Clinical outcome of osteosarcoma with primary total femoral resection

Primary total femoral resection and reconstruction rarely are indicated for patients with osteosarcoma. We determined the survivorship, complications, and functional outcome of patients with osteosarcomas who had total femoral resections. We evaluated 13 patients with osteosarcomas whose surgical conditions included multiple skip lesions along the femur (Group I, two patients), extensive femoral involvement without interruption (Group II, eight patients), and iatrogenic contamination of the femur secondary to an internal fixation (Group III, three patients). We analyzed the event-free survival, complications, and functional outcome and looked for obvious differences among the three groups. The minimum followup was 9 months (mean, 41 months; range, 9-125 months). The Kaplan-Meier event-free survival rate at 10 years was 34.6% (95% confidence interval, 7.5%-61.7%). All five patients in Groups I and III died. Four of eight patients in Group II were event-free survivors. Four patients had major complications. Five patients had good functional scores. The subset of patients who had relatively small tumors with wide resection margins had a good prognosis. In patients with other clinical conditions, hip disarticulation can be considered.