Median Musculoskeletal Tumor Society Score Research Articles

Clinical outcomes for patients with soft tissue sarcoma of the hand

In an earlier report from the current study center regarding surgical treatment for patients with soft tissue sarcoma (STS) of the hand, it was concluded that repeat resection or amputation improves outcomes. Since then, the authors have aggressively sought to achieve negative resection margins, using standard or modified amputations when needed, and performing repeat resections to negative surgical margins when they were not achieved at the time of initial surgery. The current review was conducted to determine whether this approach resulted in better outcomes. A retrospective review of 53 patients with STS of the hand who were treated between 1996 and 2005 was performed. Recurrence-free survival (RFS) and functional outcome of hand-preserving procedures were assessed according to the Musculoskeletal Tumor Society (MSTS) system. The median RFS was not reached at the time of last follow-up. Of 53 patients, 6 (11%) had positive microscopic resection margins. Three patients underwent repeat resection to negative surgical margins, whereas another 3 patients did not. All 3 patients with positive microscopic surgical margins that were not re-excised developed local disease recurrence; 2 patients also developed distant metastases. Two of the 50 patients with negative resection margins developed distant metastases. All 5 patients who developed local and/or distant disease recurrence had deep tumors. The median MSTS score was 29 (interquartile range, 27-30). Patients who underwent more extensive resections, such as double ray amputations, had lower MSTS scores. Suboptimal biopsies and positive resection margins are associated with local and distant disease recurrence in patients with STS. The results of the current study suggest that aggressive surgical treatment can result in better clinical outcomes, and underscore that care must be taken when planning biopsies of hand tumors.

Limb-sparing surgery preserves more function than amputation

We evaluated the long-term functional outcome in 118 patients treated for osteosarcoma or Ewing's sarcoma in the extremities a minimum of five years after treatment. We also examined if impaired function influenced their quality of life and ability to work. The function was evaluated according to the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Quality of life was assessed by using the Short Form-36 (SF-36). The mean age at follow-up was 31 years (15 to 57) and the mean follow-up was for 13 years (6 to 22). A total of 67 patients (57%) initially had limb-sparing surgery, but four had a secondary amputation. The median MSTS score was 70% (17% to 100%) and the median TESS was 89% (43% to 100%). The amputees had a significantly lower MSTS score than those with limb-sparing surgery (p < 0.001), but there was no difference for the TESS. Tumour localisation above knee level resulted in significantly lower MSTS scores and TESS (p = 0.003 and p = 0.02, respectively). There were no significant differences in quality of life between amputees and those with limb-sparing surgery except in physical functioning. Of the patients 11% (13) did not work or study. In multivariate analysis, amputation, tumour location above the knee and having muscular pain were associated with low physical function. We conclude that most of the bone tumour survivors managed well after adjustment to their physical limitations. A total of 105 are able to work and have an overall good quality of life.

The Anterior Popliteal Approach for Popliteal Exploration, Distal Femoral Resection, and Endoprosthetic Reconstruction

Distal femoral resection and endoprosthetic reconstruction are sometimes associated with flap necrosis and inadequate soft tissue coverage. We evaluated the anterior popliteal surgical approach, which was designed to reduce those complications by using a posteromedial myocutaneous flap based upon the vastus medialis. A retrospective analysis of 46 consecutive patients was performed, and results were compared with historical controls. Compared with 19.4% with wound complications and 22.7% with gastrocnemius flap transfers in previous series by the senior author, 7.8% of patients in the present study had minimal superficial flap necrosis, and no gastrocnemius transfers for soft tissue coverage were required. The median Musculoskeletal Tumor Society score was 26, and the local recurrence rate 2 years or more after resection of osteosarcoma was 4%. The anterior popliteal approach to the distal femur limited wound complications and provided good soft tissue coverage of the endoprostheses.

Favorable Long-Term Results of Prosthetic Arthroplasty of the Knee for Distal Femur Neoplasms

We evaluated implant survival, late complications prompting reoperation and functional outcome in long-term (> 5 years) survivors of bone neoplasms of the distal femur treated with osteoarticular resection and segmental rotating hinge total knee arthroplasty. We retrospectively reviewed 83 patients who survived more than 5 years after the first procedure. Seventy-four of the 83 patients have retained a mobile knee joint. At a median followup of 146 months (range, 62-252 months), 22 patients required 26 additional procedures for a prosthesis-specific event (n = 24) or tumor recurrence (n = 2) after reaching 5-year followup. Aseptic loosening (n = 7) and component breakage (n = 2) occurred between 5 and 10 years. Polyethylene wear (n = 12) occurred only after 10 years. One late tumor recurrence at 62 months prompted amputation. All other patients retained a mobile knee joint. Functional outcome was excellent with a median Musculoskeletal Tumor Society score of 88% and a median Toronto Extremity Severity Scale score of 94%. Patients with bone neoplasms who survive more than 5 years after limb salvage with a segmental rotating hinge total knee arthroplasty can expect to retain a mobile knee joint and function consistently at a high level. Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.