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Kim, Kim, and Chung: Outcome of Tumor Prosthetic Reconstruction in Osteosarcoma Patient
Original Article

J Korean Bone Joint Tumor Soc 2011;17(2):79-86.

Published online: 10 January 2011

DOI: https://doi.org/10.5292/jkbjts.2011.17.2.79

Outcome of Tumor Prosthetic Reconstruction in Osteosarcoma Patient

Jae Do Kim, M.D., Cheung Kue Kim, M.D., So Hak Chung, M.D.

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea

Correspondence to: So Hak Chung, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34, Amnam-dong, Seo-gu, Busan 602-702, Korea TEL: +82-51-990-6467 FAX: +82-51-243-0181 E-mail: shchung@Kosin.ac.kr

Received 21 May 2011       Revised 26 November 2011       Accepted 30 November 2011

Copyright © 2011 The Korean Bone and Joint Tumor Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Modular tumor prosthesis is the most popular recontructive modality after resection of malignat tumor in extremity. Complications and survival of tumor prosthesis reconstruction are well-known. however, reports on the long-term outcome of tumor prosthesis in osteosarcoma patientss are scarece.

Materials and Methods

In 158 cases as diagnosed as osteosarcoma from feburary 1989 to December 2006 in a single cancer center. We retrospectively reviewd 48 osteosarcoma patients who under went tumor prosthetic reconstruction. Mean follow up preiod was 75.6 months (range; 60 to 179 months). There were 28 males, 20 females and mean age was 22.4 years (range; 11–71). Pathologic subtypes were conventional central osteosarcoma in 46 cases and periosteal in 2 cases. The location of the tumor was proximal tibia (26 cases), distal femor (20 cases), femor diaphysis (1 case), and tibia diaphysis (1 case). In 41 cases built-up-type tumor prosthesis have been used and 7 cases expansion-type tumor prosthesis have been used. We used Musculoskeletal tumor society (MSTS) grading system to asses post operation function, and we analyzed survival rate of patient and tumor prosthesis and complication.

Results

The overall survival rate was 77.7% and disease free survival rate was 68.9%. The survival rate of tumor prosthesis was 73%, in last follow up tumor prosthesis has been removed in 12 cases. All of them, 17 complications occurred, which included infection in 16 cases, Periprosthetic Fracture and Loosening of tumor prosthesis in 4 cases, articular instability in 4 cases. MSTS functional score was 74.1% in post operation.

Conclusion

In long term follow up result, Primary tumor prosthesis-a reconstruction method after a wide extensional resecion of a bone tumor- can be a effective treatment method in asepect of survival rate, functional assesment and complication.

Keywords: osteosarcoma, tumor prosthesis, limb salvage

References

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Figure 1.
K-M graph for survival rate of the distal femoral and the proximal tibia prosthesis.
jkbjts-17-79f1.tif
Figure 2.
19 years-old male patient. (A, B) Preoperative radiograph show radiolucent bony lesion in left distal femur and (C) inhomogenous low signal intensity of mass and surrounging muscles. The result of insional bouposy was grade 2B osteosarcoma.
jkbjts-17-79f2.tif
Figure 3.
(A, B) After Wide excision, resconstruction with Mutars Prosthesis. 15 months follow up infection was occurred.
jkbjts-17-79f3.tif
Figure 4.
(A, B) After removal of prosthesis, athrodesis was done using endernail.
jkbjts-17-79f4.tif
Table 1.
Summary of Cases
Case No. Age/Sex Diagnosis Site F/U Recon method Onco result Meta lesion MSTS score (%) Complication Final operation
1 29/F Osa PT 64 Kotz DOD   26 86.67    
2 52/M Osa DF 149 Kotz CDF   27 90    
3 39/M Osa PT 62 Kotz CDF   23 76.67 Periprosthetic Fx. Exchange component
4 15/F Osa DF 130 Kotz CDF   27 90    
5 16/M Osa DF 100 Kotz CDF   28 93.33 Infection TP removal
6 17/M Osa PT 120 Mutars CDF   22 73.33 Infection I&D
7 15/M Osa DF 67 Kotz DOD   27 90    
8 51/F Osa PT 73 Kotz DOD   20 66.67    
9 15/M Osa PT 61 Kotz DOD   21 70    
10 66/M Osa PT 89 Kotz CDF   26 86.67    
11 17/F Osa DF 61 Kotz CDF   28 93.33    
12 25/M Osa DF 97 Kotz CDF   25 83.33 Loosening Tendon transfer
13 17/M Osa DF 88 Kotz CDF   27 90 Infection AK amputation
14 31/F Osa PT 60 Link CDF   28 93.33    
15 15/M Osa PT 80 Kotz AWD Lung 20 66.67 Loosening Infection TP removal
16 16/M Osa PT 62 Kotz CDF   18 60    
17 20/F Osa PT 65 Kotz DOD Lung 17 56.67    
18 15/M Osa DF 60 Kotz CDF   14 46.67    
19 14/F Osa DF 126 Kotz CDF   27 90    
20 17/M Osa PT 62 Kotz CDF   26 86.67    
21 13/F Osa PT 145 Kotz AWD Lung 28 93.33 Loosening LLD Tendon transfer link
22 15/F Osa DF 112 Kotz CDF   28 93.33    
23 13/M Osa PT 76 Kotz CDF   22 73.33    
24 12/M Osa DF 71 Kotz CDF   12 40 Infection I&D
25 12/F Osa PT 60 Kotz CDF   27 90    
26 20/F Osa DF 68 Kotz CDF   25 83.33    
27 12/F Osa PT 69 Kotz CDF   13 43.33    
28 11/F Osa PT 100 Link AWD Lung 26 86.67 Loosening LLD Screw fixation link
29 18/M Osa DF 90 Kotz CDF Spine 27 90    
30 16/M Osa DF 77 Kotz CDF   28 93.33 Loosening Tendon transfer
31 18/F Osa PT 86 Kotz CDF   10 33.33    
32 19/M Osa DF 144 Mutars CDF   27 90 Infection TP removal (Ender naill)
33 37/F Osa DF 121 Kotz CDF   22 73.33    
34 14/M Osa PT 60 Kotz CDF   22 73.33 Infection LLD TP removal
35 24/F Osa PT 179 Kotz CDF   19 63.33 Infection TP removal (Ender nail)
36 15/F Osa DF 82 Link CDF   15 50 Infection TP removal
37 71/M Osa PT 60 Link DOD   16 53.33 Infection AK amputation
38 17/M Osa DF 67 Kotz CDF   11 36.67    
39 14/F Osa PT 69 Kotz CDF   12 40    
40 12/F Osa DF 72 Kotz CDF Lung 13 43.33 Periprosthetic Fx TP exchange
41 18/F Osa PT 67 Kotz CDF   16 53.33    
42 12/F Osa PT 61 Kotz CDF   26 86.67    
43 36/M Osa DF 65 Mutars AWD   22 73.33    
44 14/M Osa PT 90 Mutars DOD   28 93.33    
45 13/F Osa PT 71 Mutars DOD   25 83.33    
46 19/M Osa PT 107 Kotz CDF   21 70    
47 52/F Osa PT 144 Kotz CDF   19 63.33    
48 22/M Osa PT 90 Kotz CDF   25 83.33    

DF, dist femur; PT, proximal tibia; CDF, continous disease free; AWD, alive with disease; DOD, death of disease.

Table 2.
Prevalence of Complication
Site of tumor No. of patients No. of infection No. of loosening No. of periprosthetic Fx. c No. of LLD
Dist. Femur 20 6 2 1 0
Prox. Tibia 28 4 3 1 3
Total 48 10 5 2 3
Table 3.
MSTS Score according to Surgical Site
Location N Average T-score
PT 28 73.6  
DF 20 73.8 p=0.979
Table 4.
Published Literature Review about Reconstruction Using Tumor Prosthesis
  Case Mean F/U Complication rate Complication 1st/2nd MSTS
Our study 48 115 mons 35.4% Infection/periprosthetic Fx., loosening of prosthesis 74
Gosheger9) 250 45 mons 21.6% Infection/Loosening 83
Rougraff2) 227 11 yrs 64.8% Metastasis/Local reccurance 23
Kawai6) 55 8 yrs Early 45% Aseptic loosening/ 24
      Late 65% Skin necrosis  
Hiroyuki25) 107 5 yrs 22.4% Local reccurence/Metastasis (−)
Grimer4) 18 66 mons 61% Loosening/Shortening, OA knee 84
Lee13) 88 76 mons 38.6% Infection/loosening 72
Kabukcuoglu5) 54 9 yrs 13%/1.8% Amputation/infection 83
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