Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yuan , XU Hairong , SHAN Huachao , SUN Yang , HUANG Zhen ,  NIU Xiaohui

Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China;

Corresponding author：

NIU Xiaohui, Email: niuxiaohui@263.net

Keywords：

Proximal tibial osteosarcoma; hemiprosthesis replacement; second-stage revision; length discrepancy of lower limb; children

DOI：

10.7507/1002-1892.201810022

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.Methods Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.Results All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.Conclusion The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.

Citation： LI Yuan, XU Hairong, SHAN Huachao, SUN Yang, HUANG Zhen, NIU Xiaohui. Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 131-137. doi: 10.7507/1002-1892.201810022 Copy

1.	Niu X, Xu H, Inwards CY, et al. Primary bone tumors: epidemiologic comparison of 9200 patients treated at Beijing Ji Shui Tan Hospital, Beijing, China, with 10 165 patients at Mayo Clinic, Rochester, Minnesota. Arch Pathol Lab Med, 2015, 139(9): 1149-1155.
2.	Daw NC, Neel MD, Rao BN, et al. Frontline treatment of localized osteosarcoma without methotrexate: results of the St. Jude Children’s Research Hospital OS99 trial. Cancer, 2011, 117(12): 2770-2778.
3.	Zhang C, Hu J, Zhu K, et al. Survival, complications and functional outcomes of cemented megaprostheses for high-grade osteosarcoma around the knee. Int Orthop, 2018, 42(4): 927-938.
4.	Mavrogenis AF, Pala E, Angelini A, et al. Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol, 2013, 107(4): 335-342.
5.	Nystrom LM, Morcuende JA. Expanding endoprosthesis for pediatric musculoskeletal malignancy: current concepts and results. Iowa Orthop J, 2010, 30: 141-149.
6.	Decilveo AP, Szczech BW, Topfer J, at al. Reconstruction using expandable endoprostheses for skeletally immature patients with sarcoma. Orthopedics, 2017, 40(1): e157-e163.
7.	Eckardt JJ, Kabo JM, Kelley CM, et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res, 2000, (373): 51-61.
8.	Benevenia J, Patterson F, Beebe K, et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. Springerplus, 2015, 4: 793.
9.	姬涛, 郭卫, 杨荣利, 等. Orthofix 单边外固定架在骨肿瘤外科治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1161-1167.
10.	Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013, 18(1): 101-109.
11.	McCoy TH Jr, Kim HJ, Cross MB, et al. Bone tumor reconstruction with the Ilizarov method. J Surg Oncol, 2013, 107(4): 343-352.
12.	杨华清, 章耀华, 韩庆海, 等. 微创截骨 Ilizarov 技术结合髓内钉行股骨延长疗效观察. 中国修复重建外科杂志, 2018, 32(12): 1524-1529.
13.	Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop, 2001, 21(4): 549-555.
14.	Pritchett JW. Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res, 1992, (275): 274-279.
15.	Li Y, Liao F, Xu HR, et al. Is there a reliable method to predict the limb length discrepancy after chemotherapy and limb salvage surgery in children with osteosarcoma? Chin Med J (Engl), 2016, 129(16): 1912-1916.
16.	Shapiro F. Developmental patterns in lower-extremity length discrepancies. J Bone Joint Surg (Am), 1982, 64(5): 639-651.
17.	Kelly PM, Diméglio A. Lower-limb growth: how predictable are predictions? J Child Orthop, 2008, 2(6): 407-415.

1. Niu X, Xu H, Inwards CY, et al. Primary bone tumors: epidemiologic comparison of 9200 patients treated at Beijing Ji Shui Tan Hospital, Beijing, China, with 10 165 patients at Mayo Clinic, Rochester, Minnesota. Arch Pathol Lab Med, 2015, 139(9): 1149-1155.
2. Daw NC, Neel MD, Rao BN, et al. Frontline treatment of localized osteosarcoma without methotrexate: results of the St. Jude Children’s Research Hospital OS99 trial. Cancer, 2011, 117(12): 2770-2778.
3. Zhang C, Hu J, Zhu K, et al. Survival, complications and functional outcomes of cemented megaprostheses for high-grade osteosarcoma around the knee. Int Orthop, 2018, 42(4): 927-938.
4. Mavrogenis AF, Pala E, Angelini A, et al. Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol, 2013, 107(4): 335-342.
5. Nystrom LM, Morcuende JA. Expanding endoprosthesis for pediatric musculoskeletal malignancy: current concepts and results. Iowa Orthop J, 2010, 30: 141-149.
6. Decilveo AP, Szczech BW, Topfer J, at al. Reconstruction using expandable endoprostheses for skeletally immature patients with sarcoma. Orthopedics, 2017, 40(1): e157-e163.
7. Eckardt JJ, Kabo JM, Kelley CM, et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res, 2000, (373): 51-61.
8. Benevenia J, Patterson F, Beebe K, et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. Springerplus, 2015, 4: 793.
9. 姬涛, 郭卫, 杨荣利, 等. Orthofix 单边外固定架在骨肿瘤外科治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1161-1167.
10. Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013, 18(1): 101-109.
11. McCoy TH Jr, Kim HJ, Cross MB, et al. Bone tumor reconstruction with the Ilizarov method. J Surg Oncol, 2013, 107(4): 343-352.
12. 杨华清, 章耀华, 韩庆海, 等. 微创截骨 Ilizarov 技术结合髓内钉行股骨延长疗效观察. 中国修复重建外科杂志, 2018, 32(12): 1524-1529.
13. Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop, 2001, 21(4): 549-555.
14. Pritchett JW. Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res, 1992, (275): 274-279.
15. Li Y, Liao F, Xu HR, et al. Is there a reliable method to predict the limb length discrepancy after chemotherapy and limb salvage surgery in children with osteosarcoma? Chin Med J (Engl), 2016, 129(16): 1912-1916.
16. Shapiro F. Developmental patterns in lower-extremity length discrepancies. J Bone Joint Surg (Am), 1982, 64(5): 639-651.
17. Kelly PM, Diméglio A. Lower-limb growth: how predictable are predictions? J Child Orthop, 2008, 2(6): 407-415.

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Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children

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