Management of Enneking type III pelvic defects: A comprehensive review of biomechanics and reconstruction strategies.

Resection of Enneking type III pelvic tumors and the subsequent reconstruction of the anterior pelvic ring pose significant challenges due to their deep anatomical location, limited bone stock, and close proximity to vital viscera and neurovascular bundles. The optimal surgical approach for these defects remains controversial. While non-reconstruction is widely practiced to minimize operative time and infection risks, it can disrupt the load-bridging function of the anterior ring, frequently leading to long-term biomechanical instability, compensatory stress fractures, and pelvic visceral herniation. Osseous reconstruction and three-dimensional (3D)-printed implants have markedly transformed type III pelvic reconstruction by offering precise anatomical matching, porous trabecular networks for biological integration, and restored structural continuity. Many orthopedic oncology centers have adopted osseous and prosthetic reconstruction strategies, leading to reduced visceral herniation and enhanced long-term biomechanical stability. However, most studies are limited to single centers with a small number of cases and short follow-up periods. Furthermore, current surgical decision-making relies heavily on subjective functional scores and personal experience, which provokes biomechanical controversies and highlights the urgent need for standardized, evidence-based guidelines. To provide a comprehensive assessment of this clinical domain, we conducted an analysis of existing literature, encompassing anatomical and biomechanical characteristics, the evolution of reconstruction strategies, and future precision reconstruction technologies.