Outcomes of combined chemotherapy, extensive resection, and metal prosthesis reconstruction of the proximal tibia and distal femur in Chinese patients with stage IIB knee malignant tumour: a long-term followup

Background: Complication rates reported for contemporary knee reconstruction limb salvage surgery (LSS), an alternative to amputation patients with bone tumours of the proximal tibia and distal femur, have not been extensively explored in China. Objective: Functional outcomes, survival, prosthesis failure, and complication rates were investigated in Chinese patients with malignant or aggressive tumours of the knee joint. Methods: A retrospective study was conducted of 47 patients with knee joint tumours (M:F, 23:24; mean age 27±6 years; range 15 to 39 years) treated with preand post-operative chemotherapy combined with extensive tumour resection and metal prosthesis replacement. Patients were followed from March 1998 to March 2008, until death or limb salvage failure. LSS efficacy, survival, prosthetic failure, and complications were evaluated by Musculoskeletal Tumour Society (MSTS) scoring. Results: Patients were followed up for a median of 89 months. Mean operative bleeding and surgical time were 600±154 (300-1500) mL and 2.8±0.6 (1.5-3.5), respectively. No early infections were reported; however, 8 (17.0%) and 3 (6.3%) patients developed superficial infections or deep tissue infections, respectively, and 9 (19.1%) developed deep vein thrombosis. Prosthetic loosening, breakage, and removal was reported in 7 (14.9%), 2 (4.3%), and 3 (6.3%) patients, respectively. Only 1 (2.1%) patient required subsequent amputation. A total of 12 (25.5%) developed recurrence, and 23 (48.9%) died during the follow-up time. Mean MSTS was 78±12%. Conclusions: Combined chemotherapy, extensive resection, and metal prosthesis reconstruction optimized functional recovery. However, potentially life-threatening complications, infections, and recurrence limited its broad implementation.