ABSTRACT
Purpose@#Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. @*Materials and Methods@#According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. @*Results@#The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revisionfree survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. @*Conclusion@#Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.
ABSTRACT
PURPOSE: Hemicortical resection may be applied to bone tumors arising at the bone surface or of eccentric location due to minimal medullary involvement. The purpose of this study was to evaluate the results of hemicortical resection for malignant bone tumors. MATERIALS AND METHODS: We retrospectively reviewed 18 patients who were treated with hemicortical resection between 2005 and 2014. The study included 10 patients with parosteal osteosarcoma, 5 patients with osteosarcoma, 2 patients with periosteal chondrosarcoma, and 1 patient with chondrosarcoma, who were followed-up for a mean duration of 61 months (24–125 months). We evaluated 1) the oncologic outcome (recurrence, metastasis), 2) the rate of bony union, and 3) complications, such as fracture or infection, after hemicortical resection and reconstruction. RESULTS: There were local recurrences in 3 parosteal osteosarcoma patients (16.7%). After subsequent re-excision for recurrence, one patient died of metastasis. The defect after hemicortical resection was reconstructed by bone graft in 15 patients and the grafts were removed for infection in 2 patients. Bone grafts were united in 12 (92.3%) out of 13 patients at 8 months (5–13 months) after reconstruction on average. Host bone fractures occurred in 2 patients (11.1%); infection developed in 3 patients (16.7%), who received hemicondylar resection for osteosarcoma in proximal tibia. CONCLUSION: Hemicortical resection for eccentric tumors or small tumors showed good clinical results. There is relatively a high risk of infection in the lesion of proximal tibia.