Application of rotationplasty in treatment of osteosarcoma of distal femur in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Xuelin , LIU Yatao , LI Jianxiong , BI Jingyou ,  XU Meng

Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;

Corresponding author：

XU Meng, Email: 13501175839@163.com

Keywords：

Rotationplasty; distal femur; osteosarcoma; limb salvage; child

DOI：

10.7507/1002-1892.202003083

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children.Methods A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph.Results Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°).Conclusion Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.

Citation： ZHAO Xuelin, LIU Yatao, LI Jianxiong, BI Jingyou, XU Meng. Application of rotationplasty in treatment of osteosarcoma of distal femur in children. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1215-1220. doi: 10.7507/1002-1892.202003083 Copy

1.	Han G, Bi WZ, Xu M, et al. Amputation versus limb-salvage surgery in patients with osteosarcoma: a meta-analysis. World J Surg, 2016, 40(8): 2016-2027.
2.	Tan PX, Yong BC, Wang J, et al. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol, 2012, 38(12): 1171-1177.
3.	吴凡, 方向, 郎志刚, 等. 人工全股骨置换术治疗股骨恶性肿瘤. 中国修复重建外科杂志, 2019, 33(1): 18-22.
4.	Winkelmann WW. Rotationplasty. Orthop Clin North Am, 1996, 27(3): 503-523.
5.	Lozano Calderón SA, Kuechle J, Raskin KA, et al. Lower extremity megaprostheses in orthopaedic oncology. J Am Acad Orthop Surg, 2018, 26(12): e249-e257.
6.	Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. 1980. Clin Orthop Relat Res, 2003, (415): 4-18.
7.	Han G, Wang Y, Bi WZ, et al. Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy. Med Oncol, 2012, 29(2): 1347-1353.
8.	张绍岩, 金成吉, 沈松, 等. 中华 05 RUS-CHN 法骨龄评价可靠性的再检验. 体育科学, 2014, 34(4): 92-96.
9.	Gradl G, Postl LK, Lenze U, et al. Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors. BMC Musculoskelet Disord, 2015, 24(16): 262-268.
10.	Gupta SK, Alassaf N, Harrop AR, et al. Principles of rotationplasty. J Am Acad Orthop Surg, 2012, 20(10): 657-667.
11.	Wang W, Yang J, Wang Y, et al. Bone transport using the Ilizarov method for osteosarcoma patients with tumor resection and neoadjuvant chemotherapy. J Bone Oncol, 2019, 16(6): 100224.
12.	Benedetti MG, Coli M, Campanacci L, et al. Postural control skills, proprioception, and risk of fall in long-term survivor patients treated with knee rotationplasty. Int J Rehabil Res, 2019, 42(1): 68-73.
13.	Brigman BE, Kumagai SG, McGuire MH, et al. Rotationplasty after failed limb-sparing tumor surgery: a report of two cases. Clin Orthop Relat Res, 2003, 415(10): 254-260.
14.	Sawamura C, Hornicek FJ, Gebhardt MC. Complications and risk factors for failure of rotationplasty: review of 25 patients. Clin Orthop Relat Res, 2008, 466(6): 1302-1308.
15.	Bacci G, Balladelli A, Palmerini E, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremities in preadolescent patients: the Rizzoli Institute experience. J Pediatr Hematol Oncol, 2008, 30(12): 908-912.
16.	Kotz R, Salzer M. Rotationplasty for childhood osteosarcoma of the distal part of the femur. J Bone Joint Surg (Am), 1982, 64(7): 959-969.
17.	Hillmann A, Weist R, Fromme A, et al. Sports activities and endurance capacity of bone tumor patients after rotationplasty. Arch Phys Med Rehabil, 2007, 88(7): 885-890.
18.	Rota V, Benedetti MG, Okita Y, et al. Knee rotationplasty. Int J Rehabil Res, 2016, 39(4): 346-353.
19.	沙漠, 康两奇, 丁真奇, 等. 全股骨的重建——BⅢb 型旋转成形术的外科技术和临床结果. 骨科, 2019, 10(4): 273-277.

1. Han G, Bi WZ, Xu M, et al. Amputation versus limb-salvage surgery in patients with osteosarcoma: a meta-analysis. World J Surg, 2016, 40(8): 2016-2027.
2. Tan PX, Yong BC, Wang J, et al. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol, 2012, 38(12): 1171-1177.
3. 吴凡, 方向, 郎志刚, 等. 人工全股骨置换术治疗股骨恶性肿瘤. 中国修复重建外科杂志, 2019, 33(1): 18-22.
4. Winkelmann WW. Rotationplasty. Orthop Clin North Am, 1996, 27(3): 503-523.
5. Lozano Calderón SA, Kuechle J, Raskin KA, et al. Lower extremity megaprostheses in orthopaedic oncology. J Am Acad Orthop Surg, 2018, 26(12): e249-e257.
6. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. 1980. Clin Orthop Relat Res, 2003, (415): 4-18.
7. Han G, Wang Y, Bi WZ, et al. Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy. Med Oncol, 2012, 29(2): 1347-1353.
8. 张绍岩, 金成吉, 沈松, 等. 中华 05 RUS-CHN 法骨龄评价可靠性的再检验. 体育科学, 2014, 34(4): 92-96.
9. Gradl G, Postl LK, Lenze U, et al. Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors. BMC Musculoskelet Disord, 2015, 24(16): 262-268.
10. Gupta SK, Alassaf N, Harrop AR, et al. Principles of rotationplasty. J Am Acad Orthop Surg, 2012, 20(10): 657-667.
11. Wang W, Yang J, Wang Y, et al. Bone transport using the Ilizarov method for osteosarcoma patients with tumor resection and neoadjuvant chemotherapy. J Bone Oncol, 2019, 16(6): 100224.
12. Benedetti MG, Coli M, Campanacci L, et al. Postural control skills, proprioception, and risk of fall in long-term survivor patients treated with knee rotationplasty. Int J Rehabil Res, 2019, 42(1): 68-73.
13. Brigman BE, Kumagai SG, McGuire MH, et al. Rotationplasty after failed limb-sparing tumor surgery: a report of two cases. Clin Orthop Relat Res, 2003, 415(10): 254-260.
14. Sawamura C, Hornicek FJ, Gebhardt MC. Complications and risk factors for failure of rotationplasty: review of 25 patients. Clin Orthop Relat Res, 2008, 466(6): 1302-1308.
15. Bacci G, Balladelli A, Palmerini E, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremities in preadolescent patients: the Rizzoli Institute experience. J Pediatr Hematol Oncol, 2008, 30(12): 908-912.
16. Kotz R, Salzer M. Rotationplasty for childhood osteosarcoma of the distal part of the femur. J Bone Joint Surg (Am), 1982, 64(7): 959-969.
17. Hillmann A, Weist R, Fromme A, et al. Sports activities and endurance capacity of bone tumor patients after rotationplasty. Arch Phys Med Rehabil, 2007, 88(7): 885-890.
18. Rota V, Benedetti MG, Okita Y, et al. Knee rotationplasty. Int J Rehabil Res, 2016, 39(4): 346-353.
19. 沙漠, 康两奇, 丁真奇, 等. 全股骨的重建——BⅢb 型旋转成形术的外科技术和临床结果. 骨科, 2019, 10(4): 273-277.

Next Article
Treatment of distal tibial tumor with vascularized fibula reconstruction

Chinese Journal of Reparative and Reconstructive Surgery

Application of rotationplasty in treatment of osteosarcoma of distal femur in children

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content