Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

Gaillard, J; Eveno, D.; Bokobza, Guillaume; Costa, Marta Da; Heidar, Romain; Pouedras, M.; Nich, Christophe; Crenn, Vincent

doi:10.3389/fsurg.2021.820019

Cited by 6 publications

(8 citation statements)

References 52 publications

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“…However, in recent years, limb salvage has been conducted more often (12). Currently, clinicians commonly use limb salvage surgical methods, including prosthesis reconstruction with tumor resection and prosthesis replacement and conventional internal fixation with a series of surgical procedures including lesion resection, bone cement filling, and implant fixation (12,15,(32)(33)(34)(35)(36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

“…The choice of the surgical method is the primary focus when treating malignant bone tumors. Traditionally, amputation is combined with postoperative chemotherapy ( 31 , 32 ). Amputation is considered when the tumor involves important vascular and nerve bundles and invades multiple compartments, when a severe pathological fracture is present, when the effect of simple chemotherapy is poor, or when the soft tissue is extensively involved ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

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Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur

Li²,

Cao³

et al. 2023

Front. Surg.

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BackgroundPrimary leiomyosarcoma of the bone (LMSB) is an extremely rare, invasive, and highly destructive primary osteosarcoma with limited treatment options and poor prognosis. Only a few case reports of LMSB have been described because of its rarity. Therefore, clinicians have a limited understanding of its diagnosis, treatment, and prognosis, and the final diagnosis depends on histopathological findings. In this report, we describe a rare case of primary LMSB in the trochanteric region of the femur. Reporting this case may increase the dissemination and understanding of information regarding LMSB and provide a reference for the diagnosis and treatment of similar cases.Case presentationA 63-year-old woman presented with pain and limited movement of the left hip, which had lasted for 3 months, with no history of trauma or illness. Plain radiography and computed tomography revealed a solitary osteolytic lesion in the trochanteric area of the left femur with focal cortical destruction. Magnetic resonance imaging findings suggested invasion of the lesion into the bone cortex, forming a soft tissue mass, although no distant positive findings were observed on a whole-body bone scan. A bone tumor puncture biopsy was performed to obtain a final diagnosis, and histopathological evaluation revealed left femoral intertrochanteric leiomyosarcoma, classified as G1T2M0 and staged as IB (extracompartmental low-grade malignant) according to the Enneking staging system. Thus, we performed extensive debridement and left hip arthroplasty. Postoperative chemotherapy was administered, and the patient was followed up for 4 years. Four years later, the patient's left hip pain had resolved, joint activity was good, and no signs of recurrence or distant metastasis of the bone tumor were noted.ConclusionFor proximal femoral Enneking stage IB LMSB, extensive tumor resection combined with tumor prosthesis replacement may be an effective treatment method to prolong the patient's lifespan and to restore joint function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur

Li²,

Cao³

et al. 2023

Front. Surg.

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“…Rotationplasty is a procedure that is reported to offer durable results with low complication rates and to evade the phenomenon of phantom pain after amputation. 22 , 26 , 27 The most notable complications are vascular and infectious complications, as well as superficial skin necrosis, delayed union at the knee level, and gradual de-rotation of the foot. 26 , 27 Lastly, the psychological repercussions are of paramount importance and should not be neglected by any means, requiring careful pre- and post-surgical management, as well as substantial long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…22,26,27 the most notable complications are vascular and infectious complications, as well as superficial skin necrosis, delayed union at the knee level, and gradual de-rotation of the foot. 26,27 lastly, the psychological repercussions are of paramount importance and should not be neglected by any means, requiring careful pre-and postsurgical management, as well as substantial long-term follow-up. 27 the quality of life of cancer patients following rotationplasty has been a topic of great research interest.…”

Section: Figmentioning

confidence: 99%

Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms

Filis,

Varvarousis,

Ntritsos

et al. 2023

Bone Jt Open

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AimsThe standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.MethodsThe MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.ResultsThree studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).ConclusionRotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.Cite this article: Bone Jt Open 2023;4(11):817–824.

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“…Even though this procedure is mostly carried out in children, Gaillard et al report an excellent outcome in a 38-year old patient who underwent more than 20 surgeries with a vast array of complications, in a time span of 25 years after the diagnosis of osteosarcoma before receiving the final rotationplasty [ 14 ]. For a complex surgical technique such as the described rotationplasty in lower-middle income economies with limited infrastructure and resources, a safe and reliable operation method is necessary.…”

Section: Introductionmentioning

confidence: 99%

Modified Borggreve–Van Nes-Winkelmann rotationplasty for surgery in developing countries

et al. 2022

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Background Amputation is still the most common therapy for patients suffering from osteosarcoma in Myanmar, despite the fact that limb salvage surgery e.g. Borggreve–Van Nes-Winkelmann rotationplasty for malignant tumors located within the distal femur or proximal tibia is the current state-of-the-art reconstructive procedure. A safe and reliable operation technique is crucial in order to perform a complex surgical procedure like the rotationplasty in lower-middle income economies with limited infrastructure and resources. The authors present seven cases of patients with osteosarcomas that received a Borggreve–Van Nes-Winkelmann rotationplasty with an evaluation of the procedures focusing on safety and sustainability. Methods From 2019 until 2020, seven young patients with osteosarcomas of the distal femur or proximal tibia were treated with Borggreve–Van Nes-Winkelmann rotationplasties in the Orthopaedic Hospital in Mandalay, Myanmar. As modification of the standard procedure the dissection and subsequent clamping of the femoral artery in order to minimize blood loss as well as the formation of an adipocutaneous flap that minimizes swelling and decreases the pressure on the vessels were successfully performed. This modified procedure resembles a safe and simplified surgical technique that is feasible under the circumstances of lower-middle income economies with good outcomes. Results All patients showed good functional and aesthetic results. One of the seven patients needed secondary wound closure due to wound dehiscence. Conclusions A simplified and safe operation technique for the performance of the Van Nes-Borggreve rotationplasty was adapted to the given constraints in lower-middle income economies and proved to be successful. Trial registration All patients approved to participate in the study and have given consent to publication.

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Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

Cited by 6 publications

References 52 publications

Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur

Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur

Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms

Modified Borggreve–Van Nes-Winkelmann rotationplasty for surgery in developing countries

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