Abstract
Introduction
Bone tumours rarely involve the joint surface as cartilage is thought to be a good barrier to tumour spread. When the tumour does cross the surface the surgeon is faced with the dilemma of whether to amputate the limb, resect it without reconstruction or reconstruct with an implant. This paper aims to investigate the oncological and functional outcomes of patients undergoing an extra-articular resection and reconstruction with an endoprosthesis.
Method
3100 patients have been seen in ROH with primary bone tumours. Patients were identified who had an extra-articular resection considered pre-operatively and the notes and imaging was reviewed. This group was subdivided into a group who did have an extra-articular resection (EAR) and those who either had an amputation or traditional through joint resection. The outcomes of the three groups (group 1 = no joint involvement, group 2 = EAR considered but not done and group 3 = EAR) were then compared in terms of oncological outcome, surgical margins and complications.
Results
EAR was considered in 94 cases (3%) usually due to either obvious tumour or joint effusion on initial imaging. Of these 94 cases an EAR was undertaken in 66 cases and not in 28 cases. There was no difference in age, site distribution, diagnosis between the groups. The mean size of the tumour was smaller in the EAR group. The percentage of wide margins achieved was significantly smaller in the EAR group and risk of local recurrent disease was greater in the EAR group but mainly in patients with chondrosarcoma. There was no difference in patient survival between the groups.
Conclusions
EAR gives acceptable oncological and functional results but has significantly higher rates of locally recurrent disease in patients with chondrosarcoma.
