Surgical management of pelvic Ewing's sarcoma.

BACKGROUND: Despite advances in adjuvant therapy, Ewing's sarcoma of the pelvis remains an anatomic site with a poor prognosis due to its relative inaccessibility, complex anatomy, and limited reconstructive options available. This study evaluates the role of surgery in the management of patients with pelvic Ewing's sarcoma who also have received conventional radiation therapy and chemotherapy. MATERIALS AND METHODS: From July 1990 to July 2006, we received 10 patients with Ewing's sarcoma of pelvis at our center. Nine patients were in stage II B and one in Stage III at the time of presentation to us. All patients underwent surgical resection after preoperative chemotherapy with or without radiotherapy, which was given at the discretion of the referral center. Reconstruction was attempted using plate osteosynthesis in four patients, SS wires and screws in three patients, free fibular strut graft in one patient, and none was done in two patients. RESULTS: Functional outcome assessed by Enneking's criteria revealed excellent outcome in two patients, good outcome in five patients, and poor outcome in two patients. At a mean followup of 10.3 years, seven patients remained free from the disease, and three patients died. The 5- and 10-year cumulative survival (Kaplan Meier method) was 63% and 34%, respectively. CONCLUSION: This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma, particularly in achieving local control.

Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours.

We analysed 17 patients with primary malignant bone tumour of the femur who underwent limb salvage surgery with the total femoral custom mega prosthesis during the period 1994-2008. The patients were in the age group of 12-73 years, with a mean age of 30.94 years. There were 14 males. The most common diagnosis was osteosarcoma. The average follow-up period was 54.05 months with the longest being 168 months. The average Musculoskeletal Tumour Society (MSTS) functional score was 66.6%. The two- to 14-year overall survival was 82.4%. Three patients died of disease and one patient required amputation. Complications encountered were deep infection and dislocation of the prosthesis.

Custom prosthetic replacement for distal radial tumours.

We analysed the results of 24 cases of aggressive benign and malignant tumours of the distal radius treated by resection and prosthetic replacement between 1995 and 2006. Patient ages ranged from 18 to 74 years, averaging 33 years; 18 were males. Recurrent giant cell tumour was the most common tumour. The prosthesis used was a bipolar hinge custom mega prosthesis manufactured locally. Average follow-up was 78 months. The average Musculoskeletal Tumor Society (MSTS) functional score achieved was 75%. The ten-year prosthesis survival was rate 87.5%. Infection was the most common complication.

The role of limb salvage surgery and custom mega prosthesis in multiple myeloma.

Nine patients with multiple myeloma underwent limb salvage surgery and custom megaprosthesis replacement for tumours involving long bones. The lower limb was commonly involved with an average age of 47.7 years at presentation. All patients had pathological fractures. Resection and reconstruction was done using custom megaprostheses. A proximal femoral prosthesis was used for proximal femoral tumours and an intercalary prosthesis for tumours involving the femoral shaft. One patient each had total femoral prosthesis and total knee prosthesis. With an average follow-up of 88.2 months, three patients died of their disease. One patient with total knee prosthesis had delayed deep infection requiring removal of the prosthesis and another patient with an intercalary prosthesis had a periprosthetic fracture and declined revision surgery. Radiological evidence of loosening was seen in one patient. The functional outcome was excellent in 3 and good in 3 patients. The 5-year Kaplan-Meier survival rate of the patients was 66.7%.

Management of juxta articular giant cell tumors around the knee by custom mega prosthetic arthroplasty.

BACKGROUND: Juxtaarticular giant cell tumors around the knee are common and pose a special problem of reconstruction after tumor excision. This article analyzes the functional outcome after resection of juxtaarticular giant cell tumors around the knee and replacement by custom mega prosthetic arthroplasty. MATERIALS AND METHODS: One hundred and forty-three patients with juxtaarticular giant cell tumors around the knee with mean age of 30.8 years (range 15 to 64 years) underwent resection and replacement by custom mega prosthetic arthroplasty during the period 1994 to 2005. Eighty-one patients were males and 62 were females. Fourteen patients were in Enneking Stage 2 while 129 patients were in Stage 3. Distal femur was involved in 87 patients and proximal tibia in 56 patients. Forty patients presented with pathological fracture at the time of diagnosis. The technique of sleeve resection of the quadriceps musculature was followed to achieve local clearance in distal femoral tumors, and for proximal tibial lesions resection of the tumor-bearing part and a medial gastronemius rotation flap was used routinely. The prosthesis used was a rotating hinge custom mega prosthesis manufactured locally. RESULTS: The mean follow-up was 5.4 years (1.5 years to 11 years). Functional results were analyzed using Enneking criteria. Excellent results were obtained in 90 patients (62%) and 39 patients had good (27%) results. Periprosthetic fracture (8.3%) and infection (6.9%) were the most common complications followed by aseptic loosening (4.2%). Recurrence of lesion was found in only one patient (0.69%) who was managed with wide local excision. CONCLUSION: Custom mega prosthetic arthroplasty is effective in achieving the desired goals of reconstruction with good functional results and least complications in selected patients.

Distal femoral tumours treated by resection and custom mega-prosthetic replacement.

We have analysed the results of 246 cases of distal femoral tumours treated by resection and prosthetic replacement between 1988 and 2002. Patient ages ranged from 6-67 years averaging 24 years; 133 were males. The most common tumour was osteosarcoma (67% of patients). The follow-up ranged from 2 to 14 years. Stage II tumours were seen in 72% of patients. The technique of sleeve resection of the quadriceps musculature was followed to achieve local clearance of the tumour. The prosthesis used was a rotating hinge custom mega-prosthesis manufactured locally. The functional result achieved was excellent or good in 87%; 86% of the patients had no evidence of disease, and 13% had died. The 10-year patient survival was 76.9%. Periprosthetic fracture and infection were the most common complications.

Custom megaprosthetic replacement for proximal tibial tumours.

We analysed 133 patients treated with resection and endoprosthetic proximal tibial replacement from 1988 to 2000. Mean age was 22.3 years and osteosarcoma was the most common tumour. Average follow-up was 59.4 months. An excellent functional result was achieved in 63 patients and a good result in 36. The number of patients who had no evidence of disease was 102. Twenty-four patients died due to disease. Infection was the most common complication, followed by periprosthetic fracture and aseptic loosening. The 5-year limb survival rate was 85.5%.