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Japanese Journal of Clinical Oncology Advance Access originally published online on September 22, 2009
Japanese Journal of Clinical Oncology 2009 39(11):739-744; doi:10.1093/jjco/hyp108
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© The Author (2009). Published by Oxford University Press. All rights reserved

Innovative Trident Fixation Technique for Allograft Knee Arthrodesis for High-grade Osteosarcoma around the Knee{dagger}

Alvin W. Su1,2, Wei-Ming Chen1,2, Cheng-Fong Chen1,2 and Tain-Hsiung Chen1,2

1 Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
2 Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan

For reprints and all correspondence: Wei-Ming Chen, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 11221, Taiwan. E-mail: wmchen{at}vghtpe.gov.tw

Received May 19, 2009; accepted July 8, 2009

Objective: Reconstruction for osteosarcoma around the knee after wide resection faces the challenge of great bone defect and future limb length discrepancy in the skeletally immature patients. Modern prosthetic reconstruction may provide good results, but the longevity may be of concern and may not be affordable in certain communities. Allograft knee arthrodesis still has its role in light of bone stock preservation and cost-effectiveness.

Methods: We developed the innovative trident fixation technique utilizing three Steinmann pins to minimize limb length inequality without jeopardizing knee fusion stability. Twelve patients were enrolled. The mean age was 11.5 (10–13) years. Two had high-grade osteosarcoma in proximal tibia and others in distal femur.

Results: Two patients died of oncological disease. The median follow-up of the disease-free 10 patients was 47 (41–60) months. All allograft-host bone junctions healed uneventfully without major complications except one allograft fracture. The average limb length discrepancy was 1.45 (1.0–2.1) cm at latest follow-up.

Conclusions: This straightforward technique was successful in knee arthrodesis with minimized limb length inequality. Accordingly, in light of bone stock preservation and longevity for the young children, it may be a surgical alternative for malignant bone tumors around the knee.

Key Words: orthopedics/sarcoma-surg • osteosarcoma • limb salvage • allograft • knee arthrodesis

{dagger} Investigation performed at Taipei Veterans General Hospital, Taipei, Taiwan.


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