Osteosarcoma Of Distal Femur Research Articles

An innovative staged prosthetic lengthening reconstruction strategy for osteosarcoma-related leg discrepancy

Correction of leg length discrepancy (LLD) in skeletally mature patients with osteosarcoma was rarely reported and quite challenging. This study aimed to propose a treatment strategy of staged lengthening and reconstruction with a standard static prosthesis to address LLD and restore limb function. It also evaluated the effectiveness of the strategy in terms of leg lengthening, functional outcomes, and complications. The strategy for lengthening included three stages. In stage 1, the previous prosthesis was removed and an external fixator with a temporary rod-cement spacer was placed. In this stage, the external fixator was used to lengthen the limb to the appropriate length. In stage 2, the external fixator was removed and the old rod-cement spacer was replaced with a new one. In stage 3, the rod-cement spacer was removed and the standard static prosthesis was planted. Nine skeletally mature distal femoral osteosarcoma patients with unacceptable LLD were treated in our institution from 2019 to 2021. We performed a chart review on nine patients for the clinical and radiographic assessment of functional outcomes, LLD, and complications. The mean (range) leg lengthening was 7.3 cm (3.6–15.6). The mean (range) LLD of the lower limbs decreased from 7.6 cm (4.1–14.2) before the lengthening to 0.3 cm (− 0.3 to 2.1) at the final follow-up with statistical significance (P = 0.000). The mean (range) Musculoskeletal Tumor Society score improved from 30.3% (16.7%–53.3%) before the lengthening to 96.3% (86.7%–100%) at the final follow-up with statistical significance (P = 0.000). Three patients (33.3%) had a minor complication; none needed additional surgical intervention. In the short term, the current staged lengthening and reconstruction with standard static prosthesis provided satisfactory functional outcomes and LLD correction with few complications. The long-term effects of this method need further exploration.

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Functional and Oncological Outcome of Patients with Distal Femoral Osteosarcoma Managed by Limb Salvage Using Modular Endoprosthesis

BackgroundThe aim of the study was to assess the functional and oncological outcomes of patients with distal femoral osteosarcoma managed by limb salvage using modular endoprosthesis as well as to assess related complications.Patients and MethodsA total of 82 patients were included in our study. Functional outcome was assessed using MSTS score and knee range of motion. Oncological outcome was assessed regarding local recurrence, chest metastasis, and patient survivorship. Complications were classified according to Henderson et al.ResultsThe mean MSTS score was 26.21 (87.4%) (range 8–30 points) with 70.7% of patients having more than 90° of flexion. The incidence of local recurrence was 3.7% (3 patients), while the incidence of chest metastasis was 14.6% (12 patients). Aseptic loosening (type 2 failure) was the commonest complication (19.5%), followed by infection (15.9%). The 5- and 10-year survivorships of the limb were 98.8%, while the 5- and 10-year survivorships of the prosthesis were 67.7% and 52.4%, respectively.ConclusionThis study showed that patients with osteosarcoma distal femur who are treated by chemotherapy and limb salvage have an excellent long-term prognosis in terms of patient as well as limb survivorship. The use of modular endoprosthesis in these patients offer an acceptable function, with two-thirds of the patients retaining their prosthesis after 5 years and more than half retaining them after 10 years.

Comparison of Functional Outcome in Osteosarcoma of Distal Femur and Proximal Tibia

Limb-saving therapy for primary bone tumours is the treatment of choice. We aimed at analysing the quality of life of this group of patients by combining three different tools. Thirteen patients with a primary bone tumour of the extremity, 5 patients with osteosarcoma of proximal tibia and 8 with osteosarcoma of distal femur who had undergone endoprosthetic reconstruction between 2017-2018 were included in this retrospective study. Parallel recording of the MSTS score, TESS and SF-36 provides a better measure reflecting the complex situation of the patients by combining objective and subjective parameters. Keywords: MSTS-Musculoskeletal Tumour Society Score, TESS-Toronto Extremity Salvage Scoring System, SF-36Short Form -36 Questionnaire, EA-emotional acceptance, FA-overall function., PF- physical functioning, RLPH-role limitation due to physical health, RLEP- role limitation due to emotional health, E-energy, EWB-emotional wellbeing, SF- social functioning, P-pain, GH-general health, HC-health change

Rotationplasty with Tibial Nerve Coaptation: A Case Report.

We present the case of a 14-year-old adolescent boy with a distal femoral osteosarcoma partially encasing the tibial nerve. He underwent rotationplasty with resection and coaptation (end-to-end repair) of the tibial nerve. By 1 year postoperatively, he had recovered sensation on the plantar aspect of his foot and Medical Research Council scale 4+/5 gastro-soleus contraction that powered extension of the new knee. Tibial nerve resection is not an absolute contraindication for rotationplasty, even in an adolescent. Nerve coaptation allows for well-functioning rotationplasty as an alternative to endoprosthetic reconstruction or above-knee amputation.

Abstract 3071: A reconstruction of evolutionary trajectories in primary tissue and PDTOs in a patient with metastatic osteosarcoma

Abstract Metastatic osteosarcoma is a rare and highly lethal cancer that affects children and young adults. The rarity of osteosarcoma and its highly heterogeneous genetic composition have resulted in a lack of curative treatments for recurrent and metastatic disease. In this study, we present the functional and molecular characterization of a case of a pediatric patient with left distal femur osteosarcoma and pulmonary metastases at presentation. Through longitudinal sampling over the course of the patient’s illness, we have procured tissue from the initial treatment-naïve diagnostic biopsy, primary tumor resection and multiple subsequent lung metastasectomies, and have developed patient-derived tumor organoids (PDTOs) from the viable samples. PDTOs are useful pre-clinical models that are representative of the source tissue and allow further interrogations of the biology of tumors. These models can also help with the identification of effective personalized therapies (Al Shihabi et al, 2021). We applied our mini-ring organoid screening technology (Phan et al, 2019; Nguyen et al, 2020) to perform high-throughput drug screening with different pharmacologic agents. We also performed deep whole-genome sequencing on all collected samples and corresponding organoids to reconstruct their evolutionary history, identify driver mutations and quantify heterogeneity in mutational processes across time and space. Our preliminary data show that the subclonal content of the tumor and derivative organoids as well as the PDTO drug responses vary with the patient’s treatment history. We identify the genomic makeup of the subclones and posit changes that may be responsible for chemoresistance. Furthermore, our data shows correlations between the subclonal genomic composition of the PDTOs and source tissue, thereby reinforcing that PDTOs are capable of accurately recapitulating the subclonal heterogeneity of the parental tumor. Citation Format: Ardy Davarifar, Jane Yanagawa, Ahmad Al Shihabi, Huyen T. Nguyen, Lydia Y. Liu, Adriana Salcedo, Alfredo Gonzalez, Takafumi N. Yamaguchi, Nicholas Bernthal, Scott D. Nelson, Noah Federman, Paul C. Boutros, Alice Soragni. A reconstruction of evolutionary trajectories in primary tissue and PDTOs in a patient with metastatic osteosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3071.

A prospective study on evaluating the clinical and functional outcome of limb salvage surgery and amputation in distal femoral osteosarcoma patients

A prospective study on evaluating the clinical and functional outcome of limb salvage surgery and amputation in distal femoral osteosarcoma patients

Simultaneous Bilateral Secondary Pneumothorax Complicating Osteosarcoma: A Case Report

Background: The incidence of Simultaneous Bilateral Secondary Pneumothorax (SBSP) occurring as a complication of neoplasm is rare, only <1%. The lungs can be the site for the spread of metastatic osteosarcoma. Methods: We investigated a 16-year-old female who was diagnosed with right distal femur osteosarcoma, pulmonary metastasis, and a rare SBSP complication. Pneumothorax was observed in both sites of pulmonary metastases and bronchopleural fistula on contrasting chest computed tomography. Results: This pneumothorax is the second one; the previous one was only on one side before chemotherapy. The patient died 12 months after osteosarcoma was diagnosed and four months after SBSP occurred. The progression of osteosarcoma lesions was the cause for the death of the patient. SBSP is the leading cause of severe complications in osteosarcoma. Conclusion: The clinician must perform diagnostic strategies for early detection of osteosarcoma and its proper management, which can reduce a patient’s suffering and impairment of the patient’s quality of life, thus decreasing morbidity and the risk of mortality.

Postoperative Function, Sports Activities, and Quality of Life of Inactivated Autograft Replantation with Joint Preservation for Osteosarcoma in Distal Femur Compared with Prosthetic Replacement

Postoperative Function, Sports Activities, and Quality of Life of Inactivated Autograft Replantation with Joint Preservation for Osteosarcoma in Distal Femur Compared with Prosthetic Replacement

Unexpected Metastasis to Breast, Lymph Node, Subcutaneous, Abdominal Wall, Intraabdominal, and Bone in Osteogenic Osteosarcoma: An Unusual Presentation on Bone Scintigraphy.

Osteogenic osteosarcoma is an aggressive malignant bone tumor with the tendency for local invasion and early metastases. Radionuclide bone scans play an important role in disease management by identifying other areas of skeletal involvement as well as extraosseous metastases. Osteogenic sarcoma metastasis is known to accumulate bone-avid agents due to their osteogenic potential. Here, we report a case of osteogenic osteosarcoma of distal femur with the absence of pleural effusion but extensive extraosseous areas of metastatic involvement in distant lymph nodes, subcutaneous planes (in the form of nodules), abdominal wall, multiple intraperitoneal deposits, breast, and bone metastases visualized on preoperative Tc-99 m methylene diphosphonate bone scan.

Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth.

Allograft reconstruction with or without vascularized fibula can be a valuable solution to treat childhood intercalary tumours of the distal femur. We aimed to assess the oncological status, complication rate and survival of distal femur intercalary reconstruction after trans-metaphyseal (TMR) and trans-epiphyseal resection (TER). We also evaluated the impact of distal temporary graft fixation on skeletal growth after TMR. We retrospectively reviewed 23 skeletally immature patients affected by distal femur osteosarcoma (18) and Ewing sarcoma (5). Mean patients age was 10.3years. In 11 cases, TMR was performed with physis preservation and temporary distal graft fixation. In 9 patients, TER was performed with growth plate sacrifice. The last 3 cases were treated with TMR and sliding plate fixation. Mean follow-up was 8.4years. No deaths occurred, but 3 patients presented lung metastasis and 2 cases presented local recurrence in soft tissues. 10 implant-related complications occurred, all surgically treated. At skeletal maturity, mean femoral dysmetria was 2.3cm after TMR and temporary epiphysiodesis, and 3.1cm after TER. In TMR group, a strong trend towards physeal recovery was observed after epiphyseal screws removal (p = 0.061), but valgus deformity in distal femur was more frequent (p = 0.049). MSTS score was good or excellent in all patients, with no statistically significant difference between TMR and TER. Intercalary graft reconstruction after TMR and TER allows good local disease control and excellent functional results with long-term follow-up. Temporary distal fixation might reduce the final limb discrepancy after TMR, but valgus deformity could develop. Level IV.

Outcomes of Fixed-Hinged Knee Prosthesis for Distal Femoral Osteosarcoma in Skeletally Immature Patients: First Results.

The best surgical choice for distal femur osteosarcoma in skeletally immature patients remains controversial. A fixed hinged knee prosthesis has been designed to preserve the growth plates in the adjacent tibia, expecting tibial growth to be continued. This study aims to report the (1) clinical outcomes after prosthetic replacement, (2) postoperative complications, and (3) length of discrepancy of the operative tibia with the unaffected tibia. Thirty-four skeletally immature patients (averaged 9 years at surgery; range, 5-12 years) with distal femoral osteosarcoma underwent placement of this hinged knee prosthesis between January 2015 and August 2018. Postoperative function and complications were assessed. Length discrepancy was measured using a series of full-length standing anteroposterior radiographs of the bilateral lower extremity. The average follow-up duration was 34 months (2.8 years). In the last follow-up, four patients expired because of pulmonary metastasis. Two patients presented with local recurrence of the soft tissue. Postoperatively, the flexion range of the knee joint range was between 100 and 130 degrees, with an average of 115.2 degrees. The mean functional score of living patients evaluated using the Musculoskeletal Tumor Society scoring system was 89.2% (range, 76.7-100%). Types 1 (three patients), 2 (one patient), 3 (two patients), and 5 (two patients) complications exist. Among them, three patients received revision surgery. The proximal tibial physis still grew after surgery, with an average of 74.3% (range, 30-100%) growth potential compared with the unaffected proximal tibial physis. Moreover, 27 children exhibited tibial length discrepancy compared with the contralateral tibia, and the mean discrepancy in tibial length was 1.1 cm (range, 0.2-3.1 cm). This hinged knee prosthesis can keep the growth potential in the adjacent tibia, provides satisfying functional outcomes, and has a lower postoperative complication rate. Thus, it could serve as an alternative intervention for distal femoral osteosarcoma in skeletally immature patients.

Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report

BackgroundProsthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection.Case presentationA 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.ConclusionsThis case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

Application of rotationplasty in treatment of osteosarcoma of distal femur in children

To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children. A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph. Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°). Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.

A 2-stage Distal Femur Reconstruction with Expandable Endoprosthesis in a Pediatric Patient Presenting with a Pathologic Fracture through an Osteosarcoma

Osteosarcoma in pediatric patients has traditionally been treated with amputation, especially if there is a pathologic fracture through the tumor.We report the case of a 12-year-old boy who sustained a pathologic fracture through distal femoral osteosarcoma. After neoadjuvant chemotherapy, he underwent limb saving surgery: wide excision of the osteosarcoma followed by a second-stage reconstruction with an expandable tumor endoprosthesis. He has a functional score of 93% and is free of disease 8 years since diagnosis and 2 years since the end of lengthening.This is the first reported case in Philippine medical literature of limb saving surgery in osteosarcoma reconstructed with an expandable endoprosthesis.

Closed wedge high tibial osteotomy for osteoarthritis caused by the treatment of distal femoral osteosarcoma; a case report

Closed wedge high tibial osteotomy for osteoarthritis caused by the treatment of distal femoral osteosarcoma; a case report

Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents.

* Osteosarcoma, while rare, is the most common primary bone sarcoma and accounts for up to 10% of all new pediatric cancer diagnoses annually in the United States.* Most commonly, osteosarcoma affects the distal part of the femur and occurs as a high-grade intramedullary (conventional) subtype.* Patients with osteosarcoma are managed with a multidisciplinary team approach. Often, an orthopaedic oncologist initiates the workup after making a presumptive diagnosis on the basis of classic clinical and radiographic findings. Advanced imaging and a tissue biopsy are performed to evaluate the extent of disease and to histologically confirm the diagnosis. Musculoskeletal radiologists and pathologists are key team members who evaluate the imaging and tissue samples to make a definitive diagnosis, establish a prognosis, and help the clinicians to develop a treatment plan. Medical/pediatric oncologists are essential team members who provide the appropriate neoadjuvant and adjuvant chemotherapy treatment and assist with long-term surveillance to monitor for local or distant relapse. Orthopaedic oncologists develop and execute a plan for resection of the tumor followed by appropriate reconstruction.* The current standard of care for distal femoral osteosarcoma is neoadjuvant chemotherapy followed by limb salvage for the surgically resectable tumor, reconstruction of the bone and soft-tissue defect, and adjuvant chemotherapy.* The survival rate for patients with isolated osteosarcoma is approximately 70% and has not substantially improved in >25 years.

Solid Corrosion Products in the Periprosthetic Tissues of a Distal Femoral Endoprosthesis Used to Treat Osteosarcoma

The case of a child is described who was treated for distal femoral osteosarcoma with chemotherapy, removal of the distal femoral bone, and the implantation of a series of distal femoral endoprostheses with hinged tibial components. The design of this modular prosthesis allows for expansion during the years that the bones continue to grow. The tissues from nine surgical procedures were examined, along with one tibial bearing and axle component. Wear debris was noted in variable amounts in nearly all of the tissues but solid corrosion products from the modular junctions were abundant only in the last revision tissues. The amount of wear and corrosion of the explants seemed inconsistent with the size and amount of corrosion products in the tissues. The source of the debris is likely to be in the modular connections that were not revised.

Unusual abdominal metastases in osteosarcoma.

Intraabdominal metastases in the setting of osteosarcoma are very rare. We describe a case of a 17-year-old boy with high-grade right distal femur osteosarcoma who two years after diagnosis developed extensive intra abdominal metastases involving the omentum, peritoneum, bowel serosa, psoas muscles and abdominal soft tissue. Awareness of and surveillance for unusual patterns of metastasis may allow for earlier detection, intervention, and palliative care decision-making, which may affect survival and quality of life. This report underlines the need for prospective studies evaluating surveillance guidelines for patients after medical and surgical management of osteosarcoma, especially in cases complicated by pulmonary metastases.

Leishmania Infection of a Knee Megaprosthesis.

This article presents a 19-year old patient with a distal femoral osteosarcoma treated with limb salvage and distal femoral megaprosthetic reconstruction complicated postoperatively by bone leishmaniasis. Bone biopsy was done; bone tissue was sent for cultures and histology. Cultures were negative. Histological sections showed Leishman - Donovan bodies within histiocytes confirming the diagnosis of leishmania infection of the distal femoral megaprosthesis. The patient was administered amphotericin B for a total of 10 days and gradually became afebrile. Two months after treatment the patient was readmitted with high fever, pancytopenia, liver and spleen enlargement, and chest pain. Radiographs of the chest showed lobar pneumonia and pleural effusion; thoracentesis showed Mycobacterium avium intracellulare lung infection. Despite multi-regimen antibiotic therapy and chemotherapy, disease progressed and the patient died 19 months after osteosarcoma resection and distal femoral megaprosthetic reconstruction from cancer-related complications.