D136. Spare the Limb and Spoil the Outcome: Why do Some Osteosarcoma Patients Pursue Revision Amputation and Does the Amputation Improve The Outcome?

Abstract

PURPOSE: There is tremendous emphasis on limb sparing surgery (LSS) in osteosarcoma. However, a substantial number of LSS patients choose to transition to an amputation-type revision, including rotation-plasty and turn-up plasty. The purpose of this study was to determine motivating factors for revision and whether those interventions better address the motivating factors. METHODS: We identified the most popular public Osteosarcoma Facebook group and selected posts from a 12 month period regarding surgical interventions. We used iterative inductive and deductive thematic analysis to collect qualitative data RESULTS: 378 comments from the Osteosarcoma and Ewing’s Sarcoma Support Group were analyzed. Three themes emerged: (1) There is a lack of options presented to patients seeking treatment of osteosarcoma. (2) Many patients were unsatisfied and regretted their decision to undergo LSS because of numerous revisions, physical limitations, and chronic pain. (3) Many patients treated primarily or secondarily (following LSS) with rotation-plasty were satisfied with their lifestyle outcomes and mentioned improved mobility, range of motion, and limited chronic pain. CONCLUSION: LSS can result in significant morbidity and despite sparing the limb, some patients are choosing to pursue amputation. Further work will need to examine amputation interventions to ensure that they can successfully address the problems identified with LSS, including mobility and pain. Prior concerns with amputation, including phantom limb pain, can now be addressed with targeted muscle reinnervation and regenerative peripheral nerve interfaces. Moreover, these options may deserve more discussion in the setting of the primary surgery.