Case Reports
Treatment of Radiation-Induced Soft-Tissue Fibrosis and Concomitant Acetabular Osteonecrosis: A Case Report
Am J Orthop. 2007 April;36(4):E56-E58
Author and Disclosure Information
Robert J. Goitz, MD, Matthew M. Tomaino, MD, Patrick Smith, MD, David Hannallah, MD, MSc, and Raj Sinha, MD
Dr. Goitz is Associate Professor of Orthopaedic Surgery and Chief of Hand and Upper Extremity Surgery; Dr. Smith is Assistant Clinical Professor of Orthopaedic Surgery; and Dr. Hannallah is Chief Resident, Orthopaedic Surgery, all at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Dr. Tomaino is Professor of Orthopaedic Surgery and Chief of Hand, and Upper Extremity Surgery, University of Rochester, Rochester, New York.
Dr. Sinha is Staff Physician, Desert Orthopaedic Center, Rancho Mirage, California.
Abstract not available. Introduction provided instead.
Radiation therapy is used for a variety of soft-tissue sarcomas. Complications from radiotherapy to the pelvis are well known, with most literature reports1,2 focused on consequent bony changes, including postradiation necrosis of acetabulum, osteoporosis, bone-marrow fibrosis, microfractures, and secondary osteosarcoma. Massin and Duparc3 retrospectively studied the largest series of cases (N = 71) of postradiation osteonecrosis of the pelvis. All patients had some form of radiation osteitis, such as atraumatic femoral neck fracture, osteonecrosis of femoral head or acetabulum, and radiation osteitis of the entire pelvis.
Similarly, radiation necrosis of soft tissues has been well described. The fibrosis, necrosis, ulceration, and fistula formation within the dermal layer—which occur after radiotherapy—lead to what may be described as the classic “radiation wound.”4 Early and late infections, including cellulitis and abscess formation, are also known complications of radiotherapy. Effects on muscle, which result in shortening, contracture, and decreased range of motion (ROM) of the involved joints, are less often discussed.
Wound closure after tumor extirpation is difficult. Tissue transfers can augment wound closure, but complication rates remain high. Recently, Pu and Thompson5 reported 2 cases of chronic wound drainage associated with pyarthrosis of the knee joint after radiation therapy. Both patients required soft-tissue reconstruction with free tissue transfers for limb salvage.
There have been no published reports of combined joint-and-soft-tissue reconstruction for radiation-induced osteonecrosis and concomitant soft-tissue necrosis. The challenging problem of combined soft-tissue injury and joint destruction requires joint reconstruction and free tissue transfers. In this report, we present the case of a complex hip reconstruction for primary arthroplasty failure caused by postradiation necrosis of the hip with extensive soft-tissue necrosis.