Preservation of the knee joint in limb salvage of osteosarcoma in the proximal tibia

Amitani, Asaka; Yamazaki, Takashi; Sonoda, Jun; Tanaka, Masayuki; Hirata, Hitoshi; Katoh, Kiyonobu; Uchida, Atsushi

doi:10.1007/s002640050272

Cited by 32 publications

(34 citation statements)

References 10 publications

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“…Although the rates of nonunion and fracture are similar to those of allograft bone, the overall rate of complication is <52% (15,35,36). Furthermore, the procedure is not applicable for bones that are structurally weak and in bones with pathological fractures.…”

Section: Case Reportmentioning

confidence: 95%

“…Extracorporeally irradiated bone offers an attractive option for reconstructing diaphyseal defects, by acting as a close-fitting scaffold for creeping substitution and incorporation, but it takes a long time to revascularize and incorporate into surrounding bone (14,35). Although the rates of nonunion and fracture are similar to those of allograft bone, the overall rate of complication is <52% (15,35,36).…”

Section: Case Reportmentioning

confidence: 98%

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Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

Zhao

Zhang

2015

Oncology Letters

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Abstract. The present report describes a case of a 44-year-old female patient who presented with a palpable mass of the left thigh. A diagnosis of parosteal osteosarcoma (POS) at the femoral diaphysis was made following a diagnostic workup. Previous reports of long bone diaphyseal POS are rare. A long diaphyseal segment of the femur containing the tumor was resected along with a healthy margin of soft tissues, and the damaged bone was reconstructed with a custom-made intercalary endoprosthesis. Subsequent pathological examination of the surgical sample confirmed the diagnosis of POS. No local recurrence or distant metastasis was observed, and the patient had a positive Musculoskeletal Tumor Society score of 28/30 (93.3%) at the 28-month post-surgery follow-up. The present study describes the clinical, radiological, and pathological features of this rare type of osteosarcoma.

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Section: Case Reportmentioning

confidence: 95%

Section: Case Reportmentioning

confidence: 98%

Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

Zhao

Zhang

2015

Oncology Letters

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“…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%

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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“…The functional evaluation of the patients was performed with use of the revised 30-point functional classification system established by the International Society of Limb Salvage and the Musculoskeletal Tumour Society [1]. This functional score measured six parameters: pain, function, emotional acceptance, use of walking supports, walking ability, and gait.…”

Section: Methodsmentioning

confidence: 99%

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

Hayashi

Tsuchiya

Yamamoto

et al. 2007

International Orthopaedics (SICO

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The functional results of prostheses and osteoarticular grafts for osteosarcoma around the knee joint are not satisfactory because of poor durability and gross distortion of the normal anatomy. We have investigated the functional outcome of intentional marginal excision for osteosarcoma around the knee joint in conjunction with caffeine-potentiated chemotherapy. Twenty-one patients with AJCC stage IIB high-grade osteosarcoma around the knee joint were given three to five preoperative courses of intra-arterial cisplatin and caffeine with or without doxorubicin. The histological response in these 21 patients to preoperative chemotherapy was grade IV (no viable cells) in 19 patients and grade III (only scattered foci of viable cells) in 2. The patients were separated into three groups on the basis of patterns of tumour excision. The first group underwent marginal excision of the proximal fibula, the second underwent epiphysis preservation followed by distraction osteogenesis, and the third underwent joint resection and reconstruction. The mean functional evaluations were 100, 95, and 88%, respectively. No local tumour recurrence was seen at mean follow-up of 97 months. Marginal excision of the proximal fibula resulted in excellent function. Preservation of the epiphysis leads to better function than joint resection.

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Preservation of the knee joint in limb salvage of osteosarcoma in the proximal tibia

Cited by 32 publications

References 10 publications

Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

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

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

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