Limb salvage surgery for giant cell tumours around knee joint: a single institute experience

Background: Giant cell tumours (GCTs) of bone are benign but locally aggressive tumours. The surgical treatment of GCTs in the around knee joint mainly includes curettage and bone grafting, extended curettage and cement filling, segmental resection and modular endo prosthesis reconstruction.Methods: Retrospective analysis of the presentation, the functional outcome following modular endoprosthetic reconstruction, prosthetic survival and the recurrence rate in 17 patients with Campanacci grade 3 GCTs involving distal femur and proximal tibia, who underwent segmental resection and modular endoprosthesis reconstruction in a single centre from 2015 to 2018. The surgery was performed according to the general principles of limb salvage surgery and modular segmental replacement was used. All stems were cemented in place. Isometric exercises and mobilization with crutches were started on 2nd postoperative day. Knee joint bending was started for proximal tibia patients after 2 to 3 weeks. Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Immediate post-operative complication like delayed wound healing, flap necrosis, wound infection, foot drop, leg length discrepancies were evaluated.Results: The average MSTS functional score was 78%.3 year prosthetic survival was 100%. None of the patients had recurrence. One patient had left lower lobe metastasis for which wedge resection was done.Conclusions: Segmental resection and endoprosthetic replacement has good functional outcome in patients with tumours around the knee joint. As GCTs are tumours with less chance of local and distant metastasis after complete excision, endoprosthetic prosthesis is a good treatment option after complete excision.

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Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽

10.1080/13577149878118 ◽

1998 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 20

Author(s):

Rikke Johansen ◽

Ole S. Nielsen ◽

Johnny Keller

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Univariate Analysis ◽

Soft Tissue Sarcomas ◽

Post Treatment ◽

Limb Salvage Surgery ◽

Functional Evaluation ◽

Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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Proximal Tibia Osteoarticular Allografts in Tumor Limb Salvage Surgery

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-009-1186-y ◽

2009 ◽

Vol 468 (5) ◽

pp. 1396-1404 ◽

Cited By ~ 46

Author(s):

D. Luis Muscolo ◽

Miguel A. Ayerza ◽

German Farfalli ◽

Luis A. Aponte-Tinao

Keyword(s):

Limb Salvage ◽

Proximal Tibia ◽

Salvage Surgery ◽

Limb Salvage Surgery

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EKSISI DAN MEGA PROSTHESIS PADA GIANT CELL TUMOR PROXIMAL TIBIA (LAPORAN KASUS)

JURNAL ILMU KEDOKTERAN DAN KESEHATAN ◽

10.33024/jikk.v8i1.3251 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Mujaddid Idulhaq ◽

Bayu Sakti Jiwandono ◽

Ariya Maulana Nasution ◽

Handry TH

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Limb Salvage ◽

Proximal Tibia ◽

Skin Grafting ◽

Cell Tumor ◽

Limb Salvage Surgery ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Muscular Flap

Giant cell tumor (GCT) merupakan tumor destruktif tulang yang muncul di antara dekade kedua dan keempat, lokasi predileksi umumnya pada epifisis tulang panjang. Pemilihan tatalaksana operasi sangat penting dan masih menjadi perdebatan. Sebagaimana masih beragamnya pilihan tindakan pembedahan. Klasifikasi Campanacci dapat digunakan sebagai acuan untuk panduan tatalaksana. Pada kasus ini kami melaporkan seorang wanita, usia 18 tahun dengan diagnosa giant cell tumor pada proximal tibia dextra dengan Campanacci grade III. Pasien telah menjalani operasi limb salvage tahap pertama berupa eksisi luas pada proximal tibia dextra dan knee arthrodesis. Setelah 4 bulan dilakukan operasi limb salvage tahap kedua yaitu knee arthroplasty dengan megaprosthesis. Untuk mencegah komplikasi implant expose, dilakukan muscular flap dan split thickness skin grafting (STSG). Setelah dilakukan evaluasi selama 4 bulan, klinis pasien baik, pasien dapat berjalan alat bantu dan tanpa nyeri, tidak ada komplikasi pada luka operasi dan fiksasi implan baik. Kesimpulan yang didapatkan bahwa limb salvage surgery pada giant cell tumor proximal tibia dapat dilakukan dengan tindakan rekonstruksi dua tahap. Teknik muscular flap dan split thickness skin grafting (STSG) dapat digunakan untuk mencegah terjadinya implant expose.

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A Preliminary Evaluation of Limb Salvage Surgery for Osteosarcoma around Knee Joint

PLoS ONE ◽

10.1371/journal.pone.0033492 ◽

2012 ◽

Vol 7 (3) ◽

pp. e33492 ◽

Cited By ~ 10

Author(s):

Xing Wu ◽

Zheng-dong Cai ◽

Zheng-rong Chen ◽

Zhen-jun Yao ◽

Guang-jian Zhang

Keyword(s):

Knee Joint ◽

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Preliminary Evaluation

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The medial head gastrocnemius muscle transposition flap for coverage and functional restoration in limb-salvage surgery of bone tumors in the proximal tibia

Ain Shams Journal of Surgery ◽

10.21608/asjs.2011.179198 ◽

2011 ◽

Vol 8 (1) ◽

pp. 177-186

Author(s):

Mohamed Abdel Rahman ◽

Salah Nasser ◽

Ikram Safe

Keyword(s):

Limb Salvage ◽

Bone Tumors ◽

Gastrocnemius Muscle ◽

Proximal Tibia ◽

Salvage Surgery ◽

Functional Restoration ◽

Limb Salvage Surgery ◽

Muscle Transposition ◽

Transposition Flap ◽

Medial Head

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Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

Sarcoma ◽

10.1155/2014/436598 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Sjoerd Kolk ◽

Kevin Cox ◽

Vivian Weerdesteyn ◽

Gerjon Hannink ◽

Jos Bramer ◽

...

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Lower Limb ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Toronto Extremity Salvage Score ◽

Patient Reported ◽

Functional Scores ◽

Mri Scans ◽

Preoperative Status

Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons’ ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

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Demography and Short Term Functional Outcome of Soft Tissue Sarcoma Treated with Limb Salvage Surgery

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i4.31050 ◽

2020 ◽

Vol 16 (4) ◽

pp. 238-245

Author(s):

Suresh Pandey

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Functional Outcome ◽

Limb Salvage ◽

Negative Correlation ◽

Salvage Surgery ◽

Demographic Data ◽

Functional Score ◽

Limb Salvage Surgery ◽

Positive Correlation

Background: Limb salvage surgery with or without radiotherapy and/or chemotherapy is the mainstay of treatment of Soft Tissue Sarcoma (STS). Though, many studies are found regarding the demographics and result of such malignancy from other parts of the world, such data is not available from our country. This study aimed to analyze the demographic data and functional outcome of STS treated with limb salvage surgery. Methods: It is a retrospective review of 16 cases of soft tissue sarcoma of extremities and trunk managed with limb salvage surgery followed by adjuvant radiotherapy and/or chemotherapy in indicated cases from 2012 to 2017. Demographic data and functional score after 2 years of surgery were analysed and presented. Results: There were 14 male and 2 female cases of STS with mean age of 32.88 years. The most common STS was liposarcoma (37.5%) followed by rhabdomyosarcoma (25%) and synovial sarcoma (18.8%). Extremity and lower limb were the most common sites. Mean MSTS functional score at the last follow up was 24.56 (81.83%) with range from 19-29 (63.33%-96.66%). There were good to excellent results in 13 cases (81.25%) and moderate result in 3 cases (18.75%) according to MSTS functional score. There was positive correlation of MSTS with age, radiotherapy, chemotherapy and negative correlation with grade of tumor. Conclusions: This study showed good to excellent functional results in 81.25% of cases as per Musculoskeletal Tumor Society Score (MSTS) with positive correlation with radiotherapy, chemotherapy, age and negative correlation with grade of tumor.

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Functional Outcome in Limb-Salvage Surgery for Soft Tissue Tumours of the Foot and Ankle

Sarcoma ◽

10.1080/13577149778326 ◽

1997 ◽

Vol 1 (2) ◽

pp. 67-74 ◽

Cited By ~ 24

Author(s):

Nigel R. Colterjohn ◽

Aileen M. Davis ◽

Brian O'Sullivan ◽

Charles N. Catton ◽

Jay S. Wunder ◽

...

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Limb Salvage ◽

Local Control ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Foot And Ankle ◽

Soft Tissue Tumours ◽

Limb Preservation ◽

Good Functional Outcome

Discussion. Thirty of 36 patients (83%) presenting with foot and ankle STS or fibromatosis were candidates for limb preservation. With excellent local control and good functional outcome demonstrated in this study, limb salvage should be a primary goal in the management of selected patients with STS and fibromatosis of the foot and ankle.

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