Image navigation assisted joint-saving surgery for treatment of bone sarcoma around knee in skeletally immature patients |
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Institution: | 1. Neurosurgical Department, University of Duisburg-Essen, Essen, Germany;2. Institute of Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany;1. Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China;2. Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, Shandong Province, 250012, PR China;3. Department of Spine Surgery of Traditional Chinese Hospital Affiliated with Xinjiang Medical University, Urumqi, Xinjiang, PR China;1. Department of Neurological Surgery, University of California, San Francisco, California, USA;2. Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA |
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Abstract: | PurposeIt is challenge to perform a native joint preserving resection for skeletally immature patients with bone sarcomas around the knee. We determined whether tumor resection under image-guided navigation make joint-saving surgery possible for juxta-articular sarcomas around knee while adhering oncological principles.MethodsWe performed joint-saving limb salvage surgeries on eight patients with metaphyseal bone sarcomas (6 in proximal tibia, 2 in distal femur). Six tumors extend to and 2 beyond the epiphyseal line. Planned tumor resection under image-guided navigation was employed for obtaining clear surgical margin while maximizing host tissue preservation. All tumors were en bloc removed and intercalary defect were reconstructed by combination of allograft with vascularized fibula flap. All specimens were examined for resection margin. Patients were followed up at average of 40.5 months for evaluating of oncologic and functional outcomes.ResultEntire joints were preserved in 5 patients and partial joints were saved in 3 patients. Clear surgical margins were achieved in all patients. The minimum of surgical margin width in bone is 6 mm in this series. No patient experienced local recurrence. Bone union achieved in all cases during the study period. The average MSTS score was 27.1 at final follow-up.ConclusionsWith careful patient selection, image navigation aided bone tumor resection was proved to be an effective way in joint-saving limb salvage procedures for treating skeletally immature patients with juxta-articular bone sarcomas around the knee. |
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Keywords: | Bone sarcoma Joint-saving surgery Navigation Limb salvage Knee |
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