Application of pasteurized tumor-bearing bone replantation for primary malignant bone tumor of extremities / 中国修复重建外科杂志

Objective: To assess the effectiveness of the pasteurized tumor-bearing bone replantation in treatment of primary malignant bone tumor of extremities. Methods: Between February 2012 and June 2016, 13 patients with primary malignant bone tumor of extremities were treated with pasteurized tumor-bearing bone replantation after extensive excision. There were 8 males and 5 females, aged from 11 to 27 years, with an average of 17.4 years. Tumors were located at the mid-upper humerus in 2 cases, the mid-upper femur in 2 cases, the mid-lower femur in 6 cases, the mid-upper tibia in 2 cases, and the middle tibia in 1 case. According to Enneking staging system, 3 patients were classified as stage ⅠB, 5 patients as stage ⅡA, and 5 patients as stage ⅡB. There were 11 cases of osteosarcoma and 2 cases of chondrosarcoma. The disease duration ranged from 3 to 8 months, with an average of 4.8 months. The length of the tumor-bearing bone ranged from 8 to 16 cm, with an average of 12.5 cm. Postoperative follow-up was conducted regularly to evaluate the status of inactivated bone and complications. The limb function was assessed by the Musculoskeletal Tumor Society 93 (MSTS-93) scoring system. Results: All 13 patients were followed up 26-79 months, with an average of 50.5 months. Eleven patients survived without tumors. Two patients had local soft tissue recurrence and underwent amputation, 1 had lung metastasis after amputation and died. All patients had no complications of bone resorption, shortening, and internal fixation disorder. The nonunion of osteotomy occurred in 4 cases. Among them, 3 cases were successfully healed after autologous iliac bone grafting, and 1 case was treated conservatively. The healing time of metaphyseal osteotomy end was 10-15 months (mean, 12.6 months), the healing rate was 90.9% (10/11); the healing time of diaphyseal osteotomy end was 12-21 months (mean, 17.0 months), the healing rate was 72.7% (8/11); and the total healing rate of osteotomy end was 81.8% (18/22). One case had inactivated bone fracture and 1 case had incision dehiscence and infection after operation. At last follow-up, the MSTS-93 score of affected limb ranged from 21 to 28, with an average of 25.3. Conclusion: The procedure of the pasteurized tumor-bearing bone replantation is an effective, simple, and economic way in repair of massive segmental bone defect to save limb function for primary malignant bone tumor of extremities.

Complications of Allograft Reconstruction following Wide Resection of Malignant Bone Tumors in Long Bones / 대한정형외과학회잡지

PURPOSE: We evaluated the results of allograft reconstruction following wide resection of malignant bone tumors in long bone, retrospectively. MATERIALS AND METHODS: Seven patients were included. The mean age was 44 years old. Male was 4 cases, and female was 3 cases. Mean follow-up period was 38 months. The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was evaluated. Postoperative complications were evaluated via periodic radiologic follow-up. Oncologic results were analyzed at final follow-up. RESULTS: The primary malignancies occurred at femur in 5 cases, humerus in 1 case and tibia in 1 case. Pathologic diagnoses were osteosarcoma in 4 cases, multiple myeloma in 2 cases and adamantinoma in 1 case. Mean length of allograft was 165 mm. Fixations of allograft were intramedullary nailing with additional plate in 4 cases, intramedullary nailing in 2 cases, and screw fixation in 1 case. Mean time to union was 14.5 weeks. Mean MSTS score at final follow-up was 20 (67%). Postoperative complications were nonunion in 3 cases, implant failure in 1 case, and infection in 1 case. Oncologic outcomes were continuous disease free in 5 cases and alive with disease in 2 cases at final follow-up. Autologous bone graft and hemi-cortical onlay graft were performed in 2 cases of nonunion. CONCLUSION: Allograft reconstruction following wide resection of malignant bone tumors in long bone was effective surgical option. However, the possibility of nonunion between host bone and allograft should be considered.

The Results of Hemicortical Resection for Malignant Bone Tumor / 대한정형외과학회잡지

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.

Limb Salvage Surgery with Tumor Prosthesis for the Malignant Bone Tumors Involving the Proximal Femur / 대한골관절종양학회지

PURPOSE: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. MATERIALS AND METHODS: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's(R) Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS(R) proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. RESULTS: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. CONCLUSION: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

Salvage therapy by hemicortical excision and reconstruction for low-grade malignant bone tumour / 中南大学学报(医学版)

Objective: To treat low-grade limb malignant tumors with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf. Methods:From January 2005 to January 2011, 10 patients [age (27.0±6.5) years] suffering from low-grade limb malignant tumors were treated with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf:7 were histopathologically diagnosed as parosteal osteosarcoma, and 3 as peripheral chondrosarcoma. According to the Enneking staging system, 8 were in Stage IA and 2 were in IB. Results:All the patients were followed-up for (50±23) months. All the patients had bony union at the last follow-up. The length of tumor bone resection was (9.5±2.7) cm, operation time was (150±45) min, intraoperative blood loss was (1000±350) mL, and drainage volume was (450±200) mL. hTe only fracture in the host bone during the operation was treated by internal ifxation. Local recurrence occurred in 1 patient was treated by a wide operative margin and reconstruction with a prosthesis. There was no distal metastasis. A ccording to the Enneking system, 9 patients had excellent results and 1 had good results. Conclusion:Hemicortical excision for low-grade limb malignant tumors is safe and effective.

En bloc excision and reconstruction of the defect with pasteurized autograft for femoral primary malignant bone tumor in childen / 中南大学学报(医学版)

Objective:To evaluate the efficacy of femoral primary malignant bone tumors treated by limb salvage, with wide en bloc excision and reconstruction of the defect with recycled pasteurized autogratf. Methods: From January 2008 to January 2011, 11 patients (7 males, 4 females), aged (11.0±2.5) years suffering from femoral primary malignant bone tumors were treated with en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Ten patients were histopathologically diagnosed with high-grade osteosarcoma, and 1 with Ewing’s sarcoma.According to the Enneking staging system, all patients were in Stage IIb. Results:All patients were followed-up for 24-65(42±20) months and all showed bony union at the last follow-up. hTe length of tumor bone resection was (17.5±3.2) cm, the operation time was (180±35) min, the intraoperative blood loss was (1200±250) mL, and drainage volume was (650±125) mL. Local skin necrosis occurred in 1 patient (9.1%), which was resolved by debridement. Nonunion occurred in 3 patients (27.3%), who were treated by secondary iliac crest cancellous bone gratfing.Pulmonary metastasis occurred in 1 patient (9.1%) who died 35 months post-operatively. According to the function assessment by the Enneking system, 5 patients had excellent results, 4 had good results, 1 fair and 1 poor results, with a satisfaction rate of 81.2%. Conclusion:A pasteurized autograft can be an easily accessible and economical alternative for children’s malignant bone tumor of femurs.

Development of Conventional Osteosarcoma after 13 Years Continuous Disease-free Survival of Periosteal Osteosarcoma / 대한정형외과학회잡지

Periosteal osteosarcoma is a rare variant of osteosarcoma and has represented 1-2% of all osteosarcomas. Most local recurrences or progression to metastatic disease occurred within the first 3 years after presentation and lung metastasis is more common than bony metastasis. We describe a periosteal osteosarcoma of tibia patient who developed conventional osteosarcoma of proximal humerus after 13 years from the completion of treatment.

The Primary Malignant Bone Tumors of Distal Tibia: Comparison between Limb Salvage and Amputation / 대한정형외과학회잡지

PURPOSE: The long term survival and indications of limb salvage surgery for primary malignant bone tumors of the distal tibia were evaluated, and the results of the reconstruction method using a pasteurized autograft alone or a pasteurized autograft and living fibular bone graft composite were examined. MATERIALS AND METHODS: From March 1985 to June 2004, 13 cases were considered eligible. The diagnosis included 9 osteosarcomas, 2 chondrosarcomas, 1 parosteal osteosarcoma, and 1 malignant fibrous histiocytoma of the bone. There was 1 case of stage IB, 1 IIA, and 11 IIB according to the Enneking classification. Each case underwent surgery and 10 cases underwent additional chemotherapy. Six cases underwent a below-knee amputation and 7 cases had limb salvage surgery. The reconstruction methods were pasteurized bone alone (5), an additional living fibula bone graft (1) or a living fibula bone graft alone (1). RESULTS: There was no recurrence or metastasis at the final follow up. The MSTS functional score of the limb salvage group and amputation group were 85% and 82% respectively. Two out of 5 cases of reconstruction with pasteurized bone alone achieved bony union at 6 and 9 months after surgery. The remaining 3 cases showed nonunion and fractures of the pasteurized bone that was followed by an additional living fibula graft (2 cases) and cancellous iliac bone graft (1 case). Two cases of primary living fibula grafts are in the course of healing. CONCLUSION: The prognosis was good. Neurovascular invasion by the tumor and the necessity of a radical soft tissue excision indicated an amputation. There was no difference in the functional outcome between the limb salvage group and amputation group. A reconstruction method using pasteurized bone has bio-mechanical and economical benefits. However, primary additional living fibular bone graft is a promising method.

Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: This study evaluated the effectiveness of a low-heat treated intercalary autograft reconstruction in primary malignant bone tumors mainly involving the diaphysis. MATERIALS AND METHODS: Twenty patients who had primary malignant bone tumors underwent a low-heat treated intercalary autograft reconstruction between May 1987 and May 2004. The mean age was 24 years, and the mean follow up was 59.8 months. Osteosynthesis between host bone and low-heat treated autograft was carried out using plates and screws (n=7), rigid IM nails (n=6), plates and flexible IM nails or K-wires (n=4), and rigid IM nail and plate (n=3). Intramedullary cement augmentation was performed in 10 patients but the primary bone graft on the host-graft junction was not performed. RESULTS: The mean segmental excised bone length was 152 mm. One patient died from acute cardiac arrest unrelated to the tumor but there was no local recurrence and metastasis. Host graft union was achieved in 18 patients after a mean of 8.5 months after surgery. Complications were observed in 7 patients (35%), including 3 fractures, 2 nonunions, and 2 infections. The mean functional outcome was 82% (24.6). CONCLUSION: A low-heat treated intercalary autograft is a simple, economic and best fitting reconstruction system with a low rate of ultimate failure in carefully selected patients. However, a long term study will be needed to evaluate the graft incorporation and possibility of bone resorption.

Limb Salvage with Low and Heat Treated Autobone

Limb salvage surgery for treatment of malignant bone tumors is an acceptable alternative to amputation in most patients as marked improvement has been achieved in diagnostic imaging, neoadjuvant chemotherapy, and operative techniques. There are several options for limb salvage: endoprosthesis, allograft, treated autobone, etc and each has its own advantages and disadvantages. Prosthetic replacement is an option for limb salvage surgery, but loosening, breakage, and wear are encountered during long-term follow up. Allografts require a large scale bone bank system, and there are concerns of immunologic responses, transmission of disease, religious and social circumstance, and high complication rate. Low heat treated autobone graft are reasonable option of treated autobone. Multiple studies and clinical application of heat treated bone proved the superiority of low heat treated bone(pasteurization, heating at 60 degrees ... to 65 degrees ... for 30 minutes) over other methods of heat treatment such as autoclaving or boiling. Low heat treatment has a lethal effect on malignant cells while preserving sufficient biomechanical strength and bone inducing property. Low heat treatment showed satisfactory results of bone remodeling and union, function, complication (fracture, infection and bone resorption). Several studies suggest that low heat treatment(pasteurization) may be superior to other cell-lethal treatment for autologous bone graft used for limb salvage surgery.

Reconstruction with Replantation of the Resected Bone after Low Heat Treatment for Malignant Pelvic Bone Tumors / 대한정형외과학회잡지

PURPOSE: This study evaluated the oncological and functional results of a surgical treatment for malignant pelvic bone tumors using a low-heat-treated autologous bone graft. MATERIALS AND METHODS: Eleven patients with malignant pelvic bone tumors who were followed-up for more than one year were enrolled in this study. There were six males and five females. The mean age was forty-one years and the mean follow-up period was thirty months. Nine patients had primary bone tumors and two patients had metastatic tumors with various histological origins. A surgical resection was carried out according to the anatomic location (Type I/II 3 cases, Type II 2 cases, Type II/III 6 cases). The surgical methods used were a wide resection, a low-heat-treated autologous bone graft, total hip arthroplasty and rigid internal fixation. The ISOLS score was used to determine the oncological outcome. RESULTS: The mean ISOLS score was 61.2% at the final follow-up. The index of pain and emotional acceptance showed high scores, but functional ability, support, walking ability and gait showed relatively low scores. Bone union was achieved at a mean post-operative 6 months. The post-operative complications were one case of a local recurrence, two cases of infection and one case of a dislocation of the total hip arthroplasty. CONCLUSION: A wide resection and reconstruction with a low-heat-treated autologous bone graft in malignant pelvic bone tumors were satisfactory oncologically as well as functionally in the brief period. However, a longer follow-up and an examination of more cases will be needed.

Hemiarthroplasty performed with Ultrahigh Molecular Weight Polyethylene Liner Composite in a 10 Years Old Child having Osteosarcoma of the Proximal Tibia: A Case Report / 대한정형외과학회잡지

The proximal tibia is the second most common site for primary malignant bone tumors. With the progression of chemotherapy and surgical technique, limb salvage is being accepted as a generalized procedure, even in growing child. But for those children, especially around 10 years, who still have a considerable growth potential, it is difficult to selecting the appropriate prosthesis, except for cases with arthrodesis, and arthroplasty is an unreasonable procedure in many cases. We tried to maintain the mobile joint along with minimal complications, and we designed the hemiarthroplastic technique using the ultrahigh molecular weight polyethylene (UHMWPE) liner, intramedullary nail, bone cement and low heat treated autograft composite. This article present the results of 52 months follow up on this surgical procedure.

Prosthetic Survival and Functional Evaluation in Prosthetic Reconstruction of Malignant Bone Tumors of the Proximal Tibia / 대한정형외과학회잡지

PURPOSE: This study retrospectively analyzed the prosthetic survival and functional results after a prosthetic reconstruction for malignant bone tumors of the proximal tibia. MATERIALS AND METHODS: Thirty-five patients (32 osteosarcomas and 3 chondrosarcomas) were followed up for an average 72 months (24-167 months). A gastrocnemius flap was transferred in 12 patients and cement fixation of the stem was performed in 10. More than 40% of the bone length was resected in 12 patients. RESULTS: Three patients had died of the disease at the time of the final follow-up. There were one local recurrence and five distant metastases. The major complications were infection (5), aseptic loosening (5) and periprosthetic fractures (1). Gastrocnemius flap affected the incidence of a deep infection in the proximal tibia (17.4% vs. 8.3%) but there were no statistical correlation. A resection of >40% of the involved tibia increased the incidence of aseptic loosening (p=0.002). The rate of prosthetic survival was 72% at 5 years and 58% at 10 years. The functional score at the final follow-up was 81% (43-93%). CONCLUSION: A prosthetic reconstruction in the proximal tibia showed acceptable oncologic and functional outcomes in patients at an intermediate term follow-up. Infection and loosening were the main factors threatening the survival of the prosthesis.

The Expressions of CD117 (c-kit) and Her-2/neu in Malignant Bone and Soft Tissue Tumors / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the prevalence of c-kit (CD117) and Her-2/neu expressions in malignant bone and soft tissue tumors and to identify a possible predictive role in patients with these malignancies. MATERIALS AND METHODS: A retrospective study was conducted on 40 archival paraffin-embedded tissue specimens of patients with 32 malignant bone tumors (23 osteosarcomas, 9 chondrosarcomas) and 8 synovial sarcomas. The gene expressions levels were evaluated by immunohistochemistry. RESULTS: C-kit expression was observed in 13 out of 23 osteosarcoma patients (56.5%), 4 out of 9 chondrosarcoma patients (44.4%) and 4 of 8 synovial sarcoma patients (50.0%). In particular, the relationship between c-kit expression and gender (p=0.044), a pulmonary metastasis (p=0.044), and the tumor cell grade (p=0.023) in osteosarcoma were found to be statistically significant. On the other hand, Her-2/neu expression was not found in any of the 40 cases under study. CONCLUSION: These results suggest that the c-kit expression appears to play an important role in the development of a malignant bone tumor and synovial sarcoma. In particular, it should be noted that c-kit expression is found frequently in an osteosarcoma with a pulmonary metastasis. In this respect, the tyrosine kinase inhibitors can be considered to be significant in the treatment of a malignant bone tumor and a synovial sarcoma. However, Her-2/neu does not appear to play any significant role in these malignancies.

Treatment of Infected Tumor Prosthesis in Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: The analysis points used in this study were the features, durations, and outcomes following different treatment modalities for an infected tumor prosthesis (TP). These were used to define an appropriate strategy for infected TP. MATERIALS AND METHODS: From December 1986 to November 1999, 215 patients underwent a TP replacement operation in our hospital, and 17 patients with an infected TP were eligible for the study. Forty-two operative procedures were performed on 17 patients (scarectomy 11 cases, partial TP removal and bone cementation 9 cases, complete TP removal and bone cementation 20 cases, and amputation 2 cases). Freedom from infection was defined as no sign of inflammation for 3 months after the operation and its objective variables were CRP, ESR, physical examination, and culture free body fluid. Although one patient received several procedures, we considered each event as a separate variable. The survival rates of the procedures were analysed by Kaplan-Meier plots and these were compared using the log rank test. RESULTS: The cumulative survival of each procedure was 0% by scarectomy at 11 months, 0% by partial TP removal and bone cementation at 12 months, and 34% by complete TP removal and bone cementation at 79 months. Significant differences in survival were found for these procedures (p<.001). CONCLUSION: Aggressive initial management reduces patient's pain and increases the chance of returning to the original functional status.

Evaluation of Functional Outcomes and Quality of Life Assessments in Patients with Malignant Tumors of the Musculoskeletal System / 대한정형외과학회잡지

PURPOSE: This study was designed to validate the functional evaluation system after surgery of malignant musculoskeletal tumors by ISOLS (International Symposium On Limb Salvage). MATERIALS AND METHODS: The reliability, content and criterion validities of the ISOLS system were investigated using the Nottingham Health Profile, the Medical Outcome Study 36-item Short-Form Health survey and the EuroQol instrument to measure the quality of life of patients with malignant musculoskeletal tumors. Forty nine patients were evaluated Osteosarcoma around knee joint was most commonly. Prosthetic reconstruction was performed in 55.1%. RESULTS: In content validity analysis, no social and psychological domains was found in ISOLS and the domains for functions of the lower extremities had a strong Cronbach's coefficient (0.88). ISOLS exhibited strong correlation in criterion validity. Convergent validity was good but the discriminative validity was poor. ISOLS has reliability with a strong correlation with other golden standard outcome measures. CONCLUSION: Overall reliability and validity of the ISOLS system appeared to be acceptable. However, this system may need further development of its appropriate domains to evaluate the quality of life in patients with malignant musculoskeletal tumors.

Preliminary Study of Transcatheter Arterial Chemoembolization for MalignantLimb Bone Tumor Before Limb-sparing Operation / 实用放射学杂志

Objective To evaluate the values of transcatheter arterial chemoembolization(TACE)for malignant limbs bone tumors before limb-sparing operation and the influence of TACE on operation.Methods TACE was performed in 10 patients with malignant limb bone tumor before limb-sparing operation.The complication of TACE,morphology and histology of neoplasm,incisional healing after TACE were observed.Results (1)The embolization syndrome (swelling,pain)appeared obviously in all patients at early stage and disppeared or alleviated greatly after 2 weeks of TACE.The severe complication-local skin necrosis appeared in 1 case;there was a subcrustal healing after 3 weeks.(2)In 6~28 days after embolization,all neoplasms underwent coagulation to variable extents,and the tumor cells was more than 60% necrosis in 8 cases.(3)All incisions had a good healing by first intention.Conclusion TACE is an effective and safe accessory therapeutic preecdure for malignant limbs bone tumors before limb-sparing operation.

Pathologic Fracture of Primary Malignant Bone Tumor: Survival, Limb Salvage, Local recurrence / 대한정형외과학회잡지

PURPOSE: This study analyzes the indication, survival rate, local recurrence and limb salvage possibility of primary malignant bone tumors that have had pathologic fractures. MATERIALS AND METHODS: Eighteen cases that received preoperative chemotherapy and surgery were eligible for this study. Primary tumors were osteosarcoma (13) , Ewing's sarcoma (2) and MFH (3) . Primary locations were femur (10) , humerus (6) , and tibia (2) . Fractures were classified into three grades. Grade I (10) was mild displacement, II (5) was moderate but intracompartmental, III (3) was extracompartmental. Average follow-up was 40 months. RESULT: Limbs were salvaged in 16 cases, 2 cases had amputation. Union was acquired in 7 (7/10) cases for grade I and 4 (4/6) cases for grade II. Two cases with severe displacement both ended in non-union. There were two local recurrences. The actual survival rate of the 13 cases with osteosarcoma was 33% in 80 months, showing significantly lower results compared to 238 contemporary cases of IIB (P=0.04) . CONCLUSION: Conservative external immobilization and preoperative chemotherapy for pathologic fracture of primary malignant bone tumor was good initially in the care of amputation. Local recurrence rate was 11 percent and survival rate was significantly worse.

Reconstructive surgery in primary malignant and aggressive benign bone tumor of the proximal humerus

Primary malignant bone tumors of the proximal humerus have traditionally been treated by forequarter amputation. However, with the increased interest in limb salvage operations, efforts have been made to improve reconstructive surgery and some methods have become available for tumor control and preservation of a useful distal limb. This report describes three reconstructive techniques used for reconstruction of the humerus following primary tumor excision. We followed 11 patients treated by reconstructive surgery following tumor excision for primary malignant and aggressive benign bone tumors in the proximal humerus. The average follow-up period was 35.6 months. The histologic diagnosis included osteosarcoma (9), chondrosarcoma (1) and giant cell tumor (1). The options for reconstructive surgery following tumor excision were six prosthetic arthroplasties with low heat treated autobone, four arthroplasties with Ender nail and bone cement, and one arthroplasty with custom-made tumor prosthesis. We performed a retrospective analysis regarding functional status, as well as local recurrence, distant metastasis and complication. The functional status at final follow-up averaged 16 points (53.3%) overall: 17 points (56.7%) in the six prosthetic arthroplasties with low heat treated autobone; 15 points (50.0%) in two of four arthroplasties with Ender nail and bone cement (the two others died); and 16 points (53.3%) in the one arthroplasty with custom-made tumor prosthesis. Local recurrence was not observed in any of the cases. The complications noted were one nonunion between reimplanted, low heat treated autobone and the normal distal humerus and two metal failures. Each of these techniques for reconstructive surgery resulted in a relatively good outcome, although somewhat better results were found in the case of prosthetic arthroplasty with low heat treated autobone.

Results of Limb Salvage Surgery in Primary Malignant Bone Tumors / 대한정형외과학회잡지

Limb salvage operation in primary malignant bone tumors is increasing recently, according to the improvement of diagnostic methods, surgical technique and adjuvant chemotherapy. The purpose of this study is to obtain the interim results of survival rate and the functional grade of the limb in primary malignant bone tumors treated by limb salvage operation. Between 1985 to 1993, 63 primary malignant bone tumors treated by limb salvage operations. Tumor prosthesis arthroplasty was performed in 49 patients, resection arthrodesis in 9 patients, and IM nailing with cement molding in 5 patients. Autoclave autograft was combined in 2 patients. Adjuvant chemotherapy and postoperative radiotherapy were performed in selected patients. The average follow-up period was 50 months(ranged 12 months to 116 months). In the cases of osteosarcoma, estimated survival rate was 61.9% based on Kaplan-Meier survival plot. In the parosteal sarcoma, the survival rate was 87.5% and 80% in chondrosarcoma patients. According to functional grading by Enneking, 66% was excellent, 20% was good, 11% was fair and one patients was poor. Complications occurred in 16 patients:wound infection was developed in 6 patients, local recurrence in 4, peroneal nerve palsy in 2 patients and femoral stem loosening in 2 patients. Fracture in resection arthrodesis and pulmonary metastasis were also occurred. Reoperation was performed in 10 patients at average 31 months after initial operation. Revision tumor persthesis arthroplasty was performed in one patient due to local recurrence and in 2 patients due to femoral stem loosening. Three amputations were done due to recurrence of tumor. IM nailing with cement molding was performed in one patient due to deep infection and repeated arthrodesis was done in a fracture patients. Scheduled custom-made tumor prosthesis arthroplasty was performed within a year in 2 patients treated with IM nailing with cement molding. In conclusion, with the careful preoperative assessment, adjuvant chemotherapy and skillful surgical technique, limb salvage operation would provide the primary malignant bone tumor patients for longer survival and better quality of life.