Reoperation after limb preservation surgery for sarcomas of the knee in children

Limb preservation surgery compares favorably with amputation in oncologic and functional outcomes. However, an increased incidence of complications and reoperations is associated with limb preservation. This study compared the outcome of a group of young patients who required at least one reoperation after limb preservation surgery because of a complication or need for prosthetic lengthening with the outcome of a similar group who did not require additional surgery. The functional scores before and after reoperation are compared to determine the impact on reported function and patient satisfaction. Forty-four consecutive patients younger than 19 years were treated for a malignancy of the distal femur or proximal tibia. Six of these patients required an amputation because of extensive disease or inadequate response to chemotherapy. The Musculoskeletal Tumor Society functional evaluation scores of 26 patients who required at least one reoperation (Group A) were compared with the scores of 10 patients who have not required additional surgery (Group B). Average before and after reoperation functional scores were compared to discern a decline in function with time. The minimum followup was 2 years. Patients in Group A required 54 reoperations. No difference in mean functional scores between Group A and Group B was detected. Likewise, after isolating Group A scores, no significant difference was detected between the average functional scores before (67%) and after (68%) reoperation or lengthening. Despite relatively small numbers, the current study suggests that adequate function is maintained despite reoperation or revision in young patients with malignancies of the knee who have limb preservation surgery.