Aims Children treated for osteosarcoma around the knee often have a substantial leg-length discrepancy at skeletal maturity. The aim of this study was to investigate the results of staged skeletal reconstruction after a leg lengthening procedure using an external fixator in these patients.
Patients and Methods We reviewed 11 patients who underwent staged reconstruction with either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control group of 11 patients who had undergone wide excision and concurrent reconstruction with an arthroplasty were matched for gender, location, and size of tumour. We investigated the change in leg-length discrepancy, function as assessed by the Musculoskeletal Tumor Society Scale (MSTS) score and complications.
Results A mean 5.2 cm (1.7 to 8.9) of lengthening was achieved. The mean MSTS scores significantly improved after staged reconstruction (p = 0.003) but were still worse than those of the control group (p = 0.049). However, the MSTS scores of the arthroplasty subgroup were comparable with those of the controls, although the extensor lag was greater and the range of movement was less. The patient group experienced more complications, but all of these resolved.
Conclusion Approximately 5 cm of lengthening and significant functional improvement can be achieved by staged reconstruction and lengthening, without major complications. Although it has limitations, this method of treatment seems to be a satisfactory surgical option for growing children with a significant leg-length discrepancy after excision of an osteosarcoma around the knee.
Cite this article: Bone Joint J 2017;99-B:401–8.
S. Kang: Study design, Data collection, analysis and interpretation, Writing the paper, Approval of the manuscript.
J. S. Lee: Study design, Data analysis and interpretation, Approval of the manuscript.
J. Park: Data collection and interpretation, Approval of the manuscript.
S-S. Park: Study design, Data collection, analysis and interpretation, Writing the paper, Approval of the manuscript.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by A. C. Ross and first proof edited by J. Scott.
- Received February 7, 2016.
- Accepted November 25, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery