{"title":"膝关节原发性肉瘤保关节假体重建的临床效果。","authors":"Zhuoyu Li, Weifeng Liu, Xiaohui Niu, Chunyan Jiang, Qing Zhang","doi":"10.1186/s13018-025-06252-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate the clinical outcomes of joint-preserving endoprosthesis reconstruction for primary sarcomas about the knee.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 45 patients (21 males, 24 females) who underwent joint-preserving endoprosthesis reconstruction (JPER) for bone tumours about the knee between January 2009 and January 2023. The average age was 23.9 ± 15.1 years (range, 7-66 years) and the most common pathological type was osteosarcoma (34), followed by Ewing's sarcoma (5), adamantinoma (3), spindle cell sarcoma (2), and undifferentiated pleomorphic sarcoma (UPS, 1). There were 35 cases of tumors located in the femur and 10 cases located in the tibia. The oncological outcomes included local control, metastasis, progression-free survival, and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumour Society Score (MSTS-93).</p><p><strong>Results: </strong>45 patients were included in this retrospective study, and no patient were lost in the follow-up. The mean follow-up time was 105.3 ± 44.6 months (range, 15-183 months). Five patients (11.1%) died in the last follow-up. Four patients had local recurrences, and the mean interval between the index procedure to local recurrence was 25.5 months (range, 4-36 months). The 5-year and 10-year overall survival rate was 91.2% (95% CI 82.5%-99.9%) and 86.2% (95% CI 74.3%-98.1%), respectively. The 5-year and 10-year progression-free survival rate was 85.5% (95% CI 74.9%-96.1%) and 81.5% (95% CI 69.3%-93.7%), respectively. The average MSTS-93 score was 93% (range, 70-100%). The overall survivorship of the JPER was 84.4% (38/45) at an average of 8.7 years follow-up. Failure mechanisms included 4 infections (57%), 2 local tumour progression (29%), and one structural failure (14%) according to Henderson classification.</p><p><strong>Conclusions: </strong>The joint-preserving endoprosthesis reconstruction (JPER) is a reliable technique to reconstruct massive bone defects after primary sarcoma resection about the knee with acceptable oncological outcomes, function, and satisfaction.</p><p><strong>Level of evidence: </strong>Level IV therapeutic study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"827"},"PeriodicalIF":2.8000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461980/pdf/","citationCount":"0","resultStr":"{\"title\":\"The clinical outcomes of joint-preserving endoprosthesis reconstruction for primary sarcomas about the knee.\",\"authors\":\"Zhuoyu Li, Weifeng Liu, Xiaohui Niu, Chunyan Jiang, Qing Zhang\",\"doi\":\"10.1186/s13018-025-06252-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The purpose of this study was to investigate the clinical outcomes of joint-preserving endoprosthesis reconstruction for primary sarcomas about the knee.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 45 patients (21 males, 24 females) who underwent joint-preserving endoprosthesis reconstruction (JPER) for bone tumours about the knee between January 2009 and January 2023. The average age was 23.9 ± 15.1 years (range, 7-66 years) and the most common pathological type was osteosarcoma (34), followed by Ewing's sarcoma (5), adamantinoma (3), spindle cell sarcoma (2), and undifferentiated pleomorphic sarcoma (UPS, 1). There were 35 cases of tumors located in the femur and 10 cases located in the tibia. The oncological outcomes included local control, metastasis, progression-free survival, and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumour Society Score (MSTS-93).</p><p><strong>Results: </strong>45 patients were included in this retrospective study, and no patient were lost in the follow-up. The mean follow-up time was 105.3 ± 44.6 months (range, 15-183 months). Five patients (11.1%) died in the last follow-up. Four patients had local recurrences, and the mean interval between the index procedure to local recurrence was 25.5 months (range, 4-36 months). The 5-year and 10-year overall survival rate was 91.2% (95% CI 82.5%-99.9%) and 86.2% (95% CI 74.3%-98.1%), respectively. The 5-year and 10-year progression-free survival rate was 85.5% (95% CI 74.9%-96.1%) and 81.5% (95% CI 69.3%-93.7%), respectively. The average MSTS-93 score was 93% (range, 70-100%). The overall survivorship of the JPER was 84.4% (38/45) at an average of 8.7 years follow-up. Failure mechanisms included 4 infections (57%), 2 local tumour progression (29%), and one structural failure (14%) according to Henderson classification.</p><p><strong>Conclusions: </strong>The joint-preserving endoprosthesis reconstruction (JPER) is a reliable technique to reconstruct massive bone defects after primary sarcoma resection about the knee with acceptable oncological outcomes, function, and satisfaction.</p><p><strong>Level of evidence: </strong>Level IV therapeutic study.</p>\",\"PeriodicalId\":16629,\"journal\":{\"name\":\"Journal of Orthopaedic Surgery and Research\",\"volume\":\"20 1\",\"pages\":\"827\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461980/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Surgery and Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13018-025-06252-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Surgery and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13018-025-06252-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究的目的是探讨膝关节原发性肉瘤保留关节假体重建的临床效果。方法：对2009年1月至2023年1月间行膝关节骨肿瘤保关节假体置换术（JPER）的45例患者（男21例，女24例）进行回顾性队列研究。平均年龄23.9±15.1岁（范围7 ~ 66岁），最常见的病理类型为骨肉瘤（34例），其次为尤文氏肉瘤（5例）、精质瘤（3例）、梭形细胞肉瘤（2例）和未分化多形性肉瘤（1例）。35例肿瘤位于股骨，10例肿瘤位于胫骨。肿瘤预后包括局部控制、转移、无进展生存期和总生存期。功能结果通过肌肉骨骼肿瘤学会评分（MSTS-93）进行评估。结果：本次回顾性研究共纳入45例患者，随访中无患者丢失。平均随访时间105.3±44.6个月（15 ~ 183个月）。末次随访死亡5例（11.1%）。4例患者局部复发，从指数手术到局部复发的平均间隔时间为25.5个月（范围4-36个月）。5年和10年总生存率分别为91.2% （95% CI 82.5%-99.9%）和86.2% （95% CI 74.3%-98.1%）。5年和10年无进展生存率分别为85.5% （95% CI 74.9%-96.1%）和81.5% （95% CI 69.3%-93.7%）。平均MSTS-93评分为93%（范围70-100%）。在平均8.7年的随访中，JPER的总生存率为84.4%（38/45）。失败机制包括4例感染（57%），2例局部肿瘤进展（29%），1例结构失败（14%）。结论：膝关节原发肉瘤切除术后，保关节假体植入术（JPER）是一种可靠的修复大面积骨缺损的技术，具有良好的肿瘤预后、功能和满意度。证据等级：IV级治疗性研究。
The clinical outcomes of joint-preserving endoprosthesis reconstruction for primary sarcomas about the knee.
Purpose: The purpose of this study was to investigate the clinical outcomes of joint-preserving endoprosthesis reconstruction for primary sarcomas about the knee.
Methods: A retrospective cohort study was conducted on 45 patients (21 males, 24 females) who underwent joint-preserving endoprosthesis reconstruction (JPER) for bone tumours about the knee between January 2009 and January 2023. The average age was 23.9 ± 15.1 years (range, 7-66 years) and the most common pathological type was osteosarcoma (34), followed by Ewing's sarcoma (5), adamantinoma (3), spindle cell sarcoma (2), and undifferentiated pleomorphic sarcoma (UPS, 1). There were 35 cases of tumors located in the femur and 10 cases located in the tibia. The oncological outcomes included local control, metastasis, progression-free survival, and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumour Society Score (MSTS-93).
Results: 45 patients were included in this retrospective study, and no patient were lost in the follow-up. The mean follow-up time was 105.3 ± 44.6 months (range, 15-183 months). Five patients (11.1%) died in the last follow-up. Four patients had local recurrences, and the mean interval between the index procedure to local recurrence was 25.5 months (range, 4-36 months). The 5-year and 10-year overall survival rate was 91.2% (95% CI 82.5%-99.9%) and 86.2% (95% CI 74.3%-98.1%), respectively. The 5-year and 10-year progression-free survival rate was 85.5% (95% CI 74.9%-96.1%) and 81.5% (95% CI 69.3%-93.7%), respectively. The average MSTS-93 score was 93% (range, 70-100%). The overall survivorship of the JPER was 84.4% (38/45) at an average of 8.7 years follow-up. Failure mechanisms included 4 infections (57%), 2 local tumour progression (29%), and one structural failure (14%) according to Henderson classification.
Conclusions: The joint-preserving endoprosthesis reconstruction (JPER) is a reliable technique to reconstruct massive bone defects after primary sarcoma resection about the knee with acceptable oncological outcomes, function, and satisfaction.
期刊介绍：
Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues.
Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications.
JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.
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