title: Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma.
abstract: BACKGROUND
  Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival.
  
  
  OBJECTIVE
  We therefore compared the survival, local recurrence, function, and complications of patients with distal tibia osteosarcoma treated with limb salvage or amputation.
  
  
  METHODS
  We retrospectively reviewed 42 patients with distal tibia osteosarcoma treated from 1985 to 2010. Nineteen patients had amputations and 23 had limb salvage and allograft reconstructions. We graded the histology using Broders classification, and staged patients using the Musculoskeletal Tumor Society (MSTS) and American Joint Committee on Cancer (AJCC) systems. The tumor grades tended to be higher in the group of patients who had amputations. We determined survival, local recurrence, MSTS function, and complications. The minimum followup was 8 months (median, 60 months; range, 8-288 months).
  
  
  RESULTS
  The survival of patients who had limb salvage was similar to that of patients who had amputations: 84% at 120 and 240 months versus 74%, respectively. The incidence of local recurrence was similar: three of 23 patients who had limb salvage versus no patients who had amputations. The mean MSTS functional score tended to be higher in patients who had limb salvage compared with those who had amputations: 76% (range, 30%-93%) versus 71% (range, 50%-87%), respectively. The incidence of complications was similar.
  
  
  CONCLUSIONS
  Patients treated with either limb salvage or amputation experience similar survival, local recurrence, and complications, but better function is achievable for patients treated with limb salvage versus amputation. Local recurrence and complications are more common in patients with limb salvage.
  
  
  METHODS
  Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Orthopaedic Oncology Service, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, 40136, Bologna, Italy.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Caterina Novella
authors.initials: CN
authors.lastname: Abati
authors.forename: Carlo
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019637:Orthopedic Procedures; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult