High-grade osteosarcoma treated with hemicortical resection and biological reconstruction.
OBJECTIVE
Wide excision with a 2-3 cm safe margin is widely-accepted in treating high-grade osteosarcoma. However, a wider margin sacrifices more healthy bone and may jeopardize joint function. We hypothesize that our innovative hemicortical resection for such tumors leads to better joint function without higher recurrence rate.


METHODS
Between August 2002 and April 2007, six patients of high-grade osteosarcoma were treated with hemicortical resection and biological reconstruction.


RESULTS
Five tumors were located around the knee and one was located in the distal tibia. The mean tumor size was 20.5 cm(3). The bone defects were reconstructed using recycled autograft in four cases (one by extracorporeal irradiation; three by liquid nitrogen) and structural allograft in two. In an average follow-up of 52 months (24-96), all patients survived without local recurrence or metastasis. All bone grafts incorporated well without mechanical failure or infection. The average Musculoskeletal Tumor Society score was 97.7%.


CONCLUSIONS
Hemicortical resection for high-grade osteosarcomas located eccentrically in the long bones may be a reliable technique leading to good joint function by preserving surrounding healthy tissues. The functional outcome was encouraging, although long-term follow-up is mandatory to validate. With the advancement of chemotherapy and radiographic three-dimensional imaging, the safe margin in wide excision of high-grade osteosarcoma may be narrowed down in light of joint surface preservation.
Department of Orthropaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. wmchen@vghtpe.gov.tw
Wei-Ming
WM
Chen
Po-Kuei
PK
Wu
Cheng-Fong
CF
Chen
Lien-Hsiang
LH
Chung
Chien-Lin
CL
Liu
Tain-Hsiung
TH
Chen
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D012516:Osteosarcoma / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D019651:Plastic Surgery Procedures