Novel Orthopedic Oncology Approaches and Importance of

Novel Orthopedic Oncology
Approaches and Importance of
Rehabilitation
Behavior of Sarcomas of the Extremities
INITIAL CENTRIFUGAL GROWTH
PSEUDOENCAPSULATION
CONTAINMENT IN ANATOMIC COMPARTMENTS
Treatment
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•
•
•
Wide Resection
Radiation Therapy
Chemotherapy
Rehabilitation
Traditional Treatment
• Amputation
• Imaging Could Not Accurately Detect extent of
the Tumor
• No Adjuvant Treatment Believed to be
Effective
Bone Sarcoma Success Story
Osteosarcoma 20%
70% survival
Ewing Sarcoma 0%
75% survival
Not Related to Surgery
1970’s
Dr. Jaffe
Dr. Farber
Dr. Rosen
Multiagent Chemotherapy
• Improved Survival 15-20% to 60-65%
• Could Be Given Before Surgery
– Immediate Systemic Treatment
– Local Tumor Necrosis
– Allow Operative Planning
• Prognosis Related to Necrosis
• Tolerated Reasonably Well
Parallel Developments in Limb Salvage
Allografts and Endoprostheses
Preoperative Chemotherapy
Allowed Time for
Preparation and
Manufacture
Collaboration with IndustryDevice and Tissue Banking
Controversy Over What Was
Best
Consensus
• Limb Salvage Now Standard
• Metal Endoprostheses Better Around Joints
• Allografts for Intercalary Resections or in
Combination with Joint Replacements
• Both have a relatively high rate of
complications-70% survive 10 years
Limb Salvage Compared to Amputation
• May Have Better Function-Sensate Foot and
Lower Energy Expenditure
• Cosmetic
• No Psychosocial Effect
• Less Disability but Potentially Fewer Abilities
• Relatively High Rate of Reoperation
• No Compromise of Survival
Functional Assessment
• No study shows that Limb Salvage is either
Superior or Inferior to Amputation
• Both have distinct abilities/disabilities
SF-12 Outcome
60
50
40
AKA
ETKA
Control
Median 30
20
10
0
SF-12 PCS
SF-12 MCS
Function
• Related to what muscle, nerve or bone needs
to be removed
• Related to blood supply and the effects of
radiation
• Upper extremity-Hand placement and manual
dexterity
• Lower extremity-ambulation
5/15/02
5/15/02
Pediatric Population
Articular Sparing Procedures
Growing Endoprostheses
Articular Surface Sparing
Intercalary Allografts
Locking Plates
Close Margins
November 14, 2001
March 7, 2005
Geometric Resection
Child Under 10
• No Great “Expandable” Prosthesis
Rotationplasty
Growing Prostheses
Worm Gear
Intercalary Body Exchange
“Repiphysis”
Future Directions-Prosthetics
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•
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Cementless Fixation
Prosthetic Metallurgy
Tendon Attachment
Anti-infection Coatings
Osteolysis
Osteointegration
Osteointegration-Amputees
Prostheses
Thank You