Proximal femur sarcomas with intra-articular disease-Do intra-articular resections provide adequate local control?

Background and Objectives Hip preserving (intra-articular) resections for proximal femur sarcoma have better function compared to peri-acetabular (extra-articular) resections, which are more complex and morbid. But, do intra-articular resections in selected cases with intra-articular disease provide adequate local control? Method Extra-articular resection or intra-articular resection in cases without pathologic fracture or away from joint/capsule was classified as a planned safe margin (SM). Circumferential removal of labrum without acetabular resection in cases without gross joint contamination was classified as planned close margins (CM). We analyzed local recurrence-free survival (LRFS) (death as a competing event) for 86 proximal femur resections (SM = 55, CM = 31). Results The 5 years LRFS was 84% (n = 6/55, 10%) in the SM group and 67% (n = 4/31, 12%) in the CM group. There was no worsening of local recurrence (LR) in the CM group (subdistribution hazard [sH] = 0.69; 95% confidence interval [CI], 0.21-2.29;P = .56). Poor chemotherapy-induced necrosis predicted worse LR (sH = 0.1; 95% CI, 0.01-0.8;P = .03). Overall survival was 16% (SE 8%) at 5 years with LR vs 64% (SE 7%) without LR (P = .0076). Conclusion In proximal femur sarcomas with potential for involvement of the hip joint, a CM in selected cases did not worsen LR; providing an option for avoiding additional morbidity with extra-articular resections.