Muscle Strength & Functional Assessment of Children with Rotationplasty After Osteosarcoma Resection
DALE E. JARKA, F.R.C.S.(C), J. IVAN KRAJBICH, M.D., F.R.C.S.(C), AND SHEILA HUBBARD, BSc.(PT)
Twenty-seven children and adolescents were followed in the amputee clinic of the Hugh MacMillan Rehabilitation Center after resection of a lower extremity osteosarcoma and rotationplasty limb reconstruction. There were seventeen distal femoral, nine proximal tibial and one proximal femoral lesions in twenty-three boys and four girls. The initial recorded arcs of motion was 53.3' ± 12.9' and 46.6' ± 20.8', and the final arcs was 84.2' ± 7.60 and 68.90 ± 16.7' for the femoral and tibial resections respectively. Early complications included two wound infections, four minor delays in wound healing, and one minor skin necrosis, none of which required surgical intervention or delayed prosthetic fitting. One patient had significant wound problems, necessitating serial debridements, and plate remoral and secondary closure nine months after the original surgery. Late complications included a secondary fatal leukemia, two nonunions requiring revisions of plate fixation at eight and eleven months, one distal tibial epiphyseodesis for excessive stump length, one patient with chronic magnesium wasting, and one patient with peripheral neuropathy. Ten patients developed pulmonary metasteses, of which four have survived at least 1.5 years after resection, four died of their disease, one is alive with disease, and one is two months postoperative after pulmonary wedge resection. One patient developed widespread bony metasteses and subsequently died.
Five patients died of their disease at an average of twenty-seven months postoperatively, and one died of a secondary malignancy at twenty months with no evidence of recurrent osteosarcoma. The twenty-one remaining have survived an average of 3.9 ± 1.1 years. Only one patient experienced a delay in initial prosthetic fitting secondary to local complications. Only one patient did not tolerate his prosthesis well. The remainder did gait training despite adjuvent chemotherapy, all ambulated without aids, and many participated actively in sports. "Knee" extensor mechanism data will also be presented. Rotationplasty is a viable form of limb reconstruction after lower extremity osteosarcoma resection, permitting gait and unrestricted activity comparable to below-knee amputation.
The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario Canada M5G 1X8