A Six-case Series of Pelvic Bone Tumor Resection with Limb Preservation: Prosthetic Reconstruction, Osteosynthesis, and Conservative Surgical Approaches

Abstract

Background: Pelvic bone tumors are rare, complex lesions whose management is challenging due to delayed diagnosis, intricate anatomy, and proximity to critical neurovascular structures, requiring multimodal imaging, biopsy confirmation, and individualized surgical resection with reconstruction when needed. Aims: To report the diagnostic and therapeutic features of six patients managed for pelvic bone tumors in a Moroccan tertiary orthopedic unit, highlighting surgical approaches, reconstructive choices, functional outcomes, and specific challenges in a resource-limited setting. Study Design: Retrospective descriptive case series. Place and Duration of Study: Department of Orthopedic Surgery and Traumatology, Mohammed VI University Hospital, Tangier, Morocco, January 2023 – December 2025. Methodology: Six patients (5 women, 1 man; mean age 35.7 years; range 16–67) operated for histologically confirmed pelvic bone tumors. Data on clinical presentation, multimodal imaging, histological diagnosis, neoadjuvant and adjuvant treatments, surgical resection type (Enneking–Dunham classification), reconstructive strategy, complications, functional outcomes (MSTS score), and follow-up were collected via REDCap database. Results: Histological subtypes: Ewing sarcoma (n=3), chondrosarcoma (n=1), intraosseous cavernous hemangioma with aneurysmal changes (n=1), bone metastasis from breast carcinoma (n=1). Mean diagnostic delay: 17 months. All patients underwent limb-sparing surgery. Reconstructions: ilio-femoral ice-cream cone prosthesis (n=1), plate osteosynthesis (n=2), cement + T-plate (n=1), hernia mesh filling (n=1), no reconstruction (n=1). Four patients (67%) in complete remission (7 months to 2 years follow-up). One death from Ewing sarcoma metastatic relapse. One locoregional recurrence (metastatic carcinoma). Functional recovery satisfactory in survivors. Conclusion: Limb-preserving pelvic surgery is achievable across diverse histological subtypes and reconstructive needs in a resource-limited Moroccan tertiary center, though conclusions are necessarily limited by the small and heterogeneous sample size. The 17-month mean diagnostic delay remains the primary obstacle in the Moroccan context. Multidisciplinary tumor boards, improved imaging access, and national referral networks are essential.