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KMID : 0613320010070040139
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Journal of the Korean Bone and Joint Tumor Soceity
2001 Volume.7 No. 4 p.139 ~ p.143
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Functional Result of Limb Salvage Surgery with Tumor Prosthesis for Osteosarcoma of Proximal Tibia
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Park Won-Jong
Sohn Jong-Min
Chung Yang-Guk
Kang Yong-Koo
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Abstract
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Purpose: Limb salvage for osteosarcoma of proxmal tibia is challenging problem due to difficulties in mobilizing or retracting the main neurovascular structure, inadequate soft tissue coverage, and unsolved problem of patellar tendon
reattachment to endoprosthesis. The authors analyzed the functional result of limb salvage using tumor prosthesis with medial gastrocnemius rotation plasty for osteosarcama of the proximal tibia.
Materials and Methods: Eleven patients with histologically proven osteosarcoma of the proximal tibia, treated with adjuvant and neoadjuvant chemotherapy and limb salvage operation with tumor prosthesis between January 1992 and December 1998 at our Medical Center, wee selected. There were 6 male and 5 female. Age ranged from 15 years to 23.7 years with an average of 23.7 years. Follow-up period ranged from 1 year to 4.5 years with an average of 2.5 years. The final functional result was evaluated using the method by ISOLS, 1993. The factors include pain, functional activities, emotional acceptance, use of external supports, walking ability and gait. Each of the factors has been scored from 0 to 5 depending on the appropriate description or data. The rating score is determined by dividing the individual factor scores into the total score and indicates percentage of normal function.
Results: The overall function result ranged from 53.3% to 86.7% with an average of 68.3% of normal function. In details, the averages were 82.5% for pain, 62.5% for functional activities, 67.5% for emotional acceptance, 77.5% for use of external supports, 62.5% for walking ability, and 57.5% for gait. The average range of motion of the knee joint was 5° extension and 85° flexion. Five patients have extension lag ranged from 5° to 15° with an average of 10°. Two patients suffered postoperative infection. One was treated with antibiotics injection only, but the other needed removal of the prosthesis and knee fusion. Both of them showed unsatisfactory result.
Conclusion: The overall functional result after limb salvage using tumor prosthesis with medial gastrocnemius rotational flap for osteosarcoma of the proximal tibia was relational activities, emotional acceptance and gait than pain, use of external supports due to limitation of motion and extension lag. More aggressive postoperative physical therapy and protection with brace for 6∼9 months as well as surgical technique is mandatory for more satisfactory result.
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KEYWORD
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Proximal tibia, Osteosarcoma, Tumor prosthesis, Medial gastrocnemius rotational flap
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