Surgical technique and results of limb sparing surgery for high grade bone sarcomas of the knee and shoulder.

Thirty-three patients with high grade bone sarcomas of the knee and shoulder treated by limb sparing surgery were evaluated. The histological diagnoses were osteosarcoma (25), chondrosarcoma (3), malignant fibro-histiocytoma (3), fibrosarcoma (1) and unclassified (1). The Surgical Stages were: Stage IIA (3), Stage IIB (28) and Stage III (3). The operative procedure consisted of three phases: tumor resection, skeletal reconstruction and soft tissue reconstruction. All resections obtained negative margins and were classified as, marginal excision (3), intracompartmental resections (28) and radical resections (2). Overall survival was 77%. Four of 33 patients (12.4%) required a secondary amputation. Local recurrence was 6% (2/33) with an average follow-up of 37.2 months. The most common complications were flap necrosis (33%) and transient nerve palsies (33%). There were 2 infections and one prosthetic dislocation. We believe that limb salvage surgery for high grade bone sarcomas need not be reserved for only those without extraosseous extension. Careful preoperative selection and attention to the three stages of a limb sparing procedure are important for a successful outcome. Presently, we consider the following as contraindications to resection: vascular involvement, pathologic fracture, inappropriate biopsy and infection.