This case report presents the complex surgical management of a 53-year-old patient with thigh osteosarcoma, complicated by prosthesis migration and colonic fistula formation. Initial tumor resection and prosthetic implantation were followed by severe postoperative complications, necessitating disarticulation of the lower limb, colon resection with colostomy, and ureteral reimplantation. The case highlights the critical need for a multidisciplinary approach, meticulous surgical planning, and vigilant postoperative monitoring in high-risk osteosarcoma treatment involving orthopedic prostheses.

1. CHALLENGES IN SURGICAL TREATMENT OF THIGH
OSTEOSARCOMA: A CASE STUDY INVOLVING PROSTHESIS
MIGRATION AND COLONIC FISTULA
AUTHORS: Cosma C1,2
, Molnar C.D 1
, Negruti T 1
,, Molnar C1,2
1
Chirugie Generală I – Spitalul Clinic Judetean De Urgenta- Tg.Mure Romania
ș
2
Universitatea de Medicină, Farmacie, tiin e i Tehnologie-Tg.Mure
Ș ț ș ș
INTRODUCTION: Thigh osteosarcoma presents
significant challenges in surgical management,
particularly when complicated by the need for
orthopedic prosthetic integration. This case study
illustrates the complexities and multidisciplinary
approach required for a 53-year-old patient
diagnosed with osteosarcoma of the thigh.
MATERIAL AND METHODS: Initial treatment
involved tumor resection and the placement of a
right shoulder orthopedic prosthesis. The
postoperative course was complicated by
prosthesis migration and the development of a
colonic fistula, externalizing at the surgical site.
RESULTS: The patient underwent a subsequent
surgical intervention that included right lower
limb disarticulation and colon resection,
accompanied by colostomy creation. Local
inflammation necessitated the reimplantation of
the right ureter. Histopathological analysis
confirmed a local tumor relapse. Postoperative
management required intensive care unit (ICU)
support to address the complex clinical outcomes.
CONCLUSION: This case underscores the
potential for severe complications in the surgical
management of thigh sarcoma involving
orthopedic prostheses. The occurrence of
prosthesis migration and colonic fistula
significantly complicates the postoperative
trajectory, necessitating a multidisciplinary
surgical and medical approach to manage the
complications effectively. The need for subsequent
interventions, including disarticulation and organ
resection, highlights the importance of careful
surgical planning and patient monitoring in cases
of high-risk osteosarcoma treatment.
KEYWORDS:
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