Limb salvage in the management of malignant tumours around Hip and Knee.

Abstract

Introduction - Malignant bone tumours have long been known to be very aggressive and so amputation was considered to be the only available option for a long time for the radical removal of the disease . Improvements in implant technology, surgical techniques and new chemotherapy  protocols provides a new way in the treatment of malignant bone tumours , ie. Tumour resection and custom mega    prosthesis. Aim To study the functional outcome of limb   salvage surgery by resection and custom mega prosthesis reconstruction of malignant tumours around knee and hip. Materials and methodsIn the period of 2012-2013 four              patients with malignant bone tumours were treated with wide resection of the tumour and reconstruction with the custom mega prosthesis with an average follow up of 20 months. All patients undergo an imaging workup for local extend and distand spread. Open incisional biopsy core needle biopsy are the method of choice. The prosthesis were designed based on the individual bony anatomy. 3 cycles of neo               adjuvant chemotherapy was given. surgery were done by the senior surgeon who were experienced in the arthroplasty procedures. Post operatively adjuvant chemotheraoy was given. During the review their functional status were assessed with the help of musculo skeletal tumour society score.    Discussion Among the four cases two cases had excellent results and two cases had good results with a mean MSTS score of 77.49 after a mean follow up of 20 months . Though the sample of the study may be small and a shorter duration of study, this study was to emphasise that limb salvage have good functional ability . To check the reduction of    complication like infection, implant failure , deep vein               thrombosis, periprosthetic fractures, dislocations,20 months of follow up is more than enough. Conclusion Custom megaprosthesis is the treatment of choice for the                  reconstruction following the tumour resection around hip and knee as it allows early weight bearing and good functional ability.