Abstract
Introduction: Limb preserving surgery in children with bone sarcoma remains a significant challenge as most are expected to survive their disease and put significant functional loads on their reconstructed limbs. The most common reconstructions used for children with lower limb sarcomas are endoprosthetic replacements and rotationplasty. This study aimed to investigate and compare differences in the complications and functional outcomes between these two methods of reconstruction.
Methods: This is a retrospective case control study of 12 rotationplasty patients and 12 patients who received EPR. Patients were selected at random from records provided by both centres and matched according to age at diagnosis, sex, site of disease and date of surgery. The Musculoskeletal Tumour Society (MSTS) score was used to evaluate functional outcome, and surgical complications were assessed qualitatively.
Results: Five patients (42%) treated with endoprostheses experienced some form of post-operative surgical complication compared to three patients (25%) treated with rotationplasty and one patient from each group required an amputation to treat the complications. The average MSTS score was 22.7 in the EPR cohort and 18.9 in rotationplasty patients. This difference was statistically significant (p=0.05).
Discussion: The study showed that patients who received EPR suffered more surgical complications than rotationplasty patients. However the results demonstrated superior functional outcomes in patients who received EPR.
These results suggest that the functional benefit historically attributed to rotationplasty has been negated by modern endoprostheses, probably due to improvements in surgical experience and prosthesis technology.
Conclusion: Our experience shows that patients with EPR are more likely to suffer more surgical complications but have similar, if not better functional outcomes compared to rotationplasty.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
