Limb salvage and outcome of osteosarcoma - The University of Muenster experience

One hundred thirty-six patients with nonmetastatic high grade osteosarcoma treated from 1978 to 1994 in one institution with a multidisciplinary appro ach that included intravenous neoadjuvant chemotherapy were studied to eval uate which factors influence the outcome of modern orthopaedic therapy. Ana tomic location, tumor volume, surgical margins, complications, and function al outcome were analyzed. Seventy-nine patients had a limb salvage procedur e, 21 had a rotationplasty, and 33 had an amputation. Limb salvage consiste d of 32 endoprostheses, 39 allograft replacements, six autograft replacemen ts, and two shortening procedures. Three patients died during preoperative chemotherapy treatment. At a mean followup of 43 months, 81 patients contin ue to be disease free, three are alive after local recurrence, 17 are alive after having metastatic lesions, five are alive with metastatic lesions pr esent, and 30 patients died of their disease. Forty-seven patients had pulm onary metastatic lesions, 14 had osseous metastatic lesions, three had abdo minal metastatic lesions, two had lymphatic metastatic lesions, and eight p atients had skip metastatic lesions. Prognosis correlated with chemotherapy response, surgical margins, and tumor volume. The minor complication rate for limb salvage was 4% and the major complication rate was 52%. Amputation s had a 6% minor complication rate and 34% major complication rate. Rotatio nplasties had 10% minor and 48% major complication rates. The Musculoskelet al Tumor Society functional evaluation after limb salvage showed that 23 (3 8%) patients had more than 75% of the maximum functional score, 34 (56%) we re from 50% to 75%, and three (5%) less than 50%. Of the rotationplasties, six (67%) were functionally better than 75% and three (33%) were functional ly better than from 50% to 75%. In the group of amputations, 13 (56%) were from 50% to 75%, and 10 (44%) less than 50%. The extent of preoperative nec rosis, surgical margins, and tumor volume are the most important prognostic factors. The increase in limb salvage procedures and the better long term survival of patients results in a higher rate of immediate and delayed comp lications. Functional outcome after rotationplasty is superior to limb salv age reconstruction and amputation.