An Epidemiological Study Analyzing Functional Outcome of Primary Malignant Tumors of Femur in Mohan Dai Oswal Cancer Hospital, Ludhiana, Punjab

Amputation was generally considered the standard treatment for most primary malignant tumors of femur. In recent years with the significant advances in the management of malignant bone tumors (better understanding of the histological criteria for diagnosis, better clinical staging procedure, improved surgical techniques, neo adjuvant & adjuvant chemotherapy and radiotherapy and improved techniques of Oncological reconstruction), there is increased trend towards limb salvage surgery.

1) To study functional outcome of primary malignant tumors of Femur.

This study was a retrospective as well as prospective study involving 25 patients having primary malignant tumour of femur coming to department of Orthopaedics at Mohan Dai Oswal Cancer Treatment & Research Foundation, Ludhiana from January 1999 to December 2005.

All the patients were evaluated in terms of complete clinical presentation (onset of symptoms, progression and duration). Various signs and symptoms (pain, swelling, pathological fracture, deformity, limb length discrepancy) were noted thoroughly.

Treatment included Surgical management (Limb sparing surgery or amputation), Chemotherapy, Radiotherapy wherever indicated. Functional assessment using MSTS criteria was done.

25 patients of primary malignant tumours of femur were studied in the Department of Orthopaedics at Mohan Dai Oswal Cancer Hospital, Ludhiana from January 1999 to December 2005. Average age was 22.68 years. There were 21 male patients and 4 female patients. The major histopathological diagnosis was osteosarcoma (84%) followed by spindle cell sarcoma (8%) and chondrosarcoma (8%). Distal end of femur was predominantly involved (84%) and pain was the commonest presenting complaint (92%). Majority of patients (68%) presented after 60 days of onset of symptoms.

In 19 patients skin was normal and in 6 patients it was involved (fungating in 4 and adherent in 2). 2 patient had palpable inguinal group of lymph nodes which were histologically proven for local metastasis. These 2 patients were treated by hip disarticulation with inguinal lymph node dissection.

12 patients were treated by limb salvage surgery with either endoprosthetic implant or autograft. Remaining 13 patients were treated by primary amputation surgery. They were either non-responder to neo-adjuvant chemotherapy or had fungation of growth or had distant metastasis at initial presentation.

Neoadjuvant chemotherapy was given to 11 patients, out of which 8 responded and 3 did not respond. So mutilating surgery was done in these 3 patients. 17 patients had taken adjuvant chemotherapy.

Till date 14 patients are having a disease free survival of 2–3 year. 6patients are having survival with disease of 2–3 year. Out of remaining 5 patients, 2 patients who were having survival with disease were lost to follow up after 1 year. 2 patient were lost to follow up within 1 year and 1 patient died of disease. When MSTS criteria were applied to those patients who were treated with amputation of limb, the results were calculated as poor due to need of a walking aid or prosthesis to make them ambulatory.