Articular surface sparing procedures in the treatment of bone sarcomas

Abstract

Purpose of review: Most surgical techniques presently used to treat high-grade metaphyseal bone sarcomas around the knee include resection of one or both epiphyses, causing a gross distortion of the normal anatomy and questionable durability of the reconstruction. Recently, efforts to preserve the involved epiphysis have been made, followed by an intercalary allograft reconstruction. If a safe surgical oncologic margin is obtained and if the articular surface of the affected joint is preserved, potentially better long-term functional results can be expected. Recent findings: Several publications have established the accuracy of magnetic resonance imaging in detecting epiphyseal extension of bone sarcomas showing a high sensitivity with no false negative results. Those studies indicate that magnetic resonance imaging is a sensitive indicator of epiphyseal involvement by sarcoma. Recent reports indicate that after accurate preoperative assessment of tumor extension to the epiphysis in patients with high-grade sarcomas, a transepiphyseal tumor resection with preservation of the involved epiphysis can be achieved. Summary: Oncologic orthopedic surgeons face a difficult decision when treating a patient with a bone sarcoma around the knee after neoadjuvant chemotherapy: whether to decrease the resection margins to obtain the best possible functional result, but with potential questionable margins and severe oncologic consequences, or to overtreat the tumor by creating excessive margins but having a much less functional result and the potential need for a succession of reconstructive procedures with questionable durability. With present imaging techniques, a significant number of patients with bone sarcoma around the knee can be safely treated with preservation of the epiphysis.