Limb salvage surgery for primary bone sarcoma of the lower extremities: Long-term consequences of endoprosthetic reconstructions

Background Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence. Questions/purposes We asked whether Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery are associated with low recurrence rates and high functional scores. Patients and Methods We retrospectively reviewed the records of 46 patients with Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery. Forty-one patients had tumors of the long bones. Patients were followed a minimum of 18 months (average, 47.2. months; range, 18-134 months) for evidence of recurrence and for assessment of Musculoskeletal Tumor Society (MSTS) functional score.

Section: Resultsmentioning

confidence: 99%

“…These procedures necessitate complex reconstructions and are associated with a high degree of morbidity, which may lead to lifelong disability and reduced quality of life [11,13]. The appropriate treatment for cartilaginous tumors is controversial.…”

Section: Introductionmentioning

confidence: 99%

Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

Mohler

Chiu

McCall

et al. 2010

“…Flail hips allow for reasonable function without incurring the additional risks of hardware failure that can occur with reconstructed hips in general, regardless of the type of surgical approach used. Leg-length discrepancy [3,9] and substantially reduced hip motion should be expected [13,18], but they do not preclude the ability to walk, drive, and return to work for most patients [9,27]. Shoe lifts can be used to compensate for leg-length discrepancies [3] and may help avoid consequences of abnormal gait, such as back pain or stress on the contralateral leg.…”

Section: Discussionmentioning

confidence: 99%

Internal Hemipelvectomy for Pelvic Sarcomas Using a T-incision Surgical Approach

Lackman

Crawford

Hosalkar

et al. 2009

Internal hemipelvectomy is performed for pelvic sarcomas when the tumor can be safely resected without sacrificing the entire extremity. Wide exposure and awareness of major neurovascular structures are crucial to the success of this surgery. Various modifications on the standard utilitarian approach have been used to best achieve these goals. We reviewed our experience using the T-incision technique for 30 pelvic sarcoma resections. The minimum followup was 3.6 months (mean, 55 months; range, 3.6-185.4 months). Postoperative complications included minor complications (requiring no surgery or a simple incision and drainage with primary closure) in 27% of patients and major complications (involving a deep infection or more extensive surgical treatment) in 17%. Ninety-two percent of wound complications healed uneventfully with antibiotics and incision and drainage.The 2-, 5-, and 10-year patient survival rates were 67%, 59%, and 53%. The 2-, 5-, and 10-year disease-free survival rates were 68%, 42%, and 42%. The mean Musculoskeletal Tumor Society and Toronto Extremity Salvage Scores were 69% and 86%, respectively. We believe the T-incision technique for internal hemipelvectomy is an effective surgical approach for pelvic sarcomas when limb salvage is possible.

“…For primary tumors of the distal femur, endoprosthetic replacement (EPR) as a limb salvage option achieves functional and cosmetic results that make it a reasonable choice as compared to amputation [9,16,18,23]. With advances in the medical management of musculoskeletal malignancies, patient survival has improved substantially [11].…”

Section: Introductionmentioning

confidence: 99%

Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

Pedtke

Wustrack

Fang

et al. 2012

Background Failure of endoprosthetic reconstruction with conventional stems due to aseptic loosening remains a challenge for maintenance of limb integrity and function. The Compress 1 implant (Biomet Inc, Warsaw, IN, USA) attempts to avoid aseptic failure by means of a unique technologic innovation. Though the existing literature suggests survivorship of Compress 1 and stemmed implants is similar in the short term, studies are limited by population size and followup duration.Questions/purposes We therefore compared (1) the rate of aseptic failure between Compress 1 and cemented intramedullary stems and (2) evaluated the overall intermediate-term implant survivorship. Methods We reviewed 26 patients with Compress 1 implants and 26 matched patients with cemented intramedullary stems. The patients were operated on over a 3-year period. Analysis focused on factors related to implant survival, including age, sex, diagnosis, infection, aseptic loosening, local recurrence, and fracture. Minimum followup was 0.32 years (average, 6.2 years; range, 0.32-9.2 years).