Cliniacal Research On Limb Salvage For Malignant Tumors Of The Knee

Objectives:Our aim was to evaluate the long-term clinical outcome of limb salvage in patients with a sarcoma around the knee joint who were undergone the surgery, focusing on the knee joint function,survival rate and post-operation complications.Methods:The cases of thirty-seven patients were retrospectively reviewed in ZhongShan Hospital between 1999 and 2008.37 patients were divided into two groups(endoprosthesis reconstruction group and bone reconstruction group). Twenty-six patients had had endoprosthetic reconstruction(endoprosthesis reconstruction group),ten patients had had massive bone allograft reconstruction and two patients had had devitalization and replantation after resection of malignant tumor segment surgery(bone reconstruction group).Functional evaluation was based on the Musculoskeletal Tumor Society Scoring system(MSTS),with numerical values from 0 to 5 points assigned for each of the following six categories:pain,function, emotional acceptance,use of supports,walking ability,and gait.Another functional evaluation based on the range of knee flexion.Patients' survival rates were analyzed by Kaplan-Meier method.Post-operation complications were also analyzed.Results:For the thirty-seven patients,the 3-year survival rate of endoprosthesis reconstruction group and bone reconstruction group was 69.4%and 69.3%.According to the Kaplan-Meier survival curve,there is no significant difference between two groups(P=0.67).For all the patients,the mean final functional score was 24±3.44 (80%±11.5%) in the endoprosthesis reconstruction group and 16.75±5.64 (55.83%±18.8%) in the bone reconstruction group(P=0.000).The mean range of flexion was 86°±28.1°in the endoprosthesis reconstruction group and 60°±27.9°in the bone reconstruction group(P=0.012).There were eight complications.In the endoprosthesis reconstruction group,the most frequent complications were deep infection(8%) and aseptic loosening(8%).In the massive bone allograft reconstruction group,the most frequent complications were the fracture of implant articular surface breakage(25%) and deep infection(8.3%).The local recurrence rate was 16%and 16.7%,the metastasis rate was 24%and 41.7%in endoprosthesis reconstruction group and bone reconstruction group respectively.Conclusions:1.Preoperative and postoperative chemotherapy can improve the survive rate of the patient who have the limb salvage.2.There is no significant difference of the survival rate between endoprosthetic reconstruction and massive bone allograft reconstruction.3.Endoprosthetic reconstruction as limb salvage provided better knee joint function compare to massive bone allograft reconstruction. 4.Limb savage provide better joint function and mental acceptance.