Bone sarcoma diagnosed at the time of reconstructive hip surgery.

OBJECTIVE

To describe the clinical course of a group of patients in whom sarcoma of the proximal femur was diagnosed at the time of reconstructive hip surgery.

DESIGN

A retrospective case series.

SETTING

Final management of all patients took place at a tertiary care centre.

PATIENTS AND INTERVENTIONS

Six consecutive patients with sarcoma of the proximal femur diagnosed at the time of reconstructive hip surgery. The mistaken diagnoses made before surgery were benign tumour (2 patients), avascular necrosis (2 patients), subtrochanteric fracture due to metastasis (1 patient) and granuloma from a loose hip implant (1 patient). The final diagnosis was osteosarcoma in 3 patients and chondrosarcoma in 3. Three patients with high-grade sarcoma received neoadjuvant chemotherapy followed by femoral or pelvic resection, or both, and reconstruction. Two patients with chondrosarcoma underwent wide excision of the tumour with allograft or modular implant reconstruction. One patient with widespread metastasis received only palliative chemotherapy.

MAIN OUTCOME MEASURES

Overall survival with respect to oncologic and functional results of treatment.

RESULTS

Two patients (1 who received only palliative chemotherapy) died after 5 and 21 months' followup, respectively. Average follow-up for the remaining 4 patients was 65.2 months (range from 51 to 75 months). They were disease free at latest follow-up. One patient required amputation for septic complications related to the reconstruction.

CONCLUSIONS

Limb salvage surgery for sarcoma of the proximal femur is challenging when the diagnosis is made at the time of reconstructive surgery rather than through an appropriately planned biopsy. However, this series suggests that limb preservation is feasible and that hindquarter amputation is not the only solution.