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Clinical Trial
. 2008 Feb;32(1):63-8.
doi: 10.1007/s00264-006-0289-2. Epub 2007 Feb 15.

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

K Hayashi  1 , H Tsuchiya, N Yamamoto, A Takeuchi, K Tomita
Affiliations
Clinical Trial

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

K Hayashi et al. Int Orthop. 2008 Feb.

Abstract
in English, Spanish

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.

Les résultats fonctionnels des prothèses et des greffes ostéo-articulaires réalisées pour ostéosarcome autour du genou, ne sont pas satisfaisants du fait de leur courte durée de vie, des gros troubles de torsion et de l’importante remise en cause de l’anatomie normale. Nous avons voulu étudier le devenir fonctionnel d’une chirurgie comportant une résection d’ostéosarcome à la limite des marges tumorales au niveau de l’articulation du genou en association avec une chimiothérapie à base de caféine potentialisée. 21 patients présentant un ostéosarcome de stade IIB de haut grade autour du genou ont bénéficié en préopératoire de 3 à 5 cures de cisplatine intra artérielle avec caféine avec ou sans doxorubicine. La réponse histologique chez ces 21 patients à la chimiothérapie préopératoire a été de grade IV (pas de cellules vivantes) chez 19 patients et de grade III avec seulement quelques foyers de cellules vivantes (cellules viables) chez 2 patients. Les patients ont été séparés en trois groupes à partir du type d’excision fémorale. Le premier groupe a bénéficié d’une excision marginale de l’extrémité supérieure du péroné, le second groupe a bénéficié d’une conservation de l’épiphyse, suivi d’un allongement et, le troisième groupe a bénéficié d’une résection de l’articulation avec reconstruction. Le résultat fonctionnel moyen a été respectivement de 100%, 95% et 88%. Il n’y a pas eu de récidive de la tumeur après un suivi moyen de 97 mois. L’excision marginale de l’extrémité supérieure du péroné permet un excellent résultat fonctionnel. La préservation de l’épiphyse permet également d’améliorer la fonction de l’articulation comparée à une résection de celle-ci.

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Figures

Fig. 1a–g
Fig. 1a–g
A nine-year-old girl. a The tumour of the distal femur shows lytic features on the initial radiograph. After chemotherapy, good margination of the tumour is observed. b Tumour has decreased markedly, and no tumor extension into the epiphysis is observed in the MR image after chemotherapy. c The epiphysis of the distal femur is preserved by intentional marginal excision. d The bone after tumour resection was shortened by 7 cm, and e the femur was distracted by 9 cm at the diaphysis with an intramedullary nail. The affected limb has been overextended by 2 cm to compensate for anticipated limb length discrepancy. f Transfixation. g Remodelling of the juxta-articular bone to its normal shape
See this image and copyright information in PMC

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