Outcome Of Limb Salvage Surgery Research Articles

Functional Outcome of Limb Salvage Surgery With Megaprosthesis In Primary Bone Tumour Arround Knee

The knee is the most frequent site of primary bone tumour. A majority of the tumours arising in the knee can be treated with limb salvage surgery and result in good functional outcomes. We evaluated functional outcomes for patients who underwent surgery for resection and megaprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur and proximal tibia placements. This study was an observational analysis study with cross sectional approach in primary bone tumor knee region which has been done limb salvage surgery. The study sample included 11 cases of distal femur and 6 cases of proximal tibia megaprosthesis replacement. Primary tumours were classified as follows: 5 osteosarcoma, 12 giant cell tumour (GCT). The Patients was subjected to a physical examination to complete MSTS score and then commpared data were obtained. Functional outcomes, as measured by MSTS functional assessment were good to excellent in a majority of study patients. This study shows an unsignificant differences functional outcome using MSTS Score between resection tumour in distal femur and proximal tibia (p >0.05). There were no differences in functional outcomes when comparing distal femur megaprostheses with proximal tibia megaprostheses

Functional Outcome of Limb Salvage Surgery With Megaprosthesis In Primary Bone Tumour Arround Knee

The knee is the most frequent site of primary bone tumour. A majority of the tumours arising in the knee can be treated with limb salvage surgery and result in good functional outcomes. We evaluated functional outcomes for patients who underwent surgery for resection and megaprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur and proximal tibia placements. This study was an observational analysis study with cross sectional approach in primary bone tumor knee region which has been done limb salvage surgery. The study sample included 11 cases of distal femur and 6 cases of proximal tibia megaprosthesis replacement. Primary tumours were classified as follows: 5 osteosarcoma, 12 giant cell tumour (GCT). The Patients was subjected to a physical examination to complete MSTS score and then commpared data were obtained. Functional outcomes, as measured by MSTS functional assessment were good to excellent in a majority of study patients. This study shows an unsignificant differences functional outcome using MSTS Score between resection tumour in distal femur and proximal tibia (p >0.05). There were no differences in functional outcomes when comparing distal femur megaprostheses with proximal tibia megaprostheses

Outcomes of management of primary benign aggressive or malignant bone tumors around the elbow by limb-salvage surgery

PurposeBone tumors around the elbow are rare, with frequently delayed diagnosis. The current study aimed to assess the functional and oncological outcomes of limb salvage surgery for primary benign aggressive or malignant bone tumors around the elbow.MethodsWe conducted a retrospective review of patients with primary aggressive benign and malignant bone tumors around the elbow treated with limb salvage surgery between 1995 and 2020 at a single musculoskeletal oncology center. The minimum follow-up period was 24 months. Functional results were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the last follow‐up visit. Local recurrence, chest metastasis, and complications were recorded.ResultsThis study included 30 patients, 19 males and 11 females, with a mean age of 25.4 ± 14.2 years. The tumor location was the distal humerus (n = 21), proximal radius (n = 5), and proximal ulna (n = 4). Reconstruction was done by elbow fusion using fibular graft (n = 10), mobile endoprosthesis (n = 9), excision arthroplasty (n = 7), and extracorporeal freezing and reimplantation (n = 4). The mean follow-up period was 36.2 ± 21.3 months. The median follow-up MSTS score was 27 [Interquartile range (IQR): 26–30]. Skeletally immature patients had a significantly higher MSTS score. The rate of postoperative complications was 26.7%.ConclusionLimb salvage surgery with different reconstructive options for benign aggressive and malignant bone tumors around the elbow can achieve good functional and oncological outcomes.Level of evidenceLevel IV.

Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Cross-sectional Comparative Study.

Giant cell tumor of bone (GCTB) is a benign aggressive tumor primarily treated with surgery. Neoadjuvant treatment with denosumab or zoledronic acid is a common adjunct given to down-stage tumors and facilitate limb sparing surgery. This study sought to determine the characteristics, outcomes, and occurrence of complications following resection (RS) or extended curettage (EC) for GCTB of the lower extremities. Correlation of neoadjuvant therapy with the occurrence of complications was also investigated. This is an analytical cross-sectional study of 30 patients diagnosed with GCTB of the lower extremity treated between 2015 to 2022 in a single tertiary hospital. Functional outcomes were determined using the 1993 version of the Musculoskeletal Tumor Society (MSTS) score. Mean follow-up for all patients was 2.6 years (SD 1.8). Twenty-two patients (73%) underwent resection, while eight (27%) patients underwent extended curettage. Of the 30 patients, 26 (87%) patients received neoadjuvant therapy, with 21 (81%) given denosumab and five (19%) given zoledronic acid. Functional outcomes were excellent for 23 patients (77%), with no significant difference between RS and EC groups. Nine complications occurred in the RS group, including dehiscence (n=3), superficial infection (n=2), implant failure (n=1), nonunion (n=1), palsy (n=1), and implant irritation (n=1). Five complications occurred in the EC group, four of which were noted to be recurrences, with one case of deep infection. Recurrence was noted to be significantly higher (p=0.0004) in the EC group. Separate correlation analysis showed no significant difference in incidence of complications but found that duration of surgery was significantly longer (p=0.0001), and intraoperative blood loss was significantly higher (p=0.0072) in the RS group. No significant difference (p=0.78) was noted in complication rate between patients given denosumab versus zoledronic acid. Functional outcomes of EC and RS appear to be comparable, including the incidence of complications. However, recurrence was noted to be significantly higher in EC. There appears to be no clear advantage between denosumab or zoledronic acid for GCTB. As a neoadjuvant medication and/or to control tumor progression, zoledronic acid may be the more economic option especially for patients in developing countries.

Endoprosthetic Reconstruction in Ewing's Sarcoma Patients: A Systematic Review of Postoperative Complications and Functional Outcomes.

Ewing’s sarcoma (ES) is a rare primary bone cancer managed by radiotherapy, chemotherapy and surgical resection. The existing literature on limb salvage surgery with endoprostheses combines data for ES patients with osteosarcoma. This review aimed to evaluate surgical and functional outcomes of endoprosthetic reconstruction in exclusively Ewing’s patients. We believe that this is the first comprehensive review to evaluate the outcomes of limb salvage surgery with endoprostheses exclusively in Ewing’s sarcoma patients. Clinical data and outcomes were collected from PubMed, Embase, Medline and Scopus. The inclusion criteria were studies on limb salvage surgery in ES patients, where individual patient data was available. Seventeen studies with a total of 57 Ewing’s patients were included in this review. Fifty-three of the ES patients preserved the limb after limb salvage with endoprostheses. The average five-year implant survivorship was 85.9% based on four studies in this review. Postoperative complications were categorised by Henderson’s failure modes. Soft tissue failure was the most common, occurring in 35.1% of patients, followed by deep infection in 15.7% of patients. There was a suggestion of ‘good’ functional outcomes with limb salvage surgery. The salient limitation of this review is the variability and rarity of the patient population. Homogenous data in a larger population is necessary to provide more insight into outcomes of limb reconstruction in ES.

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

What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

Background and ObjectivesAfter diagnosing a primary bone tumor involving the forearm, various excision strategies and reconstruction methods must be considered. This study explored the oncological and functional outcomes of limb salvage surgery for primary malignant bone tumors in the forearm.MethodsPatients with primary forearm bone tumors (n = 369) were retrospectively analyzed between 2000 and 2017. There were 266 patients with radial tumors, and 46 (17.3%) were malignant, whereas 103 patients had ulnar lesions and 22 (21.4%) were malignant tumors. The oncological results, prognostic factors, and functional results after limb salvage surgery of forearm malignancies were analyzed.ResultsThe follow-up averaged 72.1 (7–192, median 62.5) months. Fifty-six patients who received limb salvage surgery were included in the final evaluation. Radius resection was performed in 38 patients, and distal radius (25 patients) was most frequent. Ulnar resection was performed in 18 patients, and the proximal ulna (13 patients) was most frequent. The surgical margins obtained were intralesional in 3 patients, marginal in 8 patients and wide in 45 patients. Local recurrence occurred in 11 patients (19.6%), and distant metastasis occurred in 14 patients (25%). The 5-year recurrence-free survival rate was 79.8%. Unplanned excision, ulnar involvement, proximal forearm location and inadequate surgical margins were associated with recurrence. The overall 5-year and 10-year survival rates were 83.5 and 71.7%, respectively. Distant metastasis was a poor prognostic factor for the survival rate. Forty-two patients were evaluated by MSTS score with an average of 27.9 ± 1.5.ConclusionsThe incidence of radial malignant tumors is higher than that of ulnar lesions. The distal radius and the proximal ulna are the most frequently involved sites. Unplanned excisions, ulnar tumors, proximal forearm tumors, and inadequate surgical margin are the risk factors for local recurrence. Distant metastasis is an independent poor prognostic factor of death. The oncology control and functional results of limb salvage surgery were satisfactory.

Early Clinical Outcome of Limb Salvage Surgery of Osteosarcoma in the Lower Extremity Using Liquid Nitrogen

Background. Osteosarcoma in the lower extremity has become a challenge for orthopedic surgeons to manage because surgeons need to preserve the affected joint's functions and retain stability as physiologic as possible. Thus, limb salvage surgery may be the treatment of choice. One of the techniques using liquid nitrogen provides better functionality and efficacy in preventing recurrence.
 Methods. From October 2020 to October 2021, 7 patients with primary musculoskeletal sarcoma underwent limb salvage surgery (LSS) by wide resection of the tumor and reconstruction using recycled Autograft treated with liquid nitrogen. The resected bone was dipped in liquid nitrogen for 15 min and thawed at room temperature for 15 min. The recycled bone was re-implanted into its original site and stabilized with internal fixation, and some of them followed with arthroplasty.
 Results. Average age was 14.14 years old. The most common site was the distal femur which was found in 3 cases (42,8%). During the 6-months-follow-up period, all patients had a good function (mean functional MSTS score of 90%) with one case of local recurrence in the re-implanted bone and one case of infection. No metastasis was reported in any patient.
 Conclusion. Satisfying functional results were recorded in all subjects treated with cryosurgery in Dr. Mohammad Hoesin General Hospital Palembang with equal results with studies around the world.

Early outcomes of limb salvage surgery with mega-prosthesis

Objective: To determine the early outcomes of limb salvage surgery with mega prosthesis. Methods: This retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from 1st January 2017 till 31st January 2020. Data like demographics, histopathology, functional and survival outcomes were retrieved from the Hospital Information System. Musculoskeletal Tumor Society (MSTS) score was used to evaluate the functional outcomes after the surgery. For survival analyses, Kaplan-Meier curve was applied. Prosthesis joint infection, amputation rate, metastasis, mortality rate, and recurrence were also recorded. Results: This study included 43 patients who underwent limb salvage surgery with endoprosthesis reconstruction at SKMCH&RC. The mean age at the time of diagnosis was (26.5±15.8) years. Patients with distal femoral replacement had the highest MSTS scores (81.45±9.70) while those with proximal humerus replacement has the lowest MSTS scores (56.8±11.2). There was a strong association between site of tumor and MSTS (F=3.30, P=0.017). We also found a correlation between surgical site infection and MSTS scores (r=0.484, P=0.001). Patients with recurrence also had significantly lower MSTS scores (P<0.05). The cumulative survival rate at the end of two-year follow-up was (71.4±17.1)% in proximal femur tumor patients, (88.0±7.8)% in distal femur tumor patients, and (50.0±3.5)% in proximal humerus tumor patients. Besides, patients with Ewing sarcoma had the highest survival rate (97.5±11.0)% while patients with chondrosarcoma had the lowest survival rate (77.8±13.9)%. Conclusions: Limb salvage surgery with mega-prosthesis can be performed with satisfactory functional and survival outcomes, but further studies are needed to compare it with other limb salvage methods. This study can be used as a reference for future studies.

Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Giant cell tumor of the bone (GCTB) is a benign, locally aggressive neoplasm that is relatively rare, with a propensity to result in progressive bone destruction, and is associated with a high risk of recurrence. There is no widely held consensus regarding its ideal treatment. Worldwide, there are varying techniques ranging from intralesional curettage to resection of the lesion, supplemented with combinations of numerous adjuncts and fillers, depending on the resected amount and integrity of bone, as well as the preference of the surgeon. This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals. The mean follow-up period was 37.3 months (SD=2.84). The extended curettage (EC) group had a mean Musculoskeletal Tumor Rating Scale (MSTS) score of 28.18 (SD=7.51) which is considered as an excellent outcome, while the resection (RS) group had an mean MSTS score of 19.67 (SD=11.02), which is considered as a good outcome. EC resulted to a total of eight complications (47%), while RS had one complication (33%). Prevalence of recurrence was noted to be 11.75% among those who underwent EC, while no recurrence was noted among those in the RS group. Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts, however were both were noted to result in excellent functional outcomes. Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC, there is still report of excellent functionality. It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.

Outcomes of Vascular Resection and Reconstruction in Extremity Soft Tissue Sarcoma and Bone Tumors.

PurposeThis study aimed to evaluate and analyze the feasibility and the oncological and functional outcomes of limb salvage surgery in extremity soft tissue sarcomas (ESTS) and bone tumors invading vessels.MethodsMaterials and This single-center retrospective analysis included patients with ESTS encasing or invading major blood vessels that were treated by limb salvage surgery with vascular resection and reconstruction between January 1995 and December 2019. Patients with contiguous involvement of major blood vessels and nerves and patients requiring amputation were excluded from the study.ResultsA total of 24 vessels (14 arteries and 10 veins) in 14 patients were reconstructed. Ten (71.4%) patients underwent both arterial and venous reconstruction, and four (28.6%) underwent only arterial reconstruction. Reconstruction was performed with a reversed saphenous vein (RSV) graft in 12 patients and with a synthetic graft (SG) in the other 12 patients. At a median follow-up of 27 months, RSV grafts were patent in 10 of 12 (83.3%) vessels and SGs were patent in 6 of 12 (50.0%) vessels (log-rank test, P=0.083). Out of 14 arteries and 10 veins, 11 arteries and 5 veins were patent, respectively. No patient developed local recurrence, and 2 (14.3%) patients developed distant metastases. Limb salvage rate was 13/14 (92.9%). The mean Musculoskeletal Tumor Society score was 83.3%. The 5- and 10-year overall survival rates were 80% and 50%, respectively.ConclusionLimb salvage surgery in ESTS with vascular resection and reconstruction is feasible and provides favorable oncological and functional outcomes.

A Comparative Study on the Clinical and Functional Outcome of Limb Salvage Surgery and Amputation in Tibial Osteosarcoma

A Comparative Study on the Clinical and Functional Outcome of Limb Salvage Surgery and Amputation in Tibial Osteosarcoma

Outcome of limb salvage surgery in sarcomas around knee with mega endoprosthetic reconstruction

Outcome of limb salvage surgery in sarcomas around knee with mega endoprosthetic reconstruction

Functional Outcome of Limb Salvage Surgery by Megaprosthesis for Malignant Bone Umours-Mid and Long Term Follow Up

Functional Outcome of Limb Salvage Surgery by Megaprosthesis for Malignant Bone Umours-Mid and Long Term Follow Up

Functional outcome of limb salvage surgery in gaint cell tumour around knee with mega-endoprosthetic reconstruction

Introduction: Giant cell tumors (GCTs) represent 3-4% of all primary tumors of bone [1]. These tumour are locally aggressive and predominantly affect the ends of long bones (usually the distal femur and proximal tibia) in young adults. The ideal aim in the management of GCT is to eradicate the tumor without sacrificing the joint. Wide resection should be the treatment of choice, especially for situations such as recurrences, pathological fractures and tumors which are frankly malignant tumorAim: To determine the functional outcome and complications of mega endoprosthesis in treatment of gaint cell tumour around knee joinMaterials and Methods: Retrospective study conducted from 2010 to 2016 with age ranging from 16 to 30 years with follow up period- 48 months. All patient with primary GCTs around knee who had met with inclusion criteria underwent surgery. All patient underwent definitive wide local resection and Mega-endoprosthetic reconstruction, Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Complications related to surgery such as Infection, Aseptic loosening, Dislocation, Skin necrosis and Fractures were evaluated. The diagnosis was based on histopathological features noted on a core biopsy. Patients with a high-grade GCT were subjected to computed tomography of the chest and bone scan for metastatic evaluation.Results: The average MSTS functional score was 75% (Range- 60% to 100%), 4-year survival rate was 100% in our study. Average range of movements at 4 years was 80 (70-90). Among the 8 patients, 2 had complications related to surgery. One had infection which required intravenous antibiotics treatment but infections did not subsided so patient underwent allograft bone transplant with arthrodesis. One had foot drop secondary to common peroneal palsy, Six months post-surgery, he was able to walk with a single crutch and coped well with his foot drop. Conclusions: Wide resection and endoprosthetic replacement should be considered as a preferred treatment option in treatment of aggressive gaint cell tumour around knee joint. Mega-endoprosthetic reconstruction provides good functional outcome in patients with these kind of tumour and can be considered as treatment of choice if and when the limb can be salvageable.

Clinical outcomes of limb salvage surgery with postoperative intensity-modulated radiation therapy for soft-tissue sarcoma and metastasis.

The primary aim of intensity-modulated radiation therapy (IMRT) for treating soft tissue sarcoma of an extremity is the reduction of morbidity and maintenance of local control. We evaluated the outcomes and toxicity of adjuvant IMRT following function-preserving surgery to treat patients with soft tissue sarcoma and metastasis of the extremities. We retrospectively reviewed prospective databases at Kure Medical Center and Aichi Medical University between 2013 and 2016 and identified 10 patients with lower extremity soft tissue sarcoma who underwent both limb-sparing surgery and postoperative IMRT at one of our institutions. There were 7 men and 3 women (mean age, 67.2 years; range, 48-87 years) included in the study. Of these, four patients were continuously disease-free, two showed no evidence of disease, and four died due to disease. The average functional score was 82% (range, 53-100%). Among the 10 patients, 2 (22%) had grade 1-2 edema and 1 (11%) had grade 2 joint stiffness. Another patient developed grade 2 acute dermatitis. There were no severe complications such as infection, tissue necrosis, fracture, or nerve palsy. Although the number of patients in this study was small, our results show that adjuvant IMRT following function-preserving surgery for soft tissue sarcoma of the extremity can be valuable for treating unmanageable tumors.

Risk Factors for Perimegaprosthetic Infections After Tumor Resection.

Periprosthetic joint infection remains one of the most challenging and pervasive complications following megaprosthetic replacement after tumor resection. The authors conducted a systematic review of the literature for clinical studies that reported a risk factor analysis for perimegaprosthetic joint infections. The search included English-language studies published up to July 2015. Eight studies fulfilled the inclusion criteria. Identified factors mostly related to both surgical procedure and hospitalization. Physicians should consider these results when discussing the outcomes of limb salvage surgery with patients and trying to reduce the overall burden of perimegaprosthetic joint infections. [Orthopedics. 2017; 40(1):e11-e16.].

Limb salvage surgery for osteosarcoma: Early results in Indian patients.

Background:While limb salvage surgery has long been established as the standard of care for osteosarcoma, large studies from Indian centers are few. Given the diverse socio economic milieu of our patients, it becomes significant to determine the feasibility and outcome of management of osteosarcoma in our population. We analyzed the early outcome of limb salvage surgery with multimodality treatment of osteosarcoma of the extremity/girdle bones at a tertiary North Indian Cancer Centre.Materials and Methods:A total of 51 limb salvage surgeries performed during the months between November 2008 and November 2012 were studied. Neoadjuvant/adjuvant chemotherapy was given by the pediatric/adult medical oncology teams as applicable. The mean followup was 19.45 months (range 2-50 months). The oncological outcome was correlated with age, sex, size of tumor, stage at presentation, site, histological subtype, type of chemotherapy protocol followed and necrosis seen on postoperative examination of resected specimen. The functional outcome of the patients was evaluated using the musculoskeletal tumor society (MSTS) scoring system.Results:Out of a total of 37 males and 14 females with an average age of 18.8 years, the 3 year overall survival was 66% and 3 year event free survival was 61.8%. In this group of patients with a short followup, a better oncological outcome was associated with good postoperative tumor necrosis, nonchondroblastic histology and age <14 years. The average MSTS score was highest in patients with proximal or distal femur prosthesis and the lowest in patients undergoing a knee arthrodesis.Conclusion:The present study shows oncological and functional outcomes of limb salvage combined with chemotherapy in Indian patients with osteosarcoma comparable to those in world literature. Larger studies on Indian population with longer followup are recommended.

Osteosarcoma and Chondrosarcoma of the Shoulder: Site-specific Comparative Analysis

Osteosarcoma and chondrosarcoma compose most of the primary malignancies of the shoulder. The literature lacks site-specific comparative analyses of these 2 major shoulder sarcomas. The purposes of this study were to describe the different characteristics of the 2 major sarcomas near the glenohumeral joint, examine differences in treatment outcomes, and evaluate the functional outcomes of limb salvage surgery. Thirty-two patients with osteosarcoma or chondrosarcoma who underwent a wide resection including the glenohumeral joint were enrolled in this study. The characteristics of tumor development and treatment, oncologic and functional outcomes, and factors affecting outcomes were compared between groups and with the literature. The results showed shoulder osteosarcoma developing similarly to the literature reports, whereas chondrosarcoma tended to be of a high histologic grade. Nonetheless, the osteosarcoma group had a poorer overall 5-year survival rate (53.0%) than the chondrosarcoma group (85.7%) or those in previous reports. The osteosarcoma group had a tendency toward a worse 5-year metastasis-free survival rate than the chondrosarcoma group (35.4% vs 75.0%, respectively), although the 5-year local recurrence-free survival rate was not significantly different between the 2 groups (75.0% vs 87.5%, respectively). Histologic grade, surgical stage, and chemotherapy affected the oncologic outcomes in univariate analysis, although not a single factor was independent in multivariate analysis. The functional outcomes were not significantly affected by clinical characteristics or surgical methods in patients who had undergone a wide resection including the glenohumeral joint.

Functional outcome of limb salvage surgery with mega-endoprosthetic reconstruction for bone tumors

The use of a mega-endoprosthesis has become the method of choice for reconstruction after bone tumors. In this study, we sought to determine the functional outcome and complications associated with mega-endoprosthesis. A retrospective review of the charts of 16 patients who had undergone resection of bone tumors followed by reconstruction with mega-endoprosthesis between 2006 and 2011 was performed. Functional evaluation was based on the Musculoskeletal Tumor Society (MSTS) scoring system. Complications of the procedures were also analyzed. Eight men and eight women at an average age of 36.7 years were included in the study. The tumor involved lower limb in 14 patients and upper limb in 2 patients. The average MSTS functional score was 72.3 ± 15. Excellent results were achieved in six patients, good in five, moderate and fair in two each and poor in one. Complications occurred in eight patients. Two patients had aseptic loosening of the femoral component of total knee replacement. Flap necrosis occurred in two patients, both of whom required latissimus dorsi free flap for coverage of total knee prosthesis. One patient underwent revision of femoral component subsequent to knee dissociation. Local recurrence of tumor, patellar tendon rupture and foot drop occurred in one patient each. Mega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumors.