Dubravko Orlić

Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment

We retrospectively analysed 90 patients who underwent “en bloc” resection and modular endoprosthesis reconstruction in the lower limbs between 1987–2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.RésuméNous avons analysé de façon rétrospective 90 patients sur une période s’étendant de 1987 à 2003 et ayant bénéficié d’une résection au bloc avec reconstruction du membre inférieur par une endoprothèse modulaire. Cette reconstruction a été réalisée avec une endoprothèse de type Howmedica KFTR (Kotz), une endoprothèse médulaire de Link Lima-Lto (Wagner). La reconstruction articulaire du genou étant réalisée avec l’endoprothèse modulaire Howmedica KFTR (Kotz) après une résection du fémur distal ou du tibia proximal. Cinquante-huit patients (64.5%) présentaient une tumeur maligne, 16 (17.8%) une tumeur bénigne, 8 (8.9%) une métastase et 4 (4.4%) une tumeur tissue-like. Enfin, quatre patients ont été traités après une destruction fémorale non tumourale (4.4%). Une tumeur de haut grade a été trouvée dans la majorité des patients présentant une tumeur maligne (70.7%). Des complications sont survenues chez 26 patients avec récidive de la tumeur, infection profonde, destruction acétabulaire après hémiarthroplastie, luxation récidivante, fracture périprothétique. Au total, 23 patients (25.6%) sont morts de leur tumeur. L’endoprothèse a été considérée comme un traitement de choix pour les tumeurs osseuses de la hanche et du genou. Néanmoins, des progrès doivent être encore réalisés par les chirurgiens au cours du 21ème siècle.

TUMOR ANGIOGENESIS AND OUTCOME IN OSTEOSARCOMA

Intratumoral angiogenesis quantified by microvessel density (MVD) has been shown to be a strong prognostic indicator in a number of malignant tumors. Its association with prognosis in bone sarcomas has been subject to less extensive research. The aim of this study was to investigate prognostic significance of angiogenesis in osteosarcoma. Thirty-nine patients with osteosarcoma were included in a retrospective immunohistochemical study. Sections from diagnostic biopsies were immunostained using anti von Willebrand factor antibody and microvessels were counted at 400× magnification on 3 microscopic fields per patient. MVD was correlated with overall and disease-free survival by Kaplan–Meier and log-rank analysis. Correlation between clinicopathological variables and the degree of angiogenesis was tested using a χ2 test. Significant statistical difference was found regarding overall survival and disease-free survival between patients with high (>32.3 vessels/field) and low (≤32.3 vessels/field) microvessel counts (log-rank test p =. 0196 and p =. 0147, respectively). The rate of metastasis was significantly higher in patients with high microvessel counts (p =. 042). These findings strongly suggest that angiogenesis quantified by microvessel density is predictive of metastasis and poor prognosis in osteosarcoma.

Therapeutic embolization of aneurysmal bone cyst.

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.

Epidemiology of musculoskeletal tumors in a national referral orthopedic department. A study of 3482 cases

AIM OF THE STUDY Musculoskeletal tumors are relatively rare, and their geographic distribution varies greatly around the world. In this study, we present the incidence, age distribution and localization of musculoskeletal tumors diagnosed and/or treated at a tertiary referral orthopedic department, catering to an entire Southeastern European country. METHODS This was a retrospective study of prospectively collected data, in which all patients diagnosed and/or treated for musculoskeletal tumors at our Department in the period of 30 years (1981-2010) were included. RESULTS Data of a total of 3482 patients with musculoskeletal tumors were collected. Average age of patients was 33.5 years (range, 2 months-88 years), with even distribution according to sex. Malignant tumors were seen in 20.7% of patients, more often in men (56.9%). Most common malignant tumors were osteosarcoma (estimated incidence: 1.68/million/year), chondrosarcoma (0.79/million/year) and Ewing sarcoma (0.76/million/year). Benign tumors and tumor-like lesions were found in 79.3% of patients, with slight female predominance. Most common benign bone lesions were osteochondroma (5.81/million/year), simple bone cyst (2.13/million/year), and enchondroma (2.05/million/year). CONCLUSION This report represents a first of its kind in our region, and gives representative results to be compared to other middle and south European countries. Further nationwide studies are needed to improve strategies in bone tumor diagnosis and treatment.

Pleomorphic liposarcoma of the foot: a case report

BackgroundLiposarcomas are among the most common sarcomas of adult life. Pleomorphic liposarcoma, characterized by pleomorphic lipoblasts, is the rarest subtype. To our knowledge only three cases of pleomorphic liposarcoma of the foot or ankle have been reported so far.Case presentationA 71-year-old female presented with a large growing mass on the dorsum of her right foot. Computed tomography showed invasive tumorous mass. Excision biopsy revealed the mass to be a pleomorphic liposarcoma, and below the knee amputation was performed.ConclusionAlthough the incidence of pleomorphic liposarcoma in the foot is very low, it is essential to perform thorough histological analysis of all soft tissue masses, regardless of their benign appearance, because only prompt radical surgery can result in a good prognosis for the patient.

Orthopaedic Surgeons’ Cardiovascular Response During Total Hip Arthroplasty

The literature contains limited and contradictory information regarding the amount of physical effort and/or emotional stress needed to perform surgery. We therefore investigated cardiovascular response to psychophysical stress in orthopaedic surgeons while they were performing surgery. We monitored 29 male orthopaedic surgeons from four university centers while they performed total hip arthroplasties. Changes in their cardiovascular parameters were recorded by ambulatory monitoring methods. Exercise stress testing of each participant was used as a control state. We compared the cardiovascular response during surgery to energy requirements of everyday activities. Preoperative and postoperative testing showed lower values of cardiovascular parameters than during physically less difficult parts of the operation; physically more difficult phases of the operation additionally increased the values of parameters. We concluded performing total hip arthroplasty increases surgeons’ cardiovascular parameters because of psychologic stress and physical effort. Excitement of the cardiovascular system during total hip arthroplasty appears similar to the excitement during moderate-intensity daily activities, such as walking the dog, leisurely bicycling, or climbing stairs.