Short Term Complications and Functional Results of Sarcoma Limb Salvage Surgeries

Abstract

Background: Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bone<br />replacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction with<br />an allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced with<br />tumor prosthesis replacement.<br />Methods: We evaluated the short-term complications and functional results of 40 patients with aggressive extremity<br />tumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17<br />patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structural<br />allograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, blood<br />cell count and chemotherapy treatment in the study groups.<br />Results: We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion,<br />allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to be<br />resolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Although<br />the rate of complications was higher in allograft group, it didn't statistically indicate strong correlation (Fisher's exact:<br />0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograft<br />group and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with no<br />significant difference between them.<br />Conclusion: Although complications were higher in the allograft group, allograft could be offered to bone sarcoma<br />patients, whom are predicted to have short life expectancy.<br />Level of evidence: III