Evaluation of knee joint function and quality of life of patients with peripheral osteosarcoma of the knee treated by limb salvage with joint preservation
Hou Ziwei1,2, Zheng Kai1, Xu Ming1, Yu Xiuchun1
1Department of Orthopaedics, the 960th Hospital, PLA Joint Logistics Support Force, Jinan 250000, China; 2the First Clinical Medical College, Shangdong University of Traditional Chinese Medicine, Jinan 250355, China
Abstract：Objective To investigate the joint function and quality of life of patients with osteosarcoma around the knee joint after joint salvage operation (JPLS).Methods Thirty-four patients with knee periarticular osteosarcoma admitted to the Department of Orthopaedics of the 960th Hospital of PLA Joint Logistics Support Force from November 2000 to December 2019 were analyzed retrospectively. Among them, 17 patients who underwent JPLS were in the joint reservation group, 17 patients who underwent joint prosthesis replacement (JPRS) were in the prosthesis replacement group. In addition, 17 healthy patients from December 2019 to February 2020 were selected as the normal control group. The skeletal Muscle System Tumor Association Scoring System (MSTS), international knee committee (IKDC) knee master rating scale, and short form health (SF-36) questionnaire were used to evaluate the knee function, knee function, and quality of life in the normal control group, joint reservation group and prosthesis replacement groups. The distribution of items in the MSTS and IKDC scoring criteria was compared between the joint reservation group and prosthesis replacement group.Results (1) Baseline data among normal control group, joint reservation group and prosthesis replacement group were compared. No significant differencewas found among groups (all P values>0.05). All 34 patients in the joint reservation group and prosthesis replacement group successfully completed the operation, and all the incisions healed in one stage. (2) At 12 months after the operation, the MSTS scores in the prosthesis replacement group (22.82±5.47) were significantly lower than those in the joint reservation group (27.12±1.69) and the normal control group (28.18±1.78). Statistical differences were found among groups(F=15.152, P<0.05). No significant difference was found for MSTS scores between the joint reservation group and normal control group (P>0.05). The IKDC scores of the prosthesis replacement group, joint reservation group, and normal control groups were 59.71±11.73, 76.18±9.73, and 90.41±7.61, respectively. The scores increased successively with statistically significant differences (H=33.283, P<0.05). (3) The scores of SF-36, physiological function, physical pain, and social function in the prosthesis replacement group were lower than those in the normal control group at 12 months after the operation. The scores of health changes in the prosthesis replacement group were higher than those in the normal control group. The scores of health changes in the joint reservation group were higher than those in the normal control group. The scores of physiological function and social functions in the joint reservation group higher than those in the prosthesis replacement group. The differences were statistically significant (all P values<0.05). No significant difference was found for the other indexes (all P values>0.05). (4) Considering the scores of MSTS and IKDC in the joint reservation group and prosthesis replacement group: no significant difference was found in limb function between these groups (P>0.05). The pain, satisfaction, support, walking, and gait of the joint reservation group were significantly better than those of the prosthesis replacement group (all P values<0.05). No significant differences in terms of kneeling, squatting and knee joint bending were observed between the joint reservation group and prosthesis replacement group(all P values>0.05). For the indexes of no pain, swelling, strangulation, flexing of the soft legs, general movement up and down stairs, sitting down from a chair, running straight ahead, jumping up and down with the injured leg, and stopping or starting rapidly, significant differences were found between the joint reservation group and prosthesis replacement group (all P values<0.05).Conclusions Compared with JPRS, JPLS can bring better joint function and quality of life to patients with osteosarcoma, which is worthy of clinical promotion. For the evaluation of postoperative limb function in patients with osteosarcoma, it is recommended to combine application of IKDC, SF-36 and other evaluation indicators. In order to make up for the deficiency of MSTS function score, so as to reflect the patient's limb function more accurately and scientifically.
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Hou Ziwei, Zheng Kai, Xu Ming, Yu Xiuchun. Evaluation of knee joint function and quality of life of patients with peripheral osteosarcoma of the knee treated by limb salvage with joint preservation. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 508-515.
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2020, Vol. 25 
