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Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Limb-salvage surgery has been used during the last several decades to treat patients with high-grade bone sarcomas. In the short- and intermediate-term these surgeries have been associated with relatively good function and low revision rates. However, long-term studies show a high rate of soft tissue, implant, and bone-related complications. Multiplanar osteotomy with limited wide margins uses angled bone cuts to resect bone tumors with the goal of complete tumor removal while sparing host tissue although its impact on local recurrence is not known.

Questions/purposes

We determined whether multiplanar osteotomy was associated with local recurrences, reconstruction failures, and allograft nonunions.

Patients and Methods

We retrospectively reviewed the charts of six patients. Four patients had an osteosarcoma, one had a Ewing’s sarcoma, and one had a chondrosarcoma. Patient and treatment factors such as age, diagnosis, percent of tumor necrosis (if applicable), margin status, and time to allograft union were recorded. In all patients, reconstruction was performed with an intercalary allograft cut to fit the residual defect. The minimum followup was 25 months (average, 39 months; range, 24–66 months).

Results

No patient experienced a local recurrence or metastasis, and all patients were alive and disease-free at the most recent followup. All allografts healed during the study period.

Conclusion

With careful patient selection, the multiplanar osteotomy resection technique may be considered an option for treating patients with high-grade bone sarcomas, and, when compared with traditional surgical techniques, may lead to improved healing and function of the involved extremity.

Level of Evidence

Level IV, therapeutic study. See the guidelines online for a complete description of levels of evidence.

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Acknowledgments

We thank Larry Dixon MD and Scott Stacy MD for assistance in interpreting the radiographic data that were part of this study. We also thank Michael A. Simon MD for assistance in caring for the patients in this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St. MC 6342, Redwood City, CA, 94063, USA

    Raffi S. Avedian MD

  2. Department of Surgery, Section of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Pritzker School of Medicine, Chicago, USA

    Rex C. Haydon MD, PhD & Terrance D. Peabody MD

Authors
  1. Raffi S. Avedian MD
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  2. Rex C. Haydon MD, PhD
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  3. Terrance D. Peabody MD
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Corresponding author

Correspondence to Raffi S. Avedian MD.

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Investigation was performed at the University of Chicago.

Each author certifies that he or she has no commercial associations (eg consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that night pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

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Avedian, R.S., Haydon, R.C. & Peabody, T.D. Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas. Clin Orthop Relat Res 468, 2754–2764 (2010). https://doi.org/10.1007/s11999-010-1362-0

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  • DOI: https://doi.org/10.1007/s11999-010-1362-0

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