Elsevier

The Journal of Arthroplasty

Volume 15, Issue 6, September 2000, Pages 754-760
The Journal of Arthroplasty

Original Articles
A functional analysis of massive knee replacement after extra-articular resections of primary bone tumors*,**

https://doi.org/10.1054/arth.2000.8104Get rights and content

Abstract

We performed a functional analysis of massive knee replacements after extra-articular resection of primary bone tumors. Patients did not score as highly on the Musculoskeletal Tumour Society Score and Knee Society Score (P ≤.01) as patients who had undergone intra-articular resection. Lower scores were achieved for emotional acceptance (P ≤.01), functional restriction (P ≤.05), walking distance (P ≤.05), and managing stairs (P ≤.05). These patients had a significantly greater extension lag (P ≤.01) and greater fixed flexion (P ≤.05). This functional deficit is primarily due to a compromised extensor mechanism inherent in the type of surgical resection necessary to achieve adequate removal of the tumor.

Section snippets

Materials and methods

Twelve patients underwent massive knee replacement after an extra-articular resection of bone tumor between 1992 and 1996. Of these 12 patients, 3 subsequently died of their bone tumor disease and have been excluded from the study. The remaining 9 patients were case matched by percentage bone resection to patients who had undergone massive knee replacement after intra-articular resection of bone tumor. In all patients, the type of device used was a cemented custom-made Smiles prosthesis

Background data

There were 9 patients in each group. The average age at follow-up of the extra-articular resection group was 32.7 years (range, 20-64 years), and of the intra-articular resection group was 29.6 years (range, 17-48 years). There were 6 men and 3 women in the extra-articular resection group compared with 4 men and 5 women in the intra-articular resection group. Patient follow-up in the extra-articular resection group was an average of 2 years, 6 months (range, 6 months to 4 years, 8 months), with

Discussion

The results of this study suggest that the functional outcome of massive knee replacement after extra-articular resection for primary bone tumors is inferior to that obtained after intra-articular resection.

Summary

In our study, patients with massive knee replacements after extra-articular resection did not score as highly with MTSS and KSS as case-matched patients with massive knee replacements after intra-articular resection. After extra-articular resection, lower scores were achieved for emotional acceptance, functional restriction, walking distance, and managing stairs. These patients have a significantly greater extension lag and greater fixed flexion when compared with the intra-articular resection

References (19)

  • MA Simon et al.

    Limb-salvage treatment versus amputation for osteosarcoma of the distal end of femur

    J Bone Joint Surg Am

    (1986)
  • BT Rougraff et al.

    Limb salvage compared with amputation for osteosarcoma of the distal end of femur: a long-term oncological, functional and quality of life study

    J Bone Joint Surg Am

    (1994)
  • WF Enneking et al.

    A system for the functional evaluation of reconstruc-tive procedures after surgical treatment of tumors of the musculoskeletal system

    Clin Orthop

    (1993)
  • JN Insall et al.

    Rational of the Knee Society clinical rating system

    Clin Orthop

    (1989)
  • G Markhede et al.

    Function after removal of various hip and thigh muscles for extirpation of tumors

    Acta Orthop Scand

    (1991)
  • MP Murray et al.

    Functional performance after excision of the vastus lateralis and vastus intermedius

    J Bone Joint Surg Am

    (1993)
  • T Tsoboyama et al.

    Knee function after operation for malignancy of the distal femur: quadriceps muscle mass and knee extension strength in 21 patients with hinged endoprosthesis

    Acta Orthop Scand

    (1993)
  • R Capanna et al.

    The effect of quadriceps excision on functional results after distal femoral resection and prosthetic replacement of bone tumours

    Clin Orthop

    (1991)
  • H Kaufer

    Mechanical function of the patella

    J Bone Joint Surg Am

    (1971)
There are more references available in the full text version of this article.

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    There was no statistically significant difference in functional outcomes between the EAR and IAR groups. A previous study of EAR of malignant primary bone tumours at the knee joint described worse functional outcomes compared with those of IAR primarily due to the compromised extensor mechanisms [29]. However, the following reports demonstrated comparable function between the EAR and IAR groups with preservation of the extensor mechanism [30,31].

  • Management of sarcomas possibly involving the knee joint when to perform extra-articular resection of the knee joint and is it safe?

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    Post-operative functional results and the differences between IAR and EAR resections continue to be debated. One study described poorer functional outcome after extra-articular resections for primary bone tumours compared with intra-articular resections and this functional deficit was primarily due to a compromised extensor mechanism.19 Another group believed that EAR of the knee presents comparable functional scores to those having an IAR.2

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*

No benefits or funds were received in support of this study.

**

Reprint requests: S. J. H. Kendall, PhD, FRCS, 11 Galveston Road, Putney, London SW15 2RZ, UK.

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