BONE SARCOMA DIAGNOSED AT THE TIME OF RECONSTRUCTIVE HIP-SURGERY

OBJECTIVE: To describe the clinical course of a group of patients in w hom sarcoma of the proximal femur was diagnosed at the time of reconst ructive hip surgery. DESIGN: A retrospective case series. SETTING: Fin al management of all patients took place at a tertiary care centre. PA TIENTS AND INTERVENTIONS: Six Consecutive patients with sarcoma of the proximal femur diagnosed at the time of reconstructive hip surgery. T he mistaken diagnoses made before surgery were benign tumour (2 patien ts), avascular necrosis (2 patients), subtrochanteric fracture due to metastasis (1 patient) and granuloma from a loose hip implant (1 patie nt). The final diagnosis was osteosarcoma in 3 patients and chondrosar coma in 3. Three patients with high-grade sarcoma received neoadjuvant chemotherapy followed by femoral or pelvic resection, or both, and re construction. Two patients with chondrosarcoma underwent wide excision of the tumour with allograft or modular implant reconstruction. One p atient with wide spread metastasis received only palliative chemothera py. MAIN OUTCOME MEASURES: Overall survival with respect to oncologic and functional results of treatment. RESULTS: Two patients (1 who rece ived only palliative chemotherapy) died after 5 and 21 months' follow- up, respectively. Average follow-up for the remaining 4 patients was 6 5.2 months (range from 51 to 75 months). They were disease free at lat est follow-up. One patient required amputation for septic complication s related to the reconstruction. CONCLUSIONS: Limb salvage surgery for sarcoma of the proximal femur is challenging when the diagnosis is ma de at the time of reconstructive surgery rather than through an approp riately planned biopsy. However this series suggests that limb preserv ation is feasible and that hindquarter amputation is not the only solu tion.