BACKGROUND: @entity3478 resections for limb salvage have become the standard treatment. Recently, intercalary @entity5 resection with epiphyseal sparing has been used as an alternative in @entity1 with @entity421 . The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. QUESTIONS/PURPOSES: We wanted to assess (1) the overall survival in @entity1 treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in @entity1 who have undergone intercalary @entity5 resection. METHODS: We analyzed all 35 @entity1 with @entity421 about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5  years, unless @entity204 occurred earlier (mean, 9  years; range, 1-16  years), and no @entity1 were lost to followup. During the study period, our indications for this approach included @entity1 without @entity3 , with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1  cm thickness could be available after a surgical margin width in bone of 10  mm was planned, and 16% of @entity1 (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of @entity1 , oncologic complications such as local recurrence and @entity5 progression, limb survival, and orthopaedic complications including @entity281 , @entity174 , and nonunion. Survival rates were estimated using the Kaplan-Meier method. @entity1 function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system. RESULTS: Overall survival rate of the @entity1 was 86% (95% CI, 73%-99%) at 5 and 10  years. Five @entity1 died of disease. No @entity1 had a local recurrence in the remaining bony epiphysis, but three @entity1 (9%; 95% CI, 0%-19%) had local recurrence in the soft tissue. The limb survival rate was 97% (95% CI, 89%-100%) at 5 and 10  years. Complications treated with additional surgical procedures were recorded for 19 @entity1 (54%), including three local recurrences, two infections, 11 @entity174 , and three nonunions. In 10 of these 19 @entity1 , the allograft was removed. Only five of the total 35 study @entity1 (14%) lost the originally preserved epiphysis owing to complications. The mean functional score was 26 points (range, 10-30 points, with a higher score representing a better result) at final followup. CONCLUSIONS: Although the recurrence rate was high in this series, the small sample size means that even one or two fewer recurrences might have resulted in a much more favorable percentage. Because of this, future, larger studies will need to determine whether this is a safe approach, and perhaps should compare epiphyseal preservation with other possible approaches, including endoprosthetic reconstruction and/or osteoarticular allografts. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in XXXX of the Knee.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'fracture'] @entity3478 :: ('MESH:D001859', 'Disease') :: ['Bone tumor'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity421 :: ('MESH:D012516', 'Disease') :: ['osteosarcomas', 'osteosarcoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity421 :: (MESH:D012516,Disease) :: ['Osteosarcoma']
