The patient

A 12-year-old female presented to Norton Children’s Hospital emergency department with a one-week history of worsening right knee pain and swelling. There was no known trauma, but pain started after exertion in gym class. Initial MRI demonstrated an aggressive bone lesion involving almost the entire right femur. She underwent initial biopsy which confirmed diagnosis of osteosarcoma.

Osteosarcoma is the most common primary bone malignancy. It typically affects teenagers and young adults. Most often the bones affected are long bones such as those in the arms and legs.

The challenge

Treatment for osteosarcoma is multimodal involving both chemotherapy and surgical resection. At time of resection, due to the extent of disease in the femur, the best surgical option was felt to be a rotationplasty. This procedure involves resection of the diseased bone and reattaching the healthy lower limb, which is rotated 180 degrees. The ankle joint becomes the knee joint and the patient then learns to use a lower limb prosthesis. Most patients will have a more traditional limb-sparing surgery with an endoprosthesis placed once the diseased bone is removed. In this patient’s case, the rotationplasty was chosen as a more suitable option given the limited amount of healthy femur that would be left at the time of resection.

The physicians

Kerry K. McGowan, M.D., pediatric oncologist, Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine

Brittany K. Albers, M.D., pediatric radiologist, Norton Children’s Radiology, affiliated with the UofL School of Medicine

Jessica Hata, M.D., pediatric pathologist at Norton Children’s Hospital

Rodolfo Antonio Zamora Rendich, M.D., orthopedic oncologist and orthopedic surgeon at Norton Children’s Hospital

The solution

Patients are treated with neoadjuvant therapy followed by local control (surgery) and then complete adjuvant chemotherapy.

This patient started standard neoadjuvant chemotherapy, and after 10 weeks she had planned rotationplasty. Surgery was successful, and she recovered well post-operatively. The resected tumor margins were negative for osteosarcoma. She had a few weeks of rehabilitation, and the wound healed well, allowing her to continue the planned treatment course.

The result

Patient completed the scheduled adjuvant chemotherapy without complications. She has had further rehabilitation to adapt to the use of her prosthesis and is ambulating well. She remains with no evidence of disease.

Treatment and results may not be representative of all similar cases.