scholarly journals Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Nottrott ◽  
Arne Streitbürger ◽  
Georg Gosheger ◽  
Wiebke Guder ◽  
Gregor Hauschild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Rare Condition ◽  
Functional Results ◽  
Extensor Mechanism ◽  
Complication Rates ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.

Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

2018 ◽  
Vol 35 (04) ◽  
pp. 287-293 ◽  
Author(s):  
Rohini Kadle ◽  
Catherine Motosko ◽  
George Zakhem ◽  
John Stranix ◽  
Timothy Rapp ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Radiation Treatment ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

scholarly journals Functional Outcome After Lower Extremity Soft Tissue Sarcoma Treatment: A Pilot Study Based on Translated and Culturally Adapted Measures

2018 ◽  
Vol 108 (2) ◽  
pp. 164-171
Author(s):  
G. Kask ◽  
I. Barner-Rasmussen ◽  
J. Repo ◽  
C. Blomqvist ◽  
E. Tukiainen
Keyword(s):  
Pilot Study ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Lower Extremity ◽  
Functional Outcome ◽  
Soft Tissue Sarcomas ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Toronto Extremity Salvage Score ◽  
Extremity Salvage

Background and Aims: The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment. Materials and Methods: Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented. Results: A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively. Conclusion: This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.

Quality of life in children with osteosarcoma after limb salvage operation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 19501-19501
Author(s):  
M. Aono ◽  
I. Kudawara ◽  
K. Ohzono ◽  
Y. Aoki ◽  
A. Matsumine ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Limb Salvage ◽  
Distal Tibia ◽  
Functional Results ◽  
Wide Resection ◽  
Prosthetic Replacement ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Salvage Operation

19501 Background: There are several options for the surgical management of osteosarcoma (OS) especially in the skeletally immature patients. We evaluate the clinical results and quality of life (QOL) of OS patients with limb salvage operations. Methods: From 1996 to 2005, ten children with newly diagnosed previously untreated nonmetastatic (stage IIB) OS of extremities were reviewed. There were 5 females and 5 males. The median age was 12 years (range, 8 to 14). Tumor locations: proximal humerus in 2, proximal femur in 1, distal femur in 2, proximal tibia in 3, distal tibia in 1, and tibial shaft in 1. Patients received neoadjuvant and adjuvant chemotherapy, and local wide resection of tumor. Limb salvage procedures: intraoperative extracorporeal autogenous irradiated bone graft (IORBG) in 4 and prosthetic replacement in 6. The functional results were measured for the patients accordance with the Musculoskeletal Tumor Society rating score. Results: With a median follow up of 4 years (range, 1 to 9), 7 were continuously disease free, 2 died of disease and in one there was no evidence of disease. No local recurrence was seen. Mean functional rating scores of patients with IORBG and prosthetic replacement were 82% (range 77 to 90) and 82% (range 57 to 93), respectively. Functional results were not different between these study groups and relatively good. There was one infection in patients with prosthetic replacement. There were subchondral collapse in 2 (50%), fracture in 1 (25%) and infection in 1 (25%) with IORBG. Conclusions: Limb salvage operation with neoadjuvant chemotherapy is the optimum treatment. However there remain several problems of function after limb salvage operations, with improvement of survival of pediatric osteosarcoma patient. We should select the most suitable surgical procedure to achieve the good function of limbs as well as local control. No significant financial relationships to disclose.

scholarly journals The Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma Around the Knee in Child

2020 ◽  
Author(s):  
Jiajia Cheng ◽  
Junqi Huang ◽  
Wenzhi Bi ◽  
Gang Han ◽  
Jinpeng Jia ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Limb Salvage ◽  
Growth Period ◽  
Functional Results ◽  
Limb Salvage Surgery ◽  
High Survival ◽  
Level Of Evidence ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Abstract Background: To investigate: (1) what are the prognosis in patients treated with this chemotherapy scheme and limb salvage; (2) what are the clinical outcomes of expandable endoprosthesis reconstruction in child?Methods: From January 2009 to December 2014, we retropected 29 skeletally immature kids ( mean age, 10.5 years; range, 6-15 years) with osteosarcoma around knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, this expandable prosthesis was implanted to reconstruct. These 29 patients were included in our retrospection. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, lengthening procedures. The survivorship and recurrence were assessed by SPSS software. The function was assessed by Musculoskeletal Tumor Society (MSTS) scoring system.Results: A mean of follow-up time was 8.9 years (range, 6-12years). The overall 5-year survival was 89.1% based on Kaplan-Meier. Relapse suffered in three patients and one underwent amputation. Lung metastasis developed in one patient. At six months after operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery--one for implant infection and one for aseptic loosening.Conclusions: Chemotherapy scheme and limb salvage could achieved high survival rate. Use of this expandable prosthesis was associated with good function and low complication. The character of expandability could be a method to overcome discrepancy in the growth period.Level of Evidence Level IV, therapeutic study.

scholarly journals Utilization of Modified Rhomboid Flap to Reconstruct Limb Defect after Wide Resection of Large Soft-tissue Sarcoma: Novel Application of an Old Technique

2020 ◽  
Author(s):  
Miaomiao Liang ◽  
Yu Chen
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Wide Resection ◽  
Large Sample Size ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Limb Defects ◽  
The Mean ◽  
Rhomboid Flap

Abstract Background: Reconstruction of limb defects following wide resection of large soft-tissue sarcomas (STS) is challenging. Effectiveness of rhomboid flaps in covering these wounds remains to be addressed. Methods: From March 2018 through February 2019, we utilized modified rhomboid flaps to reconstruct limb defects following wide resection of the large STS (≥5 cm in diameter) in 6 patients. There were 3 males and 3 females. The average age was 65 years (47-77 years). Diagnoses included leiomyosarcoma in 3 patients, synovial sarcoma, undifferentiated pleomorphic sarcoma, and myxoid liposarcoma in 1 respectively. The anatomic locations included the anterior knee in 3 cases, upper arm in 2, and thigh in 1. The mean diameter of the tumor measured 10 cm (5-17 cm). The mean defect size was 113 cm2(38-270 cm2). Results: The mean follow-up duration was 10 months (range, 6-12 months), no patients were lost to follow-up. Skin grafts were utilized in 2 cases. The mean time to heal was 7 weeks (range, 3-13 weeks). At final follow-up, there were no recurrence and metastasis. One case had cerebral hemorrhage and 1 had wound dehiscence, whereas no reoperation was performed. The range of motion of the joints adjacent to the flap reconstructions were comparable to preoperative status. The mean Musculoskeletal Tumor Society score was 27 (range, 24-30). Conclusions: The modified rhomboid flap affords great versatility and is easy to design. This technique yields satisfactory effectiveness in reconstructing limb defects after resection of large STS. Long-term studies of large sample size are warranted.

scholarly journals Preliminary results of a new intercalary modular endoprosthesis for the management of diaphyseal bone metastases

2021 ◽  
Author(s):  
Kadir Büyükdoğan ◽  
Barlas Göker ◽  
Mazhar Tokgözoğlu ◽  
Ulukan İnan ◽  
Korhan Özkan ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Functional Results ◽  
Bone Lesions ◽  
Complication Rates ◽  
Short Term ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Type Iv ◽  
Diaphyseal Bone

Objectives: This study aims to evaluate functional outcomes of patients and to analyze complication rates of modular intercalary endoprosthetic reconstruction after resection of metastatic diaphyseal bone lesions. Patients and methods: Between December 2017 and February 2020, 22 patients (15 males, 7 females; median age: 64.2 years; range, 49 to 91) who underwent reconstruction with modular intercalary endoprostheses for metastatic bone tumors at five different centers were retrospectively analyzed. Age, sex, diagnosis, follow-up duration, previous treatments of patients, and resection lengths were recorded. The Musculoskeletal Tumor Society Scores (MSTS) were used to assess functional status of available patients at the final follow-up. Failures were categorized according to the Henderson classification. Results: Locations of the resected tumors included 10 humeri (45.5%), five tibiae (22.7%), and seven femurs (31.8%). The length of the resected tissues ranged from 35 mm to 180 mm. Seven patients (31.8%) died of disease, and one patient died of pneumonia within follow-up period. The functional outcomes of surviving patients were satisfying with a median MSTS score of 86.9% (range, 70 to 100%) at a median follow-up of 17 months (range, 8 to 26). There were two cases of type II (9%), one cases of type IIIa (4.5%), two cases of type IIIb (9%), and one case of type IV (4.5%) failure. Complications were most commonly observed in tibial reconstructions. Conclusion: The good short-term functional results were achieved in surviving patients. Uncomplicated patients were able to perform daily living activities without limitations. The overall rate of complications was relatively low and, among them, mechanical problems were the most commonly encountered problems.

scholarly journals 3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 707
Author(s):  
Jong-Woong Park ◽  
Hyun-Guy Kang ◽  
June-Hyuk Kim ◽  
Han-Soo Kim
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Revisional Surgery ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Proximal Ulna ◽  
Custom Made ◽  
Orthopedic Oncology ◽  
3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

scholarly journals Synovial sarcoma presenting as subcutaneous swelling: a rare presentation

2019 ◽  
Vol 6 (6) ◽  
pp. 2190
Author(s):  
Dheer S. Kalwaniya ◽  
Jaspreet S. Bajwa
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Knee Joint ◽  
Synovial Sarcoma ◽  
Lower Risk ◽  
Soft Tissue Sarcomas ◽  
Synovial Cells ◽  
Rare Presentation

Synovial sarcoma unlike its name is not originating from synovial cells. It accounts for approximately 10% of all soft tissue sarcomas with main predilection for extremities.We present here a case of synovial sarcoma of subcutaneous origin of knee joint which is rarest of presentations and early diagnosis is associated with lower risk of metastasis and hence better prognosis.

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