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Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery
K Hayashi1, H Tsuchiya, N Yamamoto
1Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. tsuchi@med.kanazawa-u.ac.jp
Abstract:
The functional results of prostheses and osteoarticular grafts for osteosarcoma around the knee joint are not satisfactory because of poor durability and gross distortion of the normal anatomy. We have investigated the functional outcome of intentional marginal excision for osteosarcoma around the knee joint in conjunction with caffeine-potentiated chemotherapy. Twenty-one patients with AJCC stage IIB high-grade osteosarcoma around the knee joint were given three to five preoperative courses of intra-arterial cisplatin and caffeine with or without doxorubicin. The histological response in these 21 patients to preoperative chemotherapy was grade IV (no viable cells) in 19 patients and grade III (only scattered foci of viable cells) in 2. The patients were separated into three groups on the basis of patterns of tumour excision. The first group underwent marginal excision of the proximal fibula, the second underwent epiphysis preservation followed by distraction osteogenesis, and the third underwent joint resection and reconstruction. The mean functional evaluations were 100, 95, and 88%, respectively. No local tumour recurrence was seen at mean follow-up of 97 months. Marginal excision of the proximal fibula resulted in excellent function. Preservation of the epiphysis leads to better function than joint resection.
Insights
Intentional marginal excision for knee osteosarcoma with caffeine-potentiated chemotherapy offers excellent outcomes. This approach, combined with specific surgical techniques, achieved no local recurrence and superior function compared to traditional methods.
Area of Science:
- Orthopedic Oncology
- Surgical Oncology
- Chemotherapy
Background:
- Prostheses and osteoarticular grafts for knee osteosarcoma yield suboptimal functional results due to poor durability and anatomical distortion.
- Effective treatment strategies are needed to improve functional outcomes for osteosarcoma around the knee joint.
Purpose of the Study:
- To investigate the functional outcomes of intentional marginal excision for osteosarcoma around the knee joint.
- To evaluate the efficacy of caffeine-potentiated chemotherapy in conjunction with surgical management.
Main Methods:
- Twenty-one patients with AJCC stage IIB high-grade osteosarcoma underwent preoperative intra-arterial cisplatin and caffeine chemotherapy.
- Patients were divided into three groups based on surgical excision: marginal excision of the proximal fibula, epiphysis preservation with distraction osteogenesis, or joint resection and reconstruction.
- Histological response to chemotherapy was assessed, with grade IV (no viable cells) in 19 patients and grade III (scattered viable cells) in 2.
Main Results:
- Mean functional evaluations were 100% for marginal fibula excision, 95% for epiphysis preservation, and 88% for joint resection.
- No local tumor recurrence was observed at a mean follow-up of 97 months.
- Marginal excision of the proximal fibula demonstrated excellent functional outcomes.
Conclusions:
- Intentional marginal excision of the proximal fibula combined with caffeine-potentiated chemotherapy provides excellent functional results and oncological control for knee osteosarcoma.
- Epiphysis preservation leads to better functional outcomes than joint resection in managing knee osteosarcoma.
- This combined approach offers a promising alternative to traditional reconstructive methods, minimizing anatomical distortion and improving patient function.