The Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma Around the Knee in Child

Background: To investigate: (1) what are the prognosis in patients treated with this chemotherapy scheme and limb salvage; (2) what are the clinical outcomes of expandable endoprosthesis reconstruction in child? Methods: From January 2009 to December 2014, we retropected 29 skeletally immature kids ( mean age, 10.5 years; range, 6-15 years) with osteosarcoma around knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, this expandable prosthesis was implanted to reconstruct. These 29 patients were included in our retrospection. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, lengthening procedures. The survivorship and recurrence were assessed by SPSS software. The function was assessed by Musculoskeletal Tumor Society (MSTS) scoring system. Results: A mean of follow-up time was 8.9 years (range, 6-12years). The overall 5-year survival was 89.1% based on Kaplan-Meier. Relapse suffered in three patients and one underwent amputation. Lung metastasis developed in one patient. At six months after operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery--one for implant infection and one for aseptic loosening. Conclusions: Chemotherapy scheme and limb salvage could achieved high survival rate. Use of this expandable prosthesis was associated with good function and low complication. The character of expandability could be a method to overcome discrepancy in the growth period. Level of Evidence Level IV, therapeutic study.