English

Abstract

BACKGROUND Limb salvage surgeries - Are they useful compared to amputation in bone tumours (malignant/recurrent). Starting from 1980s, bone tumour treatment has seen a revolution with the advent of limb salvage surgeries. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The surgeon must ensure adequate resection of the involved bone and soft tissue so as to minimize chance of local recurrence. At no stage must adequate disease clearance be compromised in an attempt to achieve limb salvage. We analyzed its relevance among our rural population at a tertiary level care centre. Limb salvage surgery basically involves resection and reconstruction. Reconstruction can be either biological or endo prosthetic. Biological can be autograft or allograft. Endoprosthesis can be fixed (custom-made) or modular. Expendable bones like fibula or ulna may not require reconstruction after resection. Prosthesis provide an immediate return to function and unlike bone they are not affected by ongoing adjuvant chemotherapy and radiotherapy. METHODS We conducted an 18-month prospective follow-up study on 10 patients (6 males and 4 females) who had undergone limb salvage surgeries during 2017 - 20 at Government Medical College, Thrissur. Wide excision, wide excision & biological autograft reconstruction, wide excision & modular endoprosthesis reconstruction are the different surgical modalities used. Patients were followed up clinically and radiologically in the orthopaedic out-patient department (OPD) at 6 weeks, 12 weeks and up to 1 ½ years at every 3 months. Functional scoring has been done using musculoskeletal tumour society (MSTS) - 87 scoring system. Study duration: 2017 October to 2020 October (3 years). RESULTS The average score is 64.6 % using the MSTS - 87 system. Maximum score was 83 % and the minimum was 62 %. Most of our patients are doing well and pursuing near-normal life with limb salvage surgeries with very minimal complications. One of our patients succumbed to the disease during the follow-up period. CONCLUSIONS Limb salvage is a better alternative to amputation in malignant and recurrent bone tumours in carefully selected and thoroughly evaluated patients. KEYWORDS Limb Salvage, Malignant & Recurrent Bone Tumours, MSTS - 87 Score, Wide Excision, Biological Autograft, Modular Endoprosthesis Reconstruction