Multiplanar osteotomy with limited wide margins: A tissue preserving surgical technique for high-grade bone sarcomas

Background: Limb-salvage surgery has been used during the last several decades to treat patients with high-grade bone sarcomas. In the short- and intermediate-term these surgeries have been associated with relatively good function and low revision rates. However, long-term studies show a high rate of soft tissue, implant, and bone-related complications. Multiplanar osteotomy with limited wide margins uses angled bone cuts to resect bone tumors with the goal of complete tumor removal while sparing host tissue although its impact on local recurrence is not known. Questions/purposes: We determined whether multiplanar osteotomy was associated with local recurrences, reconstruction failures, and allograft nonunions. Patients and Methods: We retrospectively reviewed the charts of six patients. Four patients had an osteosarcoma, one had a Ewing's sarcoma, and one had a chondrosarcoma. Patient and treatment factors such as age, diagnosis, percent of tumor necrosis (if applicable), margin status, and time to allograft union were recorded. In all patients, reconstruction was performed with an intercalary allograft cut to fit the residual defect. The minimum followup was 25 months (average, 39 months; range, 24-66 months). Results: No patient experienced a local recurrence or metastasis, and all patients were alive and disease-free at the most recent followup. All allografts healed during the study period. Conclusion: With careful patient selection, the multiplanar osteotomy resection technique may be considered an option for treating patients with high-grade bone sarcomas, and, when compared with traditional surgical techniques, may lead to improved healing and function of the involved extremity. Level of Evidence: Level IV, therapeutic study. See the guidelines online for a complete description of levels of evidence.