Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in @entity1 With XXXX of the Proximal Tibia?

@entity1 @entity174 @entity5 @entity281 @entity421 @entity85 @entity531 @entity2530
BACKGROUND: Joint-sparing surgery of a @entity1 's native joint for @entity421 likely affords better function and comparable survival. However, it sometimes is challenging to resect a @entity421 in a way that preserves the affected epiphysis because wide margins are necessary to minimize the risk of local recurrence. If there was a method to resect a @entity5 close to the joint and treat a potentially positive margin to prevent recurrence, it might allow salvage of a joint that otherwise might be lost. QUESTIONS/PURPOSES: We therefore asked (1) whether joint-preserving @entity5 resection could be performed for @entity421 after microwave ablation of the @entity5 edge under navigation without leading to local recurrences, (2) what is the resulting function, and (3) what are the complications associated with this procedure. METHODS: Between 2009 and 2011, we treated 11 @entity1 who had @entity421 of the proximal tibia (mean age, 12 years; range, 9-16 years) with joint-preserving surgery by transepiphysis @entity5 resection after navigation-assisted microwave ablation of the @entity5 edge; they were followed a minimum of 37 months (mean, 48 months; range 37-62 months), and none was lost to followup. @entity1 were considered eligible for this procedure if they had a distance from the @entity5 edge to the articular surface between 10 to 15 mm, good chemotherapy responses, no pathologic @entity174 and no @entity5 involvement of major @entity531 . Allograft in combination with a vascularized fibula flap was used for segmental reconstruction. We recorded @entity5 control, complications, and functional outcomes using the @entity85 Society score, which ranges from 0 to 30, with higher scores indicating better function. RESULTS: There were no local recurrences. Major complications included @entity2530 of part of the epiphysis in two @entity1 and @entity281 in one. The @entity85 Society score ranged from 26 to 30 with a mean of 29. CONCLUSIONS: In selected @entity1 with @entity421 invading the epiphysis, navigated resection facilitates performing joint-sparing surgery, and in our small series, the adjuvant microwave ablation seemed to provide adequate @entity5 control. Although more experience and longer followup are needed, this approach may make it possible to salvage more native joints when performing limb salvage for @entity421 . LEVEL OF EVIDENCE: Level IV, therapeutic study.
