Limb Salvage Surgery for Bone Tumors around the Knee: The Oncological and Functional Outcome—King Hussein Medical Center Experience

Abstract

Abstract:It is a challenge to save the lower limb with a malignant or invasive benign bone tumor around the knee. Retrospectively, we analyzed 30 patients with bone tumors around the knee region. The distal femur involved in 24 patients and proximal tibia in six patients. The tumors included 25 primary malignancies, two metastatic lesions and three giant cell tumors. The reconstruction procedures included 28 endoprosthesis replacements and two autogenous fibular grafts. The average follow-up was 35 months. Twelve patients died and 18 remained disease free. The five year survival rate of 25 patients with primary malignant bone tumors was 60%. The average MSTS (Musculoskeletal Tumor Society) functional score was 60% (range 20%-100%) in all patients. So we conclude that the limb-salvage procedures which accompanied with neo-adjuvant chemotherapy and post-operative chemotherapy are relatively safe. The functional outcome study has inherent limitations which are the inability to randomize treatment and the subjective of the measures, but we conclude that remaining 18 patients were active at home with efficient gait in home and outdoor at a mean of 30 months and those with more functional lower limbs had better quality of life. The infection was the leading cause of surgical complications which needed multi-staged surgery and associated with lower functional outcome. In our opinion, endoprosthesis should be considered as the treatment of choice for bone tumors around the knee joint. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopedic oncologists of the 21st century.