Abstract
In this study, the effects of surgical removal of malignant metaphyseal bone tumors with epiphysis preservation and knee arthroplasty were analyzed. A total of 15 patients with malignant metaphyseal bone tumors were investigated. Six of these patients underwent epiphyseal preservation surgery with preoperative physeal distraction, termed the physeal distraction (PD) group. Nine patients underwent resection of the knee joint, combined with metal prosthesis transfer, termed the knee arthroplasty (KA) group. Tumor control, limb length discrepancy, range of movement (ROM) of the knee and functional outcome of lower limb [Musculoskeletal Tumor Society (MSTS) score and the Toronto extremity salvage score (TESS)] were assessed for these two groups. All 15 patients were followed-up after the surgery. One patient in the PD group was found to have lung tumor metastasis; however, no local tumor recurrence was found. In the KA group, local tumor recurrence was found in one patient, and lung metastases were observed in two cases postoperatively. The limb length discrepancy in patients of the PD group was 2.58±0.27 cm, which was significantly less compared with that in patients in the KA group (4.01±0.13 cm; P<0.05). In addition, the lower limb knee ROM in patients in the PD group was 127.70±14.63°, which was increased compared to that in patients in the KA group (105.70±15.48°; P<0.05). The mean MSTS score was 86.67% with a mean TESS of 82.33% in patients from the PD group, which showed no significant difference compared with the respective scores for patients in the KA group (P>0.05). Therefore, epiphyseal sparing limb-saving surgeries should be considered for the treatment of malignant metaphyseal bone tumors in children, when certain indications are satisfied.
Highlights
Malignant bone tumors are the eighth most common type of tumor in children, accounting for 2.4% [1] of all childhood cancers
The histological diagnosis was osteosarcoma in all patients in the physeal distraction (PD) group and osteosarcoma in seven and Ewing's sarcoma in two patients in the knee arthroplasty (KA) group
Epiphyseal preservation surgery, knee arthroplasty and transepiphyseal resection are common techniques used in malignant bone tumor conservation
Summary
Malignant bone tumors are the eighth most common type of tumor in children, accounting for 2.4% [1] of all childhood cancers. Epiphysis preservation with preoperative physeal distraction was first described by Cañadell et al [9] in 1994, and may be performed when the tumor has not transgressed the physis and ≥5 mm of normal bone is preserved above the physis on the sagittal section, as determined using magnetic resonance imaging (MRI) [10]. Under these conditions, physeal distraction allows separation of the epiphysis from the tumor‐bearing metaphysis. When the tumor has crossed the physis, it is necessary to perform knee joint resection combined with metal prosthesis transfer, known as knee arthroplasty [11]
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