Abstract
Introduction: The majority of patients with extremity osteo-sarcoma undergo limb salvage surgery. The most common location is about the knee, where at least one half of the knee joint is usually removed. A select group of patients with proximal tibial osteosarcomas had preservation of the entire articular surface following reconstruction.
Method: Since 1993, 67 patients with osteosarcoma have been treated. Sixteen patients had tibial tumors. The original MRI of five patients showed part of the condyle appeared uninvolved. These five underwent joint sparing surgery. A portion of the proximal tibial condyle was resected, leaving the articular surface intact. The tibial defect was reconstructed with autograft bone from the iliac crest and a vascularised fibula. A gastrocnemius muscle flap was rotated to cover the grafts. Four patients had continuation of high dose chemotherapy following surgery and one patient had acute liver failure in the post-operative period requiring the cessation of further chemotherapy.
Results: There are three males and two females aged 10 to 18 years. The length of resection was 6.5cm to 12cm and the distance from the articular surface of the tibia to the proximal resection margin ranged from 3mm to 8mm. One patient had reattachment of the tibial tendon because the tibial tubercle had to be resected with the tumor. Pathologic examination showed greater than 90% necrosis in all patients. One patient required two additional procedures because of fracture of the vascularised fibular graft. Her leg is solidly united at 70 months follow-up. Another patient had delayed wound healing with spontaneous resolution. Two patients had contralateral epiphyseodesis to prevent a progressive limb length discrepancy. Follow-up is 13, 46, 55, 70 and 81 months since surgery. The patients are continuously disease-free. The knees in four patients are stable to medial and lateral stress; one patient has slight medial opening, and no patients exhibit anteroposterior laxity. The range of motion of all knees is complete and there is no joint narrowing. Four patients have resumed sports and two wear a brace for these activities.
Conclusion: This surgical approach resulted in excellent outcomes in a selected group of patients. Since this is a biologic reconstruction, the patient is allowed unrestricted athletic activities. There is no sign of joint deterioration after short follow-up. Further investigations are required to determine the safety of the procedure and define surgical indications.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
