Comparison of curative effect in native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients with distal femoral osteosarcoma
Liang Chao, Wang Yongjie, Xu Jiaming, Ji Weiping, Zhang Zhichang, Dong Yang
Department of Orthopaedics, the 6th People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
Abstract：Objective To compare the clinical effectiveness of native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients diagnosed with distal femoral osteosarcoma.Methods A retrospective cohort study was performed on 32 patients diagnosed with femoral osteosarcoma and who underwent bone tumor resection and reconstruction with man-made prosthesis between January 2012 to December 2019. Radiography showed good response in neoadjuvant chemotherapy. Based on the constructive procedure, 12 cases were included in the native joint-preserving custom-made prosthesis group and 20 cases in the newly pivoted knee prosthesis groups. Post-operative Musculoskeletal Tumor Society score (MSTS) and Hospital for Special Surgery (HSS) score were compared at 12 months after surgery, and the rates of tumor recurrence were compared between two groups. Postoperative complications and difference of length of lower limb in children below 15 years old were observed.Results The MSTS scores after 12 months were (26.6±2.6) points and (22.6±1.8) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. The HSS scores were (90.1±4.1) points and (70.4±5.1) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. There were significantly statistical differences between two groups(t=5.019, 11.375, all P values＜0.05). The rate of tumor recurrence was 2/12 in native joint-preserving custom-made prosthesis group and 15%(3/20) in newly pivoted knee prosthesis group with no statistically significant difference (P=0.620). The fracture of the stem of prosthesis occurred in one case, and wound healing was delayed in one case in the native joint-preserving custom-made prosthesis group. Loose prothesis in two cases and delayed wound healing in one case were observed in the newly pivoted knee prosthesis group. No postoperative limb length beyond 20 mm was recorded in children below 15 years old more than 24 months after surgery.Conclusions Compared with the newly designed pivoted knee prosthesis custom-made prosthesis that aims to preserve the joint, based on strict surgical indications and the good response of neoadjuvant chemotherapy, the construction of native joint-preserving custom-made prosthesis is a safe and effective option for preserving joint function although it failed to reduce postoperative unequal length of lower limbs in children below 15 years old with growing up.
梁超, 王永杰, 徐佳明, 嵇伟平, 张智长, 董扬. 保留自身关节的定制型假体与新轴心式膝关节假体在股骨远端骨肉瘤保肢治疗中的应用效果比较[J]. 中华解剖与临床杂志, 2021, 26(3): 298-304.
Liang Chao, Wang Yongjie, Xu Jiaming, Ji Weiping, Zhang Zhichang, Dong Yang. Comparison of curative effect in native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients with distal femoral osteosarcoma. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 298-304.
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2021, Vol. 26 
