What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee?

Li, Jing; Wang, Zhen; Ji, Chuanlei; Chen, Guojing; Liu, Dong; Zhu, Haodong

doi:10.1007/s11999-017-5356-z

Cited by 23 publications

(17 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ere was also a frequent need for revision surgery as well as, prolonged protected weight bearing after surgery and longer rehabilitation. e incidence of all major complications encountered in biological reconstruction ranges from 32 to 47% [2,[7][8][9][10][11][12][13], with similar revision rates. Furthermore, in many techniques used in bone allograft reconstruction, the fixation plate will cause premature epiphysiodesis and early closure of the epiphyseal plate, with no attempt at preserving the growth potential of the growing bone and subsequent need for bone elongation procedures Table 3 [7].…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

Shehadeh

Isleem

Abdelal

et al. 2019

Journal of Oncology

View full text Add to dashboard Cite

Background. Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. Purposes. (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. Methods. In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25–75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5–70 mm, median = 10 mm. Results. Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months–10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.014); all recurrences occurred in the soft tissue. Implant survival at 5 years was 86.15%, and MSTS score was 90% (83–96%). Conclusions. Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

Shehadeh

Isleem

Abdelal

et al. 2019

Journal of Oncology

View full text Add to dashboard Cite

show abstract

“…Limb salvaging procedures are currently often opted for in extremity OS cases as advances in chemotherapy and preoperative imaging studies have enabled us to perform precisely-planned minimal surgical resections that avoid excessive functional loss [2, 9]. Oncologic outcomes in such cases are reported to be almost the same as those after amputations, as long as the patient responds well to chemotherapy [10]. Although consensus has not yet been obtained, the appropriate margin for resection of an OS with a good response to chemotherapy has been discussed.…”

Section: Discussionmentioning

confidence: 99%

“…Further, no correlation has been reported between surgical margin width and local recurrence (1–10 mm vs. 11–20 mm) [11]. For epiphyseal-sparing resection such as ours, the distance between joint articular cartilage and the tumor is recommended to be 20 mm at minimum, securing at least 10 mm margin width from the tumor and 10 mm thickness in the residual epiphysis [9, 10]. In our case, the most distal location of the tumor which was 2 cm proximal to the growth plate, and the efficacy of preoperative chemotherapy enabled us to preserve his knee joint by way of intercalary resection, despite the fact that the bone tumor extended quite far longitudinally, with nearly 2/3 of the femur having to be resected.…”

Section: Discussionmentioning

confidence: 99%

Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

et al. 2019

View full text Add to dashboard Cite

Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.

show abstract

“…No histopathological analysis of the ablation area was conducted; regardless, no local tumor recurrence was reported in the follow-up of more than 3 years after surgery. Microwave ablation can effectively enhance the safety of the operation boundary 78 .…”

Section: Recommendation 19: Microwave Ablation Of Primary Malignant Hmentioning

confidence: 99%

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Zheng¹,

Yu²,

et al. 2020

Orthopaedic Surgery

Self Cite

View full text Add to dashboard Cite

Microwave ablation has been used to treat bone tumors in extremities for more than 30 years. With improved recognition, updated microwave equipment, and expanded clinical application, microwave ablation has recently been widely used to treat bone tumors. To standardize the application of microwave ablation in the clinical treatment of bone tumors in the limbs, research results and clinical experience involving the use of microwave ablation to treat bone tumors in the limbs have been summarized, and a clinical guideline has been designed. This guideline is aimed at providing a reliable clinical basis for indications, preoperative evaluation and decision‐making, perioperative treatment, complications, and other issues via evidence‐based medicine. Two aspects are considered—percutaneous microwave ablation and intraoperative microwave ablation of bone tumors in extremities. Ultimately, the guideline is intended to standardize treatment and improve the clinical efficacy of microwave ablation of bone tumors in extremities.

show abstract

What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee?

Abstract: Level IV, therapeutic study.

Cited by 23 publications

References 47 publications

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Contact Info

Product

Resources

About