, including the ilium, pubis, and ischium.
A custom 3D-printed hemipelvic implant was modeled based on the contralateral healthy pelvis to replicate normal anatomy. Preoperative planning accounted for:
• Acetabular version and inclination,
• Screw trajectories and lengths for fixation to the sacroiliac joint, pubis, and ischium
• Porous surfaces for promoting osseointegration,
• Holes for soft-tissue and muscular reattachment,
• Alignment aids to maintain cup orientation during implantation.
This detailed preoperative workflow allowed a structured intraoperative plan, minimizing uncertainty, facilitating accurate placement of the prosthesis, and contributing to reduced operative time despite the complexity of the surgery. The implant was manufactured in medical-grade titanium using selective laser melting (SLM) technology, followed by standard post-processing, quality control, and gamma irradiation sterilization.
Surgical Treatment
The procedure was performed under general anesthesia. The patient underwent resection using a combined anterior and posterior approach tailored to the tumor location. The tumor was carefully excised from the ilium, pubis, ischium, and sacroiliac joint while maintaining oncologic margins. Patient-specific cutting guide ensured precise osteotomies, particularly at the pubic site, reducing intraoperative uncertainty and optimizing safety margins.
The custom pelvic prosthesis was implanted according to the preoperative plan. Sacral fixation was achieved using 6.5-mm cancellous screws along the preplanned trajectories, with intraoperative verification of positioning. The dual mobility acetabular component was implanted using the alignment aids built into the prosthesis, ensuring accurate orientation.
Muscular and soft-tissue attachments were restored through designated holes to maintain pelvic stability and proper hip biomechanics. The structured preoperative planning and patient-specific instrumentation contributed to efficient execution and reduced operative time.
Post-operative Follow-up
The patient received intravenous antibiotics for 5 days postoperatively. An abduction brace was applied for 6–8 weeks. Early mobilization with partial weightbearing was initiated, alongside controlled hip range-of-motion exercises, respecting the limits imposed by soft-tissue repair.
Progressive weightbearing was introduced once radiographs confirmed early osseous integration and stable implant positioning. Rehabilitation focused on strengthening the peri-pelvic musculature and gradual functional recovery Throughout follow-up, the patient demonstrated stable fixation, correct implant orientation, and progressive improvement in mobility and independence in daily activities. Adjuvant chemotherapy was continued as per the oncologic protocol. Postoperative imaging confirmed early implant integration, and the patient showed consistent functional recovery.
Physician’s Conclusion
The use of a patient-specific 3D-printed hemipelvic implant with a dual mobility acetabular component enabled precise oncologic resection and effective reconstruction of a complex Type I + II pelvic defect. Integration of patient-specific guides, porous bone-implant interfaces, and secure fixation provided excellent anatomical fit and biomechanical stability. This case highlights the value of custom pelvic prostheses in managing extensive pelvic tumors, facilitating early rehabilitation, and restoring function while maintaining oncologic safety. The structured preoperative planning contributed to a streamlined surgery, reducing intraoperative uncertainty and optimizing operative efficiency.
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Right Hemipelvic Chondrosarcoma in a 42-Year-Old Patient | Dr. Sadegh Saberi