Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur

BMC Musculoskeletal Disorders

Qing Su¹  YuXi Sun¹  Yu Chen¹  ZhiHou Fu¹  Ming Xu¹  XiuChun Yu¹  SongFeng Xu¹ 

[1] Department of Orthopaedics, General Hospital of Ji’Nan Military Region, Ji’Nan 250031, China

关键词: Prosthesis replacement;    Articulation preservation;    Alcohol-inactivated autograft replantation;    Quality of life;    Limb function;    Reconstruction;    Osteosarcoma;   

Others  :  1090162
DOI  :  10.1186/1471-2474-15-453

 received in 2014-05-25, accepted in 2014-12-05,  发布年份 2014

【 摘 要 】

Background

We tried to compare the functional and psychosocial outcomes after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur.

Methods

We retrospectively reviewed 51 patients who underwent limb-salvage surgery of osteosarcoma in distal femur in our institution, 30 males and 21 females with an average age of 21 years (range 13–51 years). We classified osteosarcoma in distal femur into 3 types, and organized affected limb reconstruction methods after wide resection. MSTS and QOL scores were used to analyze the functional and psychological outcomes.

Results

After a mean follow-up of 43 months (12–225 months), there is no difference on functional results and QOL scores among three reconstruction groups (p > 0.05) and among three types groups (p > 0.05). No difference could be noticed on tumor-free survival and total survival among three reconstruction groups (p > 0.05) and three type groups (p > 0.05). In ≤2-year, better functional scores could be found in prosthesis group, rather than the other two inactivated-bone groups (p < 0.05).

Conclusions

Biological reconstruction with alcohol-inactivated autograft replantation could avoid prosthesis related complications and achieved comparable results with prosthesis following resection of osteosarcoma in distal femur. Different reconstruction options could be chosen according to tumor location, such as the distance to Insall line.

【 授权许可】

   
2014 Xu et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Ando K, Heymann MF, Stresing V, Mori K, Redini F, Heymann D: Current therapeutic strategies and novel approaches in osteosarcoma. Cancers 2013, 5:591-616.
• [2]Xu M, Xu SF, Yu XC: Clinical analysis of osteosarcoma patients treated with high-dose methotrexate-free neoadjuvant chemotherapy. Curr Oncol 2014, 21:e678-e684.
• [3]Yu X, Xu M, Song R, Xu S: Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg 2009, 1:196-202.
• [4]Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980, 2003:4-18.
• [5]Yu XC, Liu XP, Zhou Y, Fu ZH, Song RX, Sun HN, Xu M: Inactivated bone replantation with preservation of the epiphysis for osteosarcoma in children. Orthop J China 2007, 15:811-813.
• [6]Xu S, Yu X, Xu M, Fu Z: Inactivated autograft–prosthesis composite have a role for grade III giant cell tumor of bone around the knee. BMC Musculoskelet Disord 2013, 14:319. BioMed Central Full Text
• [7]Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993, 241-246.
• [8]Manfrini M, Gasbarrini A, Malaguti C, Ceruso M, Innocenti M, Bini S, Capanna R, Campanacci M: Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop Relat Res 1999, 358:111-119.
• [9]Yoshida Y, Osaka S, Tokuhashi Y: Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol 2010, 8:39. BioMed Central Full Text
• [10]Xu SF, Yu XC, Xu M, Liu XP, Song RX, Fu Z: Surgical technique of alcohol-inactivated autograft replantation with articulation preservation in management of malignant bone tumor around knee (In Chinese). Chin J Joint Surg (Electronic Edition) 2012, 6:355-360.
• [11]Jaffe N: Osteosarcoma: review of the past, impact on the future. The American experience. Cancer Treat Res 2009, 152:239-262.
• [12]Yamamoto N, Tsuchiya H: Chemotherapy for osteosarcoma - where does it come from? What is it? Where is it going? Expert Opin Pharmacother 2013, 14:2183-2193.
• [13]DiCaprio MR, Friedlaender GE: Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg 2003, 11:25-37.
• [14]Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD: Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am Vol 2011, 93:418-429.
• [15]Morii T, Morioka H, Ueda T, Araki N, Hashimoto N, Kawai A, Mochizuki K, Ichimura S: Deep infection in tumor endoprosthesis around the knee: a multi-institutional study by the Japanese musculoskeletal oncology group. BMC Musculoskelet Disord 2013, 14:51. BioMed Central Full Text
• [16]Gilbert NF, Yasko AW, Oates SD, Lewis VO, Cannon CP, Lin PP: Allograft-prosthetic composite reconstruction of the proximal part of the tibia. An analysis of the early results. J Bone Joint Surg 2009, 91:1646-1656.
• [17]Biau DJ, Dumaine V, Babinet A, Tomeno B, Anract P: Allograft-prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res 2007, 456:211-217.
• [18]Donati D, Colangeli M, Colangeli S, Di Bella C, Mercuri M: Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res 2008, 466:459-465.
• [19]Wunder JS, Leitch K, Griffin AM, Davis AM, Bell RS: Comparison of two methods of reconstruction for primary malignant tumors at the knee: a sequential cohort study. J Surg Oncol 2001, 77:89-99. discussion 100
• [20]Ogilvie CM, Crawford EA, Hosalkar HS, King JJ, Lackman RD: Long-term results for limb salvage with osteoarticular allograft reconstruction. Clin Orthop Relat Res 2009, 467:2685-2690.
• [21]Muramatsu K, Ihara K, Miyoshi T, Yoshida K, Iwanaga R, Hashimoto T, Taguchi T: Stimulation of neo-angiogenesis by combined use of irradiated and vascularized living bone graft for oncological reconstruction. Surg Oncol 2012, 21:223-229.
• [22]Harrington KD, Johnston JO, Kaufer HN, Luck JV Jr, Moore TM: Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts. Clin Orthop Relat Res 1986, 180-214.
• [23]Jeon DG, Kim MS, Cho WH, Song WS, Lee SY: Pasteurized autograft-prosthesis composite for distal femoral osteosarcoma. J Orthop Sci 2007, 12:542-549.
• [24]Tsuchiya H, Wan SL, Sakayama K, Yamamoto N, Nishida H, Tomita K: Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg (Br) 2005, 87-B:218-225.
• [25]Yu X, Liu X, Zhou Y, Li K, Qu Z: Inactivated bone replantation with preservation of the epiphysis in children with osteosarcoma: clinical report of two cases. Chin-Ger J Clin Oncol 2005, 4:167-170.
• [26]Sung HW, Wang HM, Kuo DP, Hsu WP, Tsai YB: EAR method: an alternative method of bone grafting following bone tumor resection (a preliminary report). Semin Surg Oncol 1986, 2:90-98.
• [27]Yu XC, Liu XP, Zhou Y, Li KH, Song RX, You MR: Influence of alcoholic devitalization and replantation with inactivated bone on knee function: clinical and experimental study. Chin J Bone Tumor Bone Dis 2004, 3:335-340.
• [28]Tsuchiya H, Abdel-Wanis ME, Tomita K: Biological reconstruction after excision of juxta-articular osteosarcoma around the knee: a new classification system. Anticancer Res 2006, 26:447-453.
• [29]Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N: Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer 2010, 54:990-999.
• [30]O’Malley JE, Foster D, Koocher G, Slavin L: Visible physical impairment and psychological adjustment among pediatric cancer survivors. Am J Psychiatry 1980, 137:94-96.