Osteosarcoma around the knee: Intraepiphyseal excision and biological reconstruction with distraction osteogenesis

Tsuchiya, Hiroyuki; Abdel-Wanis, Mohamed E.; Sakurakichi, Keisuke; Yamashiro, Teruhisa; Tomita, Katsuro

doi:10.1302/0301-620x.84b8.13330

Cited by 84 publications

(61 citation statements)

References 4 publications

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“…Normal knee flexion and extension was achieved by 18 patients and 28 patients were able to walk unaided after surgery. These results are comparable with those of previous studies of reconstruction of bone defects if the epiphysis is preserved [7,[23][24][25][26][27]. Yu et al [27] evaluated five patients in whom the epiphysis was preserved after resection of osteosarcoma of the distal femur; their patients were followed for more than 5 years.…”

Section: Discussionsupporting

confidence: 85%

“…This is likely attributable to better imaging technologies and more experience with limb-preservation techniques. However, there is a paucity of literature regarding the long-term oncologic and orthopaedic results of this approach [24]. We therefore sought to evaluate (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically, the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications; and (4) the functional outcomes in patients treated with this approach.…”

Section: Discussionmentioning

confidence: 99%

“…The most common tumor resection technique used for a metaphyseal osteosarcoma of the distal femur or proximal tibia is the intraarticular resection of the distal part of the femur, proximal part of the tibia, or both [11,23]. However, intercalary tumor resection, with preservation of the epiphysis and knee, is an alternative in patients without tumor involvement of the distal part of the femur or the proximal part of the tibia [1,5,7,14,24,26]. The technique is possible in selected patients owing to advances in preoperative imaging [9,10,[18][19][20][21][22], which allows the surgeon to determine tumor margins and plan tumor resection that preserve a patient's uninvolved epiphysis.…”

Section: Introductionmentioning

confidence: 99%

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Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Aponte-Tinao

Ayerza

Múscolo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

111

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Background Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. Questions/purposes We wanted to assess (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in patients who have undergone intercalary tumor resection. MethodsWe analyzed all 35 patients with osteosarcomas about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5 years, unless death occurred earlier (mean, 9 years; range, 1-16 years), and no patients were lost to followup. During the study period, our indications for this approach included patients without metastases, with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1 cm thickness could be available after a surgical margin width in bone of 10 mm was planned, and 16% of patients (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of patients, oncologic complications such as local recurrence and tumor progression, limb survival, and orthopaedic complications including infection, fracture, and nonunion. Survival rates were estimated using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system. Results Overall survival rate of the patients was 86% (95% CI, 73%-99%) at 5 and 10 years. Five patients died of disease. No patient had a local recurrence in the remaining bony epiphysis, but three patients (9%; 95% CI, 0%-19%) had local recurrence in the soft tissue. The limb survival rate was 97% (95% CI, 89%-100%) at 5 and 10 years. Complications treated with additional surgical procedures were recorded for 19 patients (54%), including three local recurrences, two infections, 11 fractures, and three nonunions. In 10 of these 19 patients, the allograft was removed. Only five of the total 35 study patients (14%) lost the originally preserved epiphysis owing to complications. The mean functional score was 26 points (range, 10-30 points, with a higher score representing a better result) at final followup.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Aponte-Tinao

Ayerza

Múscolo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

111

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“…With the advent of effective neoadjuvant chemotherapy and accurate MRI [8], a close but tumor-free margin resection is possible while sparing the juxtaarticular bone and joint as in some metaphyseal osteosarcomas around the knee [2,[9][10][11]15]. However, it is difficult to relate the tumor margins on preoperative CT and/or MR images to the actual extent of the tumor in the bone and to precisely carry out the resection in the operating room without the use of an image guidance or surgical navigation system.…”

Section: Introductionmentioning

confidence: 99%

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Wong

Kumta

2013

Clinical Orthopaedics &Amp; Related Research

100

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Background Joint-preserving surgery is performed in select patients with bone sarcomas of extremities and allows patients to retain the native joint with better joint function. However, recurrences may relate to achieving adequate margins and there is frequently little room for error in tumors close to the joint surface. Further, the tumor margin on preoperative CT and/or MR images is difficult to transpose to the actual extent of tumor in the bone in the operating room.Questions/purposes We therefore determined whether joint-preserving tumor surgery could be performed accurately under image-guided computer navigation and determined local recurrences, function, and complications. Methods We retrospectively studied eight patients with bone sarcoma of extremities treated surgically by navigation with fused CT-MR images. We assessed the accuracy of resection in six patients by comparing the cross sections at the resection plane with complementary prosthesis templates. Mean age was 17 years (range, 6-46 years). Minimum followup was 25 months (mean, 41 months; range, 25-60 months). Results The achieved resection was accurate, with a

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“…Distraction osteogenesis as described by Ilizarov [5,6] is widely used for limb lengthening and bone transport to reconstruct defects after trauma or tumor resection [21][22][23]. However, to achieve extensive bone regeneration, an external fixator must be applied for a considerable time, which may result in many complications [18].…”

Section: Introductionmentioning

confidence: 99%

Uncultured Autogenous Adipose-derived Regenerative Cells Promote Bone Formation During Distraction Osteogenesis in Rats

Nomura

Watanabe

Matsubara

et al. 2014

Clin Orthop Relat Res

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Background Adipose-derived stem cells have recently shown differentiation potential in multiple mesenchymal lineages in vitro and in vivo. These cells can be easily isolated in large amounts from autologous adipose tissue and used without culturing or differentiation induction, which may make them relatively easy to use for clinical purposes; however, their use has not been tested in a distraction osteogenesis model. Question/purposes The question of this animal study in a rodent model of distraction osteogenesis was whether uncultured adipose-derived regenerative cells (ADRCs), which can easily be isolated in large amounts from autologous adipose tissue and contain several types of stem and regenerative cells, promote bone formation in distraction osteogenesis. We evaluated this using several tools: (1) radiographic analysis of bone density; (2) histological analysis of the callus that formed; (3) biomechanical testing; (4) DiI labeling (a method of membrane staining for postimplant celltracing); and (5) real-time polymerase chain reaction. Methods Sixty rats were randomly assigned to three groups. Physiological saline (control group), Type I collagen gel (collagen group), or a mixture of ADRC and Type I collagen gel (ADRC group) was injected into the distracted callus immediately after distraction termination. To a rat femur an external fixator was applied at a rate of 0.8 mm/day for 8 days.Results The bone density of the distracted callus in the ADRC group increased by 46% (p = 0.003, Cohen's d = 10.2, 95% confidence interval [CI] ± 0.180) compared with the control group at 6 weeks after injection. The fracture strength in the ADRC group increased by 66% (p = 0.006, Cohen's d = 1.32, 95% CI ± 0.180) compared with the control group at 6 weeks after injection. Real-time reverse transcription-polymerase chain reaction of the distracted callus from the ADRC group had higher levels of bone morphogenetic protein-2 (7.4 times higher), vascular endothelial growth factor A (6.8 times higher), and stromal cell-derived factor-1 (4.3 times higher). Cell labeling in the newly formed bone showed the ADRCs differentiated into osseous tissue at 3 weeks after injection. Conclusions The injection of ADRCs promoted bone formation in the distracted callus and this mechanism involves both osteogenic differentiation and secretion of humoral factors such as bone morphogenetic protein-2 or vascular endothelial growth factor A that promotes osteogenesis or angiogenesis.

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Osteosarcoma around the knee: Intraepiphyseal excision and biological reconstruction with distraction osteogenesis

Cited by 84 publications

References 4 publications

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Uncultured Autogenous Adipose-derived Regenerative Cells Promote Bone Formation During Distraction Osteogenesis in Rats

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