Limb Salvage Surgery In Adult Bone Sarcoma With Good Oncological And Functional Outcome

Better understanding of tumor biology, effective chemotherapy, improved imaging studies, new surgical techniques and prosthetic designs have enabled majority of bone cancers to be treated by limb salvage surgery. Lower extremity bone defects that mainly occur following removal of bone tumors can be managed by modular or custom-made 3d printed endo-prosthetic reconstruction or by biological reconstruction methods such as recycled tumor-bearing autografts with or without vascularized fibula autograft (VFA), VFA alone, bone transport methods using external fixators, massive bone allografts (MBA) combined with VFG, MBA alone and allograft-prosthesis composites (1-5).

In the past 30 years, modular endoprostheses have become the standard for tumor reconstructions about the hip and knee. These allow reconstruction of a wide variety of skeletal defects using off-the-shelf components without the expense or time required to manufacture a custom-made implant. Modular replacement prostheses can provide a stable and secure fixation which allows immediate weight-bearing and restoration of function in patients with primary or metastatic bone tumors. Besides their ability to provide a solid and functional limb, complications of endoprosthesis have also been reported in the literature including soft tissue failure, aseptic loosening, structural/mechanical failure, infection and tumor progression.

Pre-operative planning for wide margin oncological resection and choosing the best available appropriate method of reconstruction is the back bone of any musculoskeletal malignancy treatment

In this young male with non-metastatic left proximal tibia chondroblastic osteosarcoma, pre-operative MAP based NACT (neo adjuvant chemotherapy) was given as per institution protocols. Patient underwent wide resection of left proximal tibia with standard anteromedial approach with preservation of posterior tibial, anterior tibial and peroneal vessels. Reconstruction was done with proximal tibial modular megaprosthesis. Final histopathology was chondroblastic osteosarcoma with 40 % residual tumor with all margins were free of tumor. Postoperative period was uneventful and on day 2 patient started active full weight bearing mobilisation. Patient is presently undergoing adjuvant chemotherapy and is on regular follow up.

Limb salvage surgery using modular endoprosthetic reconstruction of the lower extremities provides good functional outcomes and high acceptability rates.

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Dr. Himanshu Rohela
Consultant – Orthopaedics Oncology