Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors

Abstract

Background: In the reconstruction of the affected limb in pediatric malignant bone tumors, since the loss of joint function affects limb-length discrepancy expected in the future, reconstruction methods that not only maximally preserve the joint function but also maintain good limb function are necessary. We analysis limb function of reconstruction methods by tumor location following resection of pediatric malignant bone tumors. Patients and methods:We classified the tumors according to their location into 3 types by preoperative MRI, and evaluated reconstruction methods after wide resection, paying attention to whether the joint function could be preserved. The mean age of the patients was 10.6 years, Osteosarcoma was observed in 26 patients, Ewing's sarcoma in 3, and PNET(primitive neuroectodermal tumor) and chondrosarcoma (grade 1) in 1 each.Results: Type I were those located in the diaphysis, and reconstruction was performed using a vascularized fibular graft(vascularized fibular graft). Type 2 were those located in contact with the epiphyseal line or within 1 cm from this line, and VFG was performed in 1, and distraction osteogenesis in 1. Type III were those extending from the diaphysis to the epiphysis beyond the epiphyseal line, and a Growing Kotz was mainly used in 10 patients. The mean functional assessment score was the highest for Type I (96%: n = 4) according to the type and for VFG (99%) according to the reconstruction method. Conclusion:The final functional results were the most satisfactory for Types I and II according to tumor location. Biological reconstruction such as VFG and distraction osteogenesis without a prosthesis are so high score in the MSTS rating system. Therefore, considering the function of the affected limb, a limb reconstruction method allowing the maximal preservation of joint function should be selected after careful evaluation of the effects of chemotherapy and the location of the tumor.

Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

“…There have been attempts to improve joint function in patients with osteosarcoma by performing an intercalary resection that preserves the native joint [15,17,23,28]. However, this is not easy to do for a juxtaarticular osteosarcoma owing to possible residual tumor if the tumor is close to the articular surface.…”

“…Early histologic studies [13,25] of resected specimens and an imaging study [12] have suggested that the prevalence of transepiphyseal spread of the tumor in metaphyseal osteosarcomas is approximately 80%. Some orthopaedic surgeons would prefer treating osteosarcoma penetrating the growth plate by removing the entire epiphysis with the tumor to ensure adequate margins unless the joint is contaminated with tumor, in which case an extraarticular resection is preferred [21,22,28]. However, subsequent replacement with a tumor prosthesis or osteoarticular allograft is associated with uncertain durability of the reconstruction and the longevity of these limb salvage procedures is unlikely to last the lifetime of the patient [3,22].…”

“…Intercalary resection may result in superior joint function and longevity because of preservation of normal articular cartilage and because ligamentous stability is preserved [20,23,28]. Such a procedure was made possible by understanding the epiphyseal spread of tumor with reference to the articular surface [15,26,28].…”

“…Such a procedure was made possible by understanding the epiphyseal spread of tumor with reference to the articular surface [15,26,28]. Despite controversy [15,17,26], it generally is agreed that the joint surface-saving method can be safely used only in patients who have a tumor that does not breach the epiphyseal line or extend to the subchondral region [23,28]. Given the high risk of local recurrence and catastrophic oncologic outcome with a contaminated margin, some orthopaedic oncologists are reluctant to perform a joint-saving procedure for patients with a tumor breaking through the epiphyseal growth plate because of an unreliable margin [16,23].…”

“…Intercalary resection may result in superior joint function and longevity because of preservation of normal articular cartilage and because ligamentous stability is preserved [20,23,28]. Such a procedure was made possible by understanding the epiphyseal spread of tumor with reference to the articular surface [15,26,28]. Despite controversy [15,17,26], it generally is agreed that the joint surface-saving method can be safely used only in patients who have a tumor that does not breach the epiphyseal line or extend to the subchondral region [23,28].…”