Metachronous multifocal osteosarcoma (MFOS) is a rare form of osteosarcoma manifested by one or more new tumors developing after the initial treatment of primary osteosarcoma. We present a 61 year old Asian male who was referred with 10 week history of pain and discomfort around his left shoulder and low back pain. In 1968, he received radiotherapy followed by disarticulation of left hip for an osteosarcoma of lower end of left femur complicated with pathological fracture. He did not show any clinical features suggestive of recurrence of disease since then until he presented again in February 2005. CT scan of left scapula has revealed extensive osteosarcoma of lower part of scapula, involving subscapularis and infraspinatus muscles. An MRI scan of whole spine has shown evidence of multiple lesions in sacrum, ilium and acetabulum. A core biopsy from scapula has confirmed the histological diagnosis as high grade osteoblastic osteosarcoma. Slides from 1968 were reviewed in the context of recent recurrence and were consistent with features of intermediate grade fibroblastic osteosarcoma. He is currently undergoing chemotherapy prior to planning definitive treatment as there is evidence in the literature that MFOS is a potentially curable condition.
All were operated on by the same surgeon. 6 elbow (19%) had a pre-discharge complication, 4 ulna nerve palsies and 2 superficial wound infections. No cases of proven deep prosthetic infection. 1 case of symptomatic loosening after 12–24 months, awaiting revision. 1 case of loosening seen on X-ray after 5 years, the patient is asymptomatic but still under follow up. 21 of the 22 patients reported to be very satisfied with the outcome with only 4 elbows not allowing improvement in ADLs. Documented range of movement improved on an average by 200 of extension and 110 of flexion.
