Limb-Salvage vs. Amputation for Osteosarcoma of the Distal Femur

[Mary]

Abstract found here

A retrospective multi-institutional study of 227 patients with osteosarcoma of the distal end of the femur was done to compare rates of local recurrence, metastasis, and survival. Three cohorts of patients who had had either a limb-sparing procedure, an above-the-knee amputation, or disarticulation of the hip were compared. The results revealed prevalences of eight of seventy-three, nine of 115, and zero of thirty-nine as to local recurrence; forty-three of seventy-three, sixty-five of 115, and twenty-one of thirty-nine as to metastasis; and thirty-three of seventy-three, forty-eight of 115, and eighteen of thirty-nine as to death. The Kaplan-Meier estimates of the percentage of patients who survived and the percentage of patients without recurrent disease showed no difference among the three surgical groups after a median length of follow-up of five and one-half years. Various covariant adjusted estimates yielded similar results. It appears that, compared with above-the-knee amputation or disarticulation of the hip, the use of a limb-salvage procedure for osteosarcoma of the distal end of the femur did not shorten the disease-free interval or compromise long-term survival.

[Randy W]

Thanks for the article.  Those of you with limb salvage of the femur - do you ever think it would have been better sometimes to have been amputated and received a prosthetic?  Personally, I go back and forth when it crosses my mind.  I mean my limb salvage is working well now, but I am unable to run.  Then, I see pics of all these amputees out running marathons, etc.. and it makes me wonder.....   Just curious if anyone else has the same thoughts...

[Jeanne_C]

Randy,

I think about this alllll the time.  As a matter of fact, I had initially been given such a negative view of the limb salvage ("It's mostly for looks.  You'll probably be able to go up and down stairs") that I almost opted for amputation.  Then, thru circumstance, I had to go to another surgeon.  He literally threw out the prosthetic that was going to be used ("It's completely out of date") and told me that, with work, I should be able to do anything I wanted with greater ease than if we went with amputation.  The only thing he asked was that I not try skiing!!   I still have to "gramma two step" the stairs sometimes and the leg is stiff and painful on occasion but on most days I'm glad I went with the limb salvage.  Now if I can hike Mt Harney in South Dakota come June I KNOW I'll be ok with it!!  It is amazing though to see what amputees are accomplishing and I do wonder if, in the long run, I would be more active had I gone that route.....<sigh>

[Cari]

Something to ponder---Between the pain and limitations I sometimes think it would have been worthwhile to go with amputation--and then I think WHY would I wish that or want that--and then I think with amputation I would probably still be the active, sport playing girl I once was--and then I think but I wouldn't have my leg and it would be just as much hard work emotionally and physically--
So obviously I don't have an answer to this topic either--I guess what I am trying to accomplish is accepting the chance I do have--take along the limitations and pain and continue to work my ASS off ( )!!

[Arlene]

My last appointment with the doc(last month) ( I have 3 month followups) he wanted to see what I could or couldnot do. It wasnt as good as he expected by now. Im still walking with a crutch , my straight leg laying down only goes to a negative 20 degrees, I am still in pain so on and so on. He told me that he was hoping for better and that "HE" was sorry he didnt do better. I was difenately feeling down but what really upset me is when he said ...if you really cant tollirate the way things are you can opt for amputation. Im telling you, my tears turned into a river. I told him there is no way. He replied that he wouldnt want that for me either but just letting me know. If its not totally nessesary then its not for me. Its not like I cant do things. Im out all the time. Maybe limited but I to as much as i can. Im kinda getting use to the crutch and who knows, maybe some day Ill go to the cain and then maybe some day Ill be on my own. I live for those maybes and take one day at a time. Maybe some feel different but i would be really depressed if i resorted to aputation. And Ill tell ya why. In 1975 my little sister, JODI, at the age of 13, feel off her bike and went for xrays.They discovered she had bone cancer and had had it for some time. She HAD To get her leg amputated. Back then they didnt hyave the knowledge about bone cancer as they have now. Her cancer spread to her lungs. Being the last oneto see her..I dropped her off at childrens hospitol as my dad carr8ied her out of the car. Her skin so pail white as the red blood ran down her nose. That was the last time i saw her.This story is in no way to compare with allyour feelings but to me its just a bad , sad memory.
Stay well, Arlene

[John]

the limb-slavage worked for me.  But i think it had to do with the location of the tumor, my age, and the size of it.  I was very lucky that the tumor was small and in a spot where it was very operable.  I wonder about the amputation too, but I am still pretty active, i mean I can shoot hoops, play catch, toss the football around, play whiffle ball, golf, that kind of stuff, but not to the level i was used to.  I can't play high intensity high contact...but then i think, im almost 26 now, would i really be playing high intensity anyways?  I am glad i went with the limb salvage, but i realize this is a case by case basis and not everyone has t he recovery I had.

[Jimmy]

This topic has certainly crossed my mind many times. I agree with Cari on alot of her points. I used to think that maybe an amputation would have been less painful in the long run, but I don't think I could have mentally lived with it as easy. I think the pain and limitations of limb salvage are worth it. Amputation would still be a last ditch effort to save my life if necessary. I am anxious to see how this "bionic" leg holds up by the time I am 40 years old.

[Allan]

This is a very interesting topic. All the amps that you see running or climbing mountains or doing marathons are what we call super amps in amputee world. I have the feeling that most if not all of them would be doing the same thing if they had limb salvage. These are gifted people no better or worse than the rest of us. I think they would be called natural born athletes. I can tell you all amputation is not an easy road to take. For each and every one of us we must choose our own path it does not mean it is better or worse than some one elses  it just means it is ours.  Don't try to second guess yourself you did what was right for you at the time.

[Cari]

True Allan!!!
Where have you been?  Missed ya!
Cari