Impacts of Tumor Location, Nature and Bone Destruction of Extremity Osteosarcoma on Selection of Limb Salvage Operative Procedure

Chen, Yu; Yu, Xiuchun; Xu, Songfeng; Xu, Ming; Song, Ran

doi:10.1111/os.12237

Cited by 15 publications

(16 citation statements)

References 46 publications

(98 reference statements)

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“…We found that the MSTS limb function score in the joint preservation group was higher than that in the prosthesis replacement group, consistent with a previous study by Chen et al [15]. In their MSTS function evaluation of 90 osteosarcoma patients, the biological reconstruction and joint preservation scores (25.0 ± 3.3 and 25.1 ± 3.6) were signi cantly higher than the mechanical reconstruction and joint resection scores (23.4 ± 3.7 and 23.1 ± 3.4, P < 0.05).…”

Section: Discussionsupporting

confidence: 92%

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Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Hou¹,

Bai²,

Xu³

et al. 2020

Preprint

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BackgroundWe compared the effects of two surgical procedures on limb function and quality of life in patients with osteosarcoma in the knee.MethodsThis retrospective study evaluated the postoperative outcomes of patients treated with JPLS and JPRS for osteosarcoma around the knee between November 2000 and December 2019. All patients were followed up for at least one year. Patients' lower extremity function, knee function, and quality of life were evaluated during follow-up using the MSTS score, IKDC score, and SF-36 score.ResultsAll 38 patients received a successful operation, and all incisions healed in one stage after surgery. At 12 months after the operation, the MSTS score in the prosthetic-replacement group (22.79±5.22) was lower than that in the joint-preservation group (27.05±1.62)(P=0.002). The IKDC score was lower in the prosthetic-replacement group (59.89±11.22) than in the joint-preservation group (76.84±9.42)( P <0.001). After 12 months, the SF-36 scores of physiological and social function in the joint-preserving group were higher than those in the prosthetic-replacement group (P <0.05), and there were no significant differences among the other indexes (P >0.05). Comparing the distribution of each item in the MSTS and IKDC scoring criteria between the joint-preservation and the prosthetic-replacement group revealed that the limb function, pain, satisfaction, support assistance, and the walking and gait of the joint preservation group were superior to those of the prosthetic-replacement group (P < 0.05). There was no significant difference in knee flexion between the two groups (P > 0.05). However, the joint preservation group was superior to the prosthesis replacement group in terms of pain, swelling, twisting, softening of the leg, movement downstairs, sitting up from a chair, kneeling, squatting, running straight forward, jumping up with the injured leg and landing, and quickly stopping or starting (P < 0.05).ConclusionCompared with joint-prosthesis replacement surgery, joint-preservation limb salvage leads to better joint function and quality of life. To improve the limb function and quality of life of patients with long-term survival osteosarcoma, joint-preservation limb salvage should be carried out according to the principles of Operation Indication, neoadjuvant and effective chemotherapy.

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Section: Discussionsupporting

confidence: 92%

“…In a recent study, Takeuch et al called it joint-preserving surgery (JPS) [11]. In the past decade, our team has been studying and improving this surgical approach [12][13][14][15], and because of the rise of the patient's age and the closure of the physis, we named it jointpreservation limb salvage.…”

Section: Discussionmentioning

confidence: 99%

Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Hou¹,

Bai²,

Xu³

et al. 2020

Preprint

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“…The occurring rate was 4.0 (3.5–4.6) for 0–14 year-old children per year per million of people for males and females and from all ethnicities ( 1 ). Tumors arise primarily on the metaphysis, which is near the growth plate and gradually invade the epiphysis and eventually the whole joint space ( 2 ). The distal femur and proximal tibia are the most common sites for osteosarcomas, and the epiphyses of the distal femur and proximal tibia contribute ~35 and 30% to the growth of the lower extremity, respectively ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment of osteosarcoma around the knee in skeletally immature patients

et al. 2017

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Limb sparing surgery in growing young patients with malignant tumors is difficult as invasion of the physis by the tumor or surgical resection through the metaphysis may cause significant limb discrepancy following surgery. At present, hinged tumor prosthesis or biological reconstructions are the main methods following tumor resection in these patients. The aim of the present study was to assess different procedures for the treatment of osteosarcoma around knee joints in immature patients. A retrospective study of 56 patients (<15 years old, open physis) who had been treated for osteosarcoma around the knee joint between January 2007 and December 2015 was performed. Clinical data collected included patient demographics (age at diagnosis, sex and date of diagnosis), tumor characteristics [location, Enneking stage and subtype on magnetic resonance imaging (MRI)], treatment (response to neoadjuvant chemotherapy and type of primary surgery) and clinical outcomes (limb function, discrepancy and overall survival). The median age at the time of diagnosis was 12.14 years (range, 3–15 years). There were 32 male patients (57.1%). A total of 41 (82%) tumors were located at the distal femur, and 15 (18%) at the proximal tibia. A total of 49 (87.5%) patients were diagnosed with stage IIB tumors, and 7 (12.5%) had stage III, according to the Enneking stage classification. Different surgical methods, including amputation, rotation-plasty, endoprosthesis and biological instructions (e.g., allograft) were performed according to MRI type classification. During follow-up, 21 patients (37.5%) succumbed to disease. The Musculoskeletal Tumor Society score ranged from excellent to fair functional result. Recurrence (2 cases, 16.67%) and infection (2, cases, 16.67%) were the main complications following endoprosthesis replacement, while delayed union (12 cases, 57.14%) and fracture (3 cases, 14.29%) were the main causes for biological reconstructions. Limb-length discrepancy ranged from 0–10 cm in limb-saving surgery. The overall survival rate was 57.66% with different cohorts in Enneking stages IIB and III, with or without involvement of the physis and different cycles of chemotherapy. Results of the present study indicated that different limb saving surgeries, including epiphysis/physis preservation with biological construction in patients with MRI types I to III and endoprosthetic/osteoarticular reconstruction in patients with MRI types IV and V, are useful in the management of osteosarcoma in growing young patients with proper surgery indications, and knee joint function was maintained with acceptable complications including limb discrepancy, delayed union, infection, recurrence and fracture.

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“…According to the Musculoskeletal Tumour Society (MSTS) resection classification system [12], the defects were classified as S4 (4 patients), S5 (20 patients), S45 (3 patients) and S45E1 (one patient). Based on Mirel’s scoring system [13] and the invasion score for evaluating the extent of bone destruction through osteosarcoma [14], we made some improvements and proposed the bone strength scoring system. Five variables, including pain degree, tumor site, nature, length and transverse diameter, were utilized to evaluated the bone strength of the tumor segment (Table 2).…”

Section: Methodsmentioning

confidence: 99%

Limb salvage surgery with joint preservation for malignant humeral bone tumors: operative procedures and clinical application

Zhao

Zheng

et al. 2019

BMC Surg

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Background However, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. Methods The medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8–82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score. Results The mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15–66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9–48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups ( p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups ( p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1). Conclusions Alcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).

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Impacts of Tumor Location, Nature and Bone Destruction of Extremity Osteosarcoma on Selection of Limb Salvage Operative Procedure

Cited by 15 publications

References 46 publications

Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Treatment of osteosarcoma around the knee in skeletally immature patients

Limb salvage surgery with joint preservation for malignant humeral bone tumors: operative procedures and clinical application

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