LOWER LIMB SALVAGE FOR TUMOURS AROUND THE KNEE USING ONCOLOGICAL RESECTIONS AND MEGAPROSTHETIC RECONSTRUCTIONS
Keywords:Knee megaprosthetic reconstructions, Tumours around the knee, Giant cell tumour, Osteosarcoma, Modular megaprostheses.
AbstractBackground: This descriptive case series documented the clinical presentation of tumours around the knee in our population and explored the outcome of lower limb salvage with oncological resections and megaprosthetic reconstructions. The variables analysed included return of knee function, disease free survival and any complications observed over a follow up period of 5-years. Methods: The study spanned over a period of 13-years. It included adult patients of all genders who presented with tumours around the knee and underwent tumour resections followed by megaprosthetic reconstructions at our institute. Results: Out of 73 patients, there were 43 (58.90%) males and 30 (41.09%) females. Their ages ranged between 16–53 years with a mean of 32.97±10.68 years. The tumours included giant cell tumours (n=41), osteosarcomas (n=24), Spindle cell sarcoma (n=5), chondrosarcoma (n=2) and Ewing’s sarcoma (n=1). The average postoperative musculoskeletal tumour society (MSTS) score was 84.65%. Various complications encountered included superficial infections/ delayed wound healing among 9 (12.32%) patients, local recurrence in 6 (8.21%), deep infections among 5 (6.84%) and transient palsy of peroneal nerve in 3 (4.10%) cases. There was aseptic loosening and traumatic disruption of extensor mechanism one each (1.36%). There were 7 (9.58%) mortalities in our series. Conclusion: Giant cell tumours and osteosarcomas were the most frequent tumours observed around the knee. The tumours affected relatively younger population. Safe oncological resections of the tumours followed by megaprosthetic reconstructions provided reasonable outcome in the majority of patients.
Guo W, Ji T, Yang R, Tang X, Yang Y. Endoprosthetic replacement for primary tumours around the knee. J Bone Joint Surg 2008;90(8):1084–9.
Gkavardina A, Tsagozis P. The use of megaprostheses for reconstruction of large skeletal defects in the extremities: a critical review. Open Orthop J 2014;8:384–9.
Henshaw RM, Malawer MM. Advances in modular endoprosthetic reconstruction of osseous defects. Curr Opin Orthop 2003;14(6):429–37.
Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br 2007;89-B:521–6.
Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours. J Bone Joint Surg Br 2007;89-B:1632–7.
Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res 2010;468(11):2885–95.
Jaffe N, Puri A, Gelderblom H. Osteosarcoma: Evolution of treatment paradigms. Sarcoma 2013;2013:203531.
Saaiq M, Zimri FUK. Clinical applications and outcome of proximally based medial gastrocnemius muscle flap. World J Plast Surg 2020;9(1):22–8.
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993;286:241–6.
Li D, Zhang J, Li Y, Xia J, Yang Y, Ren M, et al. Surgery methods and soft tissue extension are the potential risk factors of local recurrence in giant cell tumor of bone. World J Surg Onco 2016;14:114.
Singh AS, Chawla NS, Chawla SP. Giant-cell tumor of bone: treatment options and role of denosumab. Biologics 2015;9:69–74.
Thomas DM, Skubitz T. Giant-cell tumour of bone. Curr Opin Oncol 2009;21:338–44.
Ueda T, Morioka H, Nishida Y, Kakunaga S, Tsuchiya H, Matsumoto Y, et al. Objective tumor response to denosumab in patients with giant cell tumor of bone: a multicenter phase II trial. Ann Oncol 2015;26(10):2149–54.
Allison DC, Carney SC, Ahlmann ER, Hendifar A, Chawla S, Fedenko A, et al. A meta-analysis of osteosarcoma outcomes in the modern medical era. Sarcoma 2012;2012:704872.
Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG. A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty 1999;14(2):187–96.
Ilyas I, Kurar A, Moreau PG, Younge DA. Modular megaprosthesis for distal femoral tumors. Int Orthop 2001;25(6):375–7.
Bernthal NM, Greenberg M, Heberer K, Eckardt JJ, Fowler EG. What are the functional outcomes of endoprosthestic reconstructions after tumor resection? Clin Orthop Relat Res 2015;473:812–9.
Ruggieri P, Bosco G, Pala E, Errani C, Mercuri M. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res 2010;468(11):2860–6.
Pala E, Trovarelli G, Calabro`T, Angelini A, Abati CN, Ruggieri P. Survival of Modern Knee Tumor Megaprostheses: Failures, Functional Results, and a Comparative Statistical Analysis. Clin Orthop Relat Res 2015;473(3):891–9.
Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C. Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol 2010;23(4):1005–13.
Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 2005;87:842–9.
Zimel MN, Cizik AM, Rapp TB, Weisstein JS, Conrad EU 3rd. Megaprosthesis versus condyle-sparing intercalary allograft for distal femoral sarcoma. Clin Orthop Relat Res 2009;467(11):2813–24.
Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relate Res 2006;450:164–71.
Jeys LM, Grimer R. The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res 2009;179:75–84.
Höll S, Schlomberg A, Gosheger G, Dieckmann R, Streitbuerger A, Schulz D, et al. Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure. Knee Surg Sports Traumatol Arthrosc 2012;20(12):2513–8.
Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 2006;88(6):790–5.
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