Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint

Abstract

BackgroundEpiphyseal-preservation surgery for osteosarcoma is an alternative method which has been indicated carefully to selected patients. The tumor-devitalised autograft treated with liquid nitrogen procedure is one of the biological reconstruction method to reconstruct the defect after tumor excision. The limb length discrepancy is usually appeared in children with their growth after limb-sparing surgery. This study was aimed to investigated the growth of residual epiphysis following epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint.MethodsWe retrospectively reviewed 12 patients with osteosarcoma who underwent epiphysis preserving tumor excision (8 in distal femur and 4 in proximal tibia) and reconstructed by using tumor-devitalized autograft treated with liquid nitrogen. The mean patient age was 11 (range, 6 to 14) years. The mean follow-up period were 63 (range, 41 to 90) months. Epiphysis transverse growth rate, epiphysis-width discrepancy (EWD) and collapse of epiphysis were evaluated by using pre- and post-operative whole standing leg radiographs. A retrospective chart review was performed to investigate functional outcome, complications and oncological status.ResultsThe mean growth of epiphysis rate was 12.6% (range, 3.3 to 28.0%) of affected side and 12.7% (range, 3.8 to 28.9%) of contralateral side, mean EWD was 0.1 mm (range, − 1.0 to 1.7 mm), mean LLD was + 26.1 mm (range, + 1 to + 48 mm) and two patients with distal femoral reconstruction underwent limb lengthening of tibia. There was no collapse of the residual epiphysis. The mean MSTS score was 27.7 (range, 18 to 30).ConclusionsEpiphysis transverse growth was not diminished, and there was absence of epiphyseal collapse even after epiphyseal-preservation surgery in this small series of childhood osteosarcoma around the knee. With careful assessment for epiphyseal tumor involvement, epiphyseal-preservation surgery shall be possible, and could be an alternative method worth considering.

Three‐dimensional‐printed intercalary prosthesis for the reconstruction of large bone defect after joint‐preserving tumor resection

“…However, the reconstruction of the segmental bone defects following joint‐preserving intercalary tumor resection has been a great challenge. Several techniques have been applied for the reconstruction of such segmental bone defects, including distraction osteogenesis, vascularized fibular graft, irradiated autograft, allograft, combined fibula allograft, segmental transport, segmental prosthesis and tissue engineering techniques . However, these reconstruction techniques are usually associated with frequent complications.…”

“…However, the reconstruction of the large bone defect following joint‐preserving intercalary tumor resection has been a great challenge for orthopedic oncologists. At present, various methods, including vascularized fibular graft, tumor‐devitalized autograft, allograft, combined fibular allograft, segmental transport, segmental prosthesis and tissue engineering techniques, have been used to reconstruct these large intercalary bone defects . Although biological reconstructions with autograft and allograft can obtain a low incidence of long‐term complications and reasonable joint function, they are often associated with too many early complications .…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-Dimensional-Printed Prothesis for Children with Osteosarcoma in Distal Femur

“…The LLD would also be happened for the patients with epiphysis preservation for the patients in our study, but the shortened distance would be similar compared to reconstruction of expandable prosthesis which could be corrected by the assistance of insole and the incidence of complications would be much lower [15,[26][27][28] (Table 4). Besides, Takeuchi et al reviewed 12 patients with osteosarcoma who underwent epiphysis preserving tumor excision and found out that epiphysis transverse growth would not be diminished after epiphyseal-preservation surgery in their small series of childhood osteosarcoma around the knee which would be very important to maintain the stability of the knee [24]. Also, according to our research, there was absence of epiphyseal collapse after the surgery and all the patients who underwent JSLSS, achieved similar results for ROMs in 6DOF during gait compared with normal data of Chinese knees.…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-dimensional-printed Prothesis for Children With Osteosarcoma in Distal Femur

“…The LLD would also be happened for the patients with epiphysis preservation for the patients in our study, but the shortened distance would besimilar compared to reconstruction of expandable prosthesis which could be corrected by the assistance of insole and the incidence of complications would be much lower [15,[26][27][28] (Table 4). Besides, Takeuchi et al reviewed 12 patients with osteosarcoma who underwent epiphysis preserving tumor excision and found out that epiphysis transverse growth would not be diminishedafter epiphyseal-preservation surgery in their small series of childhood osteosarcoma around the knee which would be very important to maintain the stability of the knee [24]. Also, according to our research, there was absence of epiphyseal collapse after the surgery and all the patients who underwent JSLSS, achieved similar results for ROMs in 6DOF during gait compared with normal data of Chinese knees.…”