A prospective study on evaluating the clinical and functional outcome of limb salvage surgery and amputation in distal femoral osteosarcoma patients

Aim: The main aim of this study was to assess the survival, recurrence, complications and also the quality of life (QOL) in distal femoral osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft and by amputation or disarticulation. Methods and Materials: 44 distal femoral osteosarcoma patients were enrolled, where 20 patients were managed by custom- designed endoprosthetic arthroplasty (LSS1), 16 patients only by resection and bone graft (LSS2), while only 8 patients were managed by amputation. A comparison was made between the patients undergoing LSSs and amputation/disarticulation based on postoperative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated based on standard SF-36 form and MSTS scoring system. Results: The results of our study showed that the incidence of femoral OSA was higher in <20 years (65.91%), where M: F was 1.44:1 (p=0.512). We had 44 distal femoral OSA patients included in this study. The mean survival of patients with LSS1 was 0.85 years, 1.48 years for LSS2 patients (1.165 years in LSS, which is LSS1 + LSS2) and 1.6 years for amputees respectively by means of Kaplan Meier survival analysis (P = 0.0218). The total complication free patients was 36.36 %( LSS1+ LSS2 43.18%, amputation group 2.27% %, p = 0.0096). The mean MSTS score was 62% (range, 46%-83%) with significantly lower results in amputations (p = 0.0001). The QOL assessment done by SF-36 revealed a better state of LSS patients. The sarcoma led to emotional and functional disturbances in patients who underwent amputation (p < 0.05). Conclusion: LSS for distal femoral osteosarcoma is superior to amputation due to its better emotional and functional outcome.