Fujiwara Tomohiro, Tsuda Yusuke, Stevenson Jonathan, Parry Michael, Jeys Lee
Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
J Bone Oncol. 2021 Nov 1;31:100401. doi: 10.1016/j.jbo.2021.100401. eCollection 2021 Dec.
While extra-articular resection (EAR) of the knee and shoulder joint is associated with poorer clinical outcomes, the oncological and functional risks of EAR of the hip joint are unknown. We aimed to compare these risks between EAR of the hip joint and intra-articular resection (IAR).
We conducted a comparative study of 75 patients who underwent tumour resection and limb-salvage reconstruction for bone sarcomas of the -acetabulum between 1996 and 2016. We divided patients into two groups for analyses; EAR (n = 21) and IAR (n = 54).
There was no statistical difference in oncological outcomes; the 5-year cumulative incidence of disease-specific death was 34% and 35% in the EAR and IAR groups, respectively ( = 0.943), and the 5-year cumulative incidence of LR was 26% and 34%, respectively ( = 0.482). The most common complications were dislocation (28%) and deep infection (28%); there was equally no difference between the groups. The mean Musculoskeletal Tumour Society score was 66% and 65% in the EAR and IAR groups, respectively ( = 0.795), and were significantly lower in patients with deep infection (52% vs. 69%; = 0.013). In a sub-analysis on the outcomes in patients who underwent PI-uninvolved PII-resection for chondrosarcoma, no major differences in oncologic and functional outcomes were confirmed.
Patients undergoing EAR and limb-salvage reconstructions of the hip joint have undistinguishable oncological, clinical and functional outcomes compared to those undergoing IAR and reconstructions. If preoperative imaging suggests articular tumour involvement, there appears to be no detrimental effect of undertaking EAR to optimise local control.
虽然膝关节和肩关节的关节外切除术（EAR）与较差的临床结果相关，但髋关节EAR的肿瘤学和功能风险尚不清楚。我们旨在比较髋关节EAR与关节内切除术（IAR）之间的这些风险。
我们对1996年至2016年间因髋臼骨肉瘤接受肿瘤切除和保肢重建的75例患者进行了一项比较研究。我们将患者分为两组进行分析；EAR组（n = 21）和IAR组（n = 54）。
肿瘤学结果无统计学差异；EAR组和IAR组的5年疾病特异性死亡累积发生率分别为34%和35%（P = 0.943），5年局部复发累积发生率分别为26%和34%（P = 0.482）。最常见的并发症是脱位（28%）和深部感染（28%）；两组之间同样没有差异。EAR组和IAR组的肌肉骨骼肿瘤学会平均评分分别为66%和65%（P = 0.795），深部感染患者的评分显著较低（52%对69%；P = 0.013）。在对接受PI未受累PII切除的软骨肉瘤患者的结果进行的亚分析中，未证实肿瘤学和功能结果有重大差异。
与接受IAR和重建的患者相比，接受髋关节EAR和保肢重建的患者在肿瘤学、临床和功能结果上没有明显差异。如果术前影像学提示关节肿瘤受累，进行EAR以优化局部控制似乎没有有害影响。
