Quality of life in long term osteosarcoma survivors: amputation versus limb salvage

The long term survivors that were diagnosed in the ’70 and ’80 have written this successful story, along with their visionary pioneer oncologists. Limb salvage surgery using endoprosthesis, allografts or reconstructions is applied in about 85% of patients affected by osteosarcoma of the middle and/or distal femur. For the osteosarcoma long term survivors one drawback in limb-salvage surgery is that endoprostheses have a limited duration and long-term prosthetic failure with the inherent high rate of reoperation remains a serious long-term problem. Replacing a damaged, infected or severely worn out arthroplastic joint is difficult, especially if it has long cemented stems, as in endoprostheses used in the 80’s. Infection represents a major complication of prosthetic joint surgery, despite advances in theatre design, surgical technique and antibiotic prophylaxis. Periprosthetic infections were found to be more frequent in patients treated for a neoplastic condition and their outcome can be devastating, resulting in total loss of joint function, amputation, and systemic complications. Numerous treatments have been proposed including irrigation, debridement and prosthesis retention, revision or excision arthroplasty, and knee arthrodesis. While the limb salvage procedures are becoming increasingly common in the treatment of osteosarcoma, there are still few literature studies on the quality of life in long term survivors comparing limb salvage procedure with amputation. In long term osteosarcoma survivors, after an endoprostheses failure, the decision to undergo additional limb salvage procedures is difficult and multifaced. Although amputation is often considered the simplest surgical solution for bone cancer, especially if associated with extensive soft tissue involvement, this is not always acceptable to the patients and relatives in the current health climate. Amputation would leave the patients with a lifelong requirement for a prosthetic leg. While artificial limbs are much more sophisticated than those used in the past, phantom limb sensations remain a substantial and unpredictable problem. The possibility of stump problems, such as bleeding and infections should also be considered. The cost difference between amputation and reconstruction in patients with a severely injured leg has been debated, resulting in wide variations in surgical and medical expenses across hospitals and rehabilitation centers. We are evaluating the functional and quality of life study in long term survivors of osteosarcoma of the lower limbs. Dr. Norman Jaffe, MD, ScD, has treated over 1,500 patients with childhood/adolescence bone tumors in the last 40 years, giving a first-hand account of the development of treatment strategies. Over 100 osteosarcoma patients, admitted to the University of Texas MD Anderson Cancer Center from 1978 to 1996, entered to our study as long term (10 to 28 years) survivors. Our study has preliminarily underlined that the adult survivors have overall borne well their motor disability. We have been able to esteem that the limb-saved survivors have had a similar psychological and quality of life outcome compared to the amputees, but if we will await their answers to a detailed questionnaire. The Dr. Norman Jaffe’s annual ski trip for amputees has been held over the past two decades. This program can be useful to evaluate the survivors’ psychological participation to recreational and sport activities. All the survivors have found their economical independence and were initially helped by their family, associative environment or volunteers.