So far with the advancement in treatment modalities for malignant bone and soft tissue sarcomas the survival rate become higher. Till now there are some questions who can survive. Temporary procedure not affecting the treatment schedule would
have
more
advantages than primary permanent one. When there is higher possibility of survival, this can be switched to permanent one.
From Dec. 1986 to Jan, 1994, we had performed 40 cases of temporary arthrodesis after segmental resection of malignant bone and soft tissure tumors around the knee by using intramedullary nail and bone cement.
Thirty eight cases of bone tumors[osteosarcoma(33), malignant fibrous histiocytoma(MFH)(3), chondrosarcoma(1), Ewing's sarcoma(1)] and 2 cases of soft tissue sarcomas[MFH(1), squamous cell carcinoma(1)] were analysed. Types of intramedullary nail
used
were rigid(Huckstep, 23 cases) or flexible(Ender, 17 cases). Six cases(15%) showed mechanical implant failure due to fracture (Huckstep ; 5, Ender ; 1) between 2 to 20 months after operation. Rearthrodesis using Ender nail and bone cement(5) or
arthroplasty using Kotz prosthesis(1) were done for fractured cases. The other complications were deep infection(2), peroneal nerve palsy(2), or transfixing screw fracture(2). Second reconstruction procedure was carried out in 2 cases with
arthroplasty
using Kotz prothesis. For IM nail, multiple Ender nailing seems to be superior to the Huckstep in mechanical strength.
Contrary to the primary permanent reconsturction of the bone defect, this procedure has several advantages : 1) simple and does not hinder postoperative chemotherapy, 2) even in the extensively involved cases, can save the limb if the
neurovascular
structures are spared, 3) in Stage III, can save the salvagable limb, 4) economic and immediate stability can be helpful in the patient's quality of life, 5) two years later, when the survival approaches plateau, we can switch to another kinds of
salvage operation, 6) Ender nail was superior to Huckstep in mechanical stability. 7) can be used for children expecting leg lengthening near puberty.
It is useful for sarcoma patients around knee who require prolonged chemotherapy and whose life expectancy is relatively unexpectable.
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