Application of the modiifed anteromedial approach on limb salvage for osteosarcoma of proximal tibia involved tibiaifbular department

HE Fang-zhou; ZHANG Wei-bin; SHEN Yu-hui

doi:10.3969/j.issn.2095-252X.2016.07.013

Abstract：Objective To evaluate the results and technique of the modiifed anteromedial approach on limb salvage for osteosarcoma of proximal tibia involving posterior or lateral cortex.Methods Between Jul. 2004 and Mar. 2013, 21 patients ( Male 9, Female 12 ) with osteosarcoma of proximal tibia involving tibioifbular department underwent resection and endoprosthetic arthroplasty with modified anteromedial approach. The average age of the 21 patients was 24.4 years ( range: 12 - 47 years ). Two cases were stage II A, 19 cases were stage II B according to the Enneking classiifcation system. All patients received neoadjuvant chemotherapy. After that, all of the tumors underwent en bloc resection. We evaluated the results using Musculoskeletal Tumor Society Score ( MSTS ) system and pulmonary metastases, morbidity and 5-year overall survival rate.Results The early complications included 2 cases of peroneal nerve transient palsy and 1 case of skin necrosis and healed ifnally. The average follow-up time was 66.6 months ( range: 5 - 138 months ). Seven patients died due to pulmonary metastases, and 1 patient with solitary lung metastasis underwent resection survived. Two cases received amputation because of local recurrence within 5 and 6 months after the limb salvage surgery, respectively. The mean range of movement ( ROM ) of the knee was 101.0 degrees ( 95%IC, 91.7 - 110.3 degrees ) and the limit of extension was 20 degrees in 2 cases. There were no other severe complications in this series. The mean MSTS score was 28.5 ( 95%IC, 27.2 - 29.8 ). The 5-year overall survival rate was 71.4% ( 95%CI, 52.1% - 90.7% ).Conclusions The modiifed anteromedial approach for osteosarcoma of proximal tibia involving posterior or lateral cortex and muscles. This procedure is one of the available choices on limb salvage techniques for the Enneking stage II B.