Osteosarcoma Of Proximal Tibia Research Articles

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

Functional Outcome Following Proximal Tibial Osteosarcoma Resection and Reconstruction by Modular Endoprosthesis

PurposeThe proximal tibia is a common location for osteosarcoma. Modular endoprosthesis is a popular reconstructive option, yet it has been associated with many complications. Our study aimed to evaluate the functional outcome and complications of proximal tibial osteosarcoma patients treated by limb salvage using modular endoprosthesis.MethodsA retrospective study of a prospective database was performed during the period between January 2000 and July 2017. Fifty-five patients with proximal tibial osteosarcoma underwent resection and modular endoprosthetic reconstruction. The functional outcome was evaluated using the Musculoskeletal tumor society scoring system and knee range of motion. Postoperative complications were classified according to Henderson classification; Type 1 (soft tissue failure), Type 2 (aseptic loosening), Type 3 (structural failure), Type 4 (infection) and Type 5 (local tumor progression).ResultsThe mean follow-up period was 71.69 ± 49.76 months. The mean musculoskeletal tumor society score was 26.5 ± 2.22; the mean range of motion was 72.63 ± 25.07, and the mean extension lag was 15.09 ± 15.38. Type 1, type 2, type 3, type 4, and type 5 complications occurred in 7.3%, 14.5%, 21.8%, 23.6%, and 5.5%, respectively. Chest metastasis developed in 10 patients (18.2%). The estimated 5-year and 10-year survival rates for the treated patients were 83.6% and 79.9%.ConclusionsProximal tibial osteosarcoma reconstruction with a modular endoprosthesis is a reliable treatment option for retaining limb function. Most complications are manageable.

Designing a better incision for proximal tibial osteosarcoma resection and reconstruction: a reminder of the skin's vascular anatomy.

Designing a better incision for proximal tibial osteosarcoma resection and reconstruction: a reminder of the skin's vascular anatomy.

Pedicled fibular transfer for biologic knee extensor tendon reinsertion following proximal tibial resection in pediatric osteosarcoma: Long-term outcomes.

Proximal tibial sarcoma resections result in a reconstructive challenge, necessitating joint and extensor mechanism reconstruction. The gait and functional outcomes for children reconstructed with a combination of megaprosthesis and pedicled fibular flap for extensor mechanism reconstruction, are presented. Four patients, aged 11-18 years old, were available for comprehensive analysis. The proximal tibial osteosarcoma was resected, and the reconstructive technique involved a megaprosthesis for the knee joint, used in combination with a pedicled fibula flap as a biologic structure for reinsertion of the knee extensor mechanism. Outcomes were measured with three-dimensional gait analysis and patient questionnaires. Minor postoperative wound issues occurred in some patients, requiring debridement with skin grafting. One patient fractured their transferred fibula, requiring fixation. The follow up period ranged from 1.7 to 24 years postoperatively. The longevity and quality of reconstructions were strong, measured by both objective and patient-reported outcomes. All patients reported independent walking >500m in the Functional Mobility Scale and rated their walking as a nine or 10 (out of 10) on the Functional Assessment Questionnaire. Knee society scoring revealed overall satisfaction rate of 75-80%. No patients required gait aids. The gait profile analysis revealed effective gait patterns, with patterns deviating 5.4-7° from "typical gait." Deviations >6.5° are considered abnormal. The long-term results of combining a megaprosthesis with a pedicled fibula flap for extensor reinsertion, revealed a high level of independent function. The patients performed well, without the need for aids, and gait study evidence of minimal gait deviations.

Prosthetic Reconstruction for Proximal Tibial Osteosarcoma with an Anterolateral Surgical Approach: Case Report

Prosthetic Reconstruction for Proximal Tibial Osteosarcoma with an Anterolateral Surgical Approach: Case Report

Popliteal lymph nodes in patients with osteosarcoma: are they metastatic?

To evaluate the prevalence, imaging appearance, and significance of popliteal lymph nodes (PLN) on magnetic resonance imaging (MRI) in patients with distal femoral or proximal tibial osteosarcoma (OS). This study included consecutive patients with OS presenting from May 2016 to March 2018. Inclusion criteria were patients with distal femoral or proximal tibial OS with MRI and pathology at our institution. On MRI, two radiologists recorded primary tumor features (size, location, signal, extra-compartmental extension), and PLN characteristics (mean size, presence/absence of fatty hilum, mineralization, PET/bone scintigraphy avidity, contrast enhancement, and diffusion restriction). Tumor histology, stage, and clinical follow-up were recorded. Descriptive statistics were provided. Sixteen patients with OS (age 20 ± 10 (range10-40) years, 10/16 male) were included. Although 81% (13/16) of the patients had PLNs at presentation (size range 0.3-3.6cm), fewer patients had extra-compartmental spread: intra-articular extension 50% (8/16), skip lesions 19% (3/16), lung metastases 31% (5/16), and osseous metastases 12% (2/16). Four (25% (4/16)) patients had PLN ≥ 1cm; two were histologically proven reactive. One was presumed metastatic due to rapid development, mineralization, and FDG-avidity on PET/CT. The other ≥ 1cm PLNs along with all twelve (75% (12/16)) that were < 1cm in mean diameter were presumed non-metastatic with documented stability for at least 12months of follow-up. PLNs are frequently visible on MRI in patients with OS but are rarely (prevalence = 6%) metastatic. Features on MRI which may suggest metastatic PLNs include large size > 1cm and loss of a fatty hilum.

Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children

To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma. Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively. All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively. The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.

Comparison of clinical features, management and outcomes of osteosarcoma located in proximal fibula and proximal tibia: a propensity score matching analysis

BackgroundThe aim of this study was to compare proximal fibular and proximal tibial sites regarding osteosarcoma in the proximal crus. Furthermore, we proposed a hypothesis explaining the differences.MethodsFrom Jaunary 2000 to February 2015, 28 patients with non-metastatic proximal fibular osteosarcoma and 214 patients with non-metastatic proximal tibial osteosarcoma underwent surgery were identified in our center. All clinical data were analyzed retrospectively. Propensity score matching of patients in a 1:2 ratio was conducted based on age, gender and Enneking stage. To analyze possible factors resulting in amputation, we investigated extraosseous tumor volumes (ETVS), the nearest of the blood vessel to reactive zone (NBR) and the nearest of the blood vessel to tumor (NBT).ResultsAmputation rates were higher in the proximal fibula cohort (35.7%) than in the proximal tibia cohort (14.3%; p = 0.046). Comparing possible clinical characteristics related with amputation between two cohorts, the proximal fibula cohort had larger ETVS (p = 0.000). Moreover, the proximal fibula cohort had a smaller NBT for anterior tibial vessels (p = 0.025), a smaller NBR for posterior tibial vessels (p = 0.013) and a smaller NBT for posterior tibial vessels (p = 0.007) than the proximal tibia cohort. Univarite and multivariable analyses showed that NBT for posterior tibial vessels was the only independent factor associated with amputation. The 3-year event-free survival (EFS) and overall survival (OS) rates for the proximal fibula cohort vs. the proximal tibia cohort were 52.6% vs. 78.0% (p = 0.045) and 63.7% vs. 81.2% (p = 0.177), respectively. The MSTS scores for the functional evaluation of limb-salvaging surgery were similar in both groups (p = 0.212).ConclusionsAmputation rates among patients were higher when osteosarcoma was located in proximal fibula than in proximal tibia. A smaller NBT for posterior tibial vessels was associated with higher amputation rates. Prognosis of the proximal fibula cohort was poorer than that of the proximal tibia cohort of osteosarcoma patients.

Association of tibial plateau leveling osteotomy with proximal tibial osteosarcoma in dogs.

OBJECTIVE To assess for any association between a history of tibial plateau leveling osteotomy (TPLO) and subsequent development of proximal tibial osteosarcoma in dogs. DESIGN Matched case-control study. ANIMALS 34 client-owned dogs in which proximal tibial osteosarcoma was diagnosed between January 2005 and December 2012 (cases) and 79 dogs without osteosarcoma, matched 3:1 to cases (when possible) by age, breed, and initial examination date (controls). PROCEDURES Information on each case and control was collected from the medical records and other sources regarding date of birth, sex and neuter status, body weight, breed, and whether TPLO had been performed ≥ 1 year ago. A multivariable conditional logistic regression model was constructed to evaluate associations of body weight and history of TPLO with the outcome of proximal tibial osteosarcoma in dogs. RESULTS After adjusting for body weight in the multivariable model, dogs with a history of TPLO were 40 times as likely to develop proximal tibial osteosarcoma as were dogs with no history of TPLO. In addition, each 1-kg (2.2-lb) increase in body weight was associated with an 11% increase in the odds of proximal tibial osteosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that dogs with a history of TPLO were at increased risk of developing osteosarcoma of the proximal region of the tibia relative to dogs with no such history. Therefore, it is important for proximal tibial osteosarcoma to be included among the differential diagnoses for new or worsening hind limb lameness in dogs that underwent TPLO ≥ 1 year previously.

Asymptomatic High Grade Osteosarcoma of Proximal Tibia: A Case Report

Asymptomatic High Grade Osteosarcoma of Proximal Tibia: A Case Report

What's New in Primary Bone Tumors.

This Update provides a review of work published in the area of primary musculoskeletal tumors between May 2015 and June 2016. The studies are largely Level III and IV, in part due to the rarity and varied nature of such tumors. The articles were identified by searching PubMed and reviewing prominent journals. Margins and local recurrence were the focus of several osteosarcoma studies. Bertrand et al. reviewed 51 high-grade extremity sarcomas with localized disease at presentation and found that a positive margin compared with a negative margin of >1 mm was the only factor that independently predicted local recurrence1. They confirmed that patients with a positive surgical margin had an increased risk of death from disease compared with those with negative margins. In another study, no local recurrences were noted among 11 patients followed for a minimum of 37 months who had undergone joint-sparing surgery for proximal tibial osteosarcoma that invaded the physis2. The proximal edge of the tumors was treated with intraoperative microwave ablation prior to tumor resection. The proximal osteotomies were planned at the edge of the tumor, but there were no positive margins. As Ewing sarcoma survival has improved, the factors influencing long-term outcomes have become more important. Stish et al. analyzed scores of the Toronto Extremity Salvage Score (TESS) and Pediatric Quality of Life Inventory (PedsQL) for 74 patients at an average duration of follow-up of 17.8 years3. They found that TESS results were better for those diagnosed at <18 years of age and that PedsQL scores were better for male patients than for female patients. Pelvic tumors were associated with decreased functional outcomes but not lower quality-of-life scores compared with tumors from other sites. The authors were not able to measure an effect of local therapy modality. Survival among …

The Use of Free Microvascular Techniques to Improve the Results of Van Nes Rotationplasty

Van Nes rotationplasty is a limb-salvage used for reconstruction after resection of a distal femoral or proximal tibial osteosarcoma in the pediatric patient. After resection, the distal leg is reapproximated to the level of tumor resection. The goal is to optimize extremity functionality such that the ankle functions as a knee joint. Traditionally, the vessels and nerves around the tumor are preserved within the distal leg. In the first case of our series, this method resulted in thrombosis, flap loss, and ultimately amputation secondary to venous torsion and thrombosis. In the following 2 cases, the intervening vasculature was resected along with the tumor, and the distal pedicles were anastomosed to their proximal counterparts using microvascular techniques. In addition to expediting resection of the tumor as well as allowing wider tumor resection margins, this technique also precludes thrombosis and subsequent flap loss.

Medial head gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma

To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma. From January 2000 to January 2010, 65 patients [37 males, 28 females; (17.0±6.5) years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation. According to the Enneking staging system, 35 patients were in stage IIa, 30 in stage IIb. All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis. Among them, there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn't. All the patients were followed-up. In the group with the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (13.5±4.2) cm, operation time was (150±45) min, intraoperative blood loss was (700±135) mL, and drainage volume was (500±200) mL. In the group without the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (12.3±5.8) cm, operation time was (135±37) min, intraoperative blood loss was (600±105) mL, and drainage volume was (450±250) mL. There was significant difference in the operation time (P<0.05) but no significant difference in the intraoperative blood loss and drainage volume (P>0.05). In the group with the transposition of medial gastrocnemius muscle flap, local skin necrosis occurred in 2 patients (5.7%), and prosthesis deep infection occurred in 1 (2.9%). In the group without the transposition of medial gastrocnemius muscle flap, subctaneous hematocele, and effusion occurred in 3 (10.0%), wound infection occurred in 4 (13.3%), 1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications (P<0.05). According to the function assessment by the Enneking system, in the group with the transposition of medial gastrocnemius muscle flap, 13 patients had excellent results, 17 had good results, 3 had fair results and 2 had poor results, with a satisfaction rate of 85.7%. In the group without the transposition of medial gastrocnemius muscle flap, 10 patients had excellent results, 12 had good results, 5 had fair results and 3 had poor results, with a satisfaction rate of 73.3%. There was significant difference in function assessment between the 2 groups (P<0.05). The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.

Is bone lengthening over an intramedullary prosthesis stem possible and safe?

Here we report the case of a 13-year-old girl with a history of massive left knee arthroplasty after excision of a proximal tibial osteosarcoma with subsequent leg length inequality. Owing to her short stature and her parents' refusal of surgical shortening by epiphysiodesis of the right lower limb, tibial lengthening over the prosthesis stem using an Ilizarov apparatus was undertaken and achieved 5 cm good quality regenerate but with a secondary infection leading to prosthesis removal. To the best of the authors' knowledge, no similar case has been previously reported in the literature. Although the goal of bone lengthening was achieved, this procedure should be avoided because of the high risk of secondary infection.

Custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved

The therapeutic results of managing proximal tibial osteosarcoma have been dramatically improved because of the recent advancements in imaging, chemotherapy, and surgical techniques. Further, the prognosis of patients with proximal tibial osteosarcoma is improved and the chance of survival with limb salvage surgery is increased. Among the limb salvage procedures, endoprosthetic reconstruction is now preferred to other methods such as allograft, composite allograft prosthesis, or arthrodesis. However, the treatment for proximal tibial osteosarcoma with proximal tibiofibular joint involved has not been reported. The report of the preliminary results of custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved following the primary tumor resection. The oncological results, functional outcomes, and complications were assessed in this present study. Eleven patients with osteosarcoma of the proximal tibia and proximal tibiofibular joint were studied in 1995-2005, at Qilu Hospital of the Shandong University. Seven cases were males and four cases were females, with a mean age of 17 years (range 14-23). The surgical stage of all of the patients was Stage IIB, according to the Enneking Surgical Staging System. After neo-adjuvant chemotherapy, all of the patients underwent en bloc resection. This procedure included the proximal tibiofibular joint and the upper end of the fibula, followed by custom prosthetic replacement. The extensor mechanism was repaired by reattachment of the patellar tendon to the slot in the tibial component, with reinforcement by autologous bone-graft and suturing of the patellar tendon to a medial gastrocnemius rotation flap. The medial gastrocnemius rotation flap was then used to cover the implants. During the mean follow-up time of 47 months (range 12-96), six patients lived free of the disease, and five patients experienced various complications. One patient was still alive yet affected by the disease; one patient had an amputation due to local recurrence; and three died of pulmonary metastases. Several early complications had occurred amongst those five patients: one developed skin necrosis; two experienced transient palsy of the common peroneal nerve; and two developed deep vein thrombus of the lower limb. The mean Musculoskeletal Tumor Society score was 70% (range 55-86%), the mean postoperative range of motion was 85 degrees (range 0-120 degrees ), and the mean extension lag was 11 degrees (range 0-20 degrees ). Custom prosthetic reconstruction could yield as much satisfactory results as neoadjuvant chemotherapy and limb salvage surgery, for patients with osteosarcoma in proximal tibia and proximal tibiofibular joint. During the present study, most patients had good or excellent motor functioning with few incidences of complications. However, more attention should have been given to both the quality of function and long-term survival of patients.

Application of the proximal tibiofibular joint resection on the limb salvage for osteosarcoma of the proximal tibia

To evaluate the proximal tibiofibular joint resection on the limb salvage for osteosarcoma of the proximal tibia. Between August 1995 and January 2004, 11 patients with osteosarcoma of proximal tibia and tibiofibular joint involved underwent resection and endoprosthetic proximal tibial replacement. Seven patients were male and 4 were female. The patients ranged in age from 14 to 23 years (mean 18 years). The surgical stage were IIB. The follow-up period varied from 2 to 9 years (mean 59 months). Three patients died of pulmonary metastases, 1 patient was still alive with pulmonary metastasis, 1 patient underwent amputation for local recurrence. There was 1 early skin necrosis, 2 transient palsy of the common peroneal nerve, and 2 thrombus of lower limb vein. The mean postoperative Musculoskeletal Tumor Society score of the knee joint was 70% (range 55% - 86%), the mean postoperative range of motion was 85 degrees (range 0 degrees - 120 degrees ), and the extensor lag varied from 0 degrees to 20 degrees . Limb salvage for osteosarcoma of the proximal tibia with proximal tibiofibular joint resection and custom-made prosthesis reconstruction has had excellent results, however, the prevention and treatment of relevant complications should be given more attention.

Solitary hemorrhagic intra-cerebral metastatic osteosarcoma

Osteosarcoma is the most common type of bone malignancy. The primary mode of metastasis is hematogenous. Lung metastasis is common. Isolated hemorrhagic intra-cerebral metastasis has not been reported earlier. This case report is of an 11-year-old boy with proximal tibial osteosarcoma who presented with right focal seizures secondary to a hemorrhagic solitary deposit in the left posterior frontal region. Histopathology confirmed this to be a metastasis from an osteosarcoma.

Clinical outcome of limb-salvage surgery for patients with proximal tibial osteosarcoma

Clinical outcome of limb-salvage surgery for patients with proximal tibial osteosarcoma

Endobronchial Metastasis From Osteosarcoma of Bone: Treatment With Intraluminal Radiotherapy

Lung parenchymal metastases are common manifestations in patients with osteosarcoma; however, spread to the major airway itself is extremely rare. We present a young man who had been previously treated with surgical resection following preoperative chemotherapy and immediate postsurgical adjuvant chemotherapy for proximal tibial osteosarcoma. He developed metastasis to the major airways. The patient was treated with intraluminal radiotherapy (ILT) for the endobronchial metastasis. This is the first report of an endobronchial osteosarcoma that was treated with ILT with a complete endoscopic response. ILT provided excellent palliation in this particular case.

Through knee amputation with gastrocnemius musculocutaneous flap. 6 cases of tibial osteosarcoma followed for 3 (1-6) years.

6 cases of proximal tibial osteosarcoma were operated on by through knee amputation using a long dorsal gastrocnemius musculocutaneous flap; the usual anterior flap could not be used because of tumor size and the location of the biopsy tract. The only complication was one wound dehiscence which healed. The stump was of good quality in all patients. At follow-up, the patients walked without walking aids.