title: Endoprosthetic reconstruction for large extremity soft-tissue sarcoma with juxta-articular bone involvement: functional and survival outcome.
abstract: BACKGROUND
  Large extracompartmental limb soft-tissue sarcoma with juxta-articular bone involvement poses major challenges in disease management. Radical resection of sarcoma frequently requires concomitant bone resection and reconstruction. We describe the clinical outcomes of endoprosthetic reconstruction and the complications associated with this procedure.
  
  
  METHODS
  Thirty patients with soft-tissue sarcomas with local juxta-articular bone involvement in an extremity underwent surgery at our center between May 2004 and October 2011, 20 for primary sarcomas and 10 for local recurrences. Clinical data from those patients were analyzed retrospectively. The bone affected included the proximal femur (10 cases), the distal femur (nine cases), the proximal humerus (eight cases), the proximal tibia (two cases), or the total femur (one case). Wide excision of the tumor and the bone tissue involved was performed on every patient, followed by reconstruction of the subsequent defect using tumor endoprosthesis. All patients underwent regular follow-up for an average of 25 (range, 3-84) mo.
  
  
  RESULTS
  Three patients had poor wound healing. Implant fractures leading to additional revisions occurred in two cases. Local tumor recurrence developed in four patients. There were 15 patients with lung metastases, and 11 patients died of disseminated metastases. In the latest follow-up, 14 patients survived free of disease and five were alive with tumors. The mean Musculoskeletal Tumor Society functional analysis for proximal femur, distal femur, proximal tibia, proximal humerus, and total femur were 90%, 82%, 73%, 71%, and 60%, respectively. The 2- and 5- y survival rates were 61.6% and 30.0%, respectively.
  
  
  CONCLUSIONS
  Endoprosthetic reconstruction could yield satisfactory results as a wide excision and limb salvage therapeutic strategy for patients with large extracompartmental soft-tissue sarcomas with juxta-articular bone involvement. Acceptable complications occurred in the present report.
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Tai-Qiang
authors.initials: TQ
authors.lastname: Yan
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Wen-Hao
authors.initials: WH
authors.lastname: Zhou
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China. Electronic address: yantqzh@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Rong-Li
authors.initials: RL
authors.lastname: Yang
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Sen
authors.initials: S
authors.lastname: Dong
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Liang
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone invasion; Bone resection; Endoprosthesis replacement; Soft-tissue sarcoma