Giulia Trovarelli

Survival of current production tumor endoprostheses: Complications, functional results, and a comparative statistical analysis

Retrospectively analyze outcomes of current‐generation Global Modular Replacement System (GMRS) modular tumor endoprosthesis for the lower limb in primary and secondary implantation procedures.

Resection and reconstruction of pelvic bone tumors.

The objective of this study was to assess outcome and recurrence rate after limb-salvage surgery with reconstruction for pelvic bone tumors and analyze complications and their relationship with surgery. The authors analyzed 129 patients followed for a mean of 6 years (range, 2-19 years). Chondrosarcoma was the most frequent histotype. Thirty-one cases with no acetabular involvement were reconstructed with allograft only. Acetabular resections were reconstructed with allograft prosthetic composite (n=60), allograft only (n=11), trabecular metal components (n=2), prosthesis only (n=10), saddle prosthesis (n=11), and iliofemoral arthrodesis (n=1). Margins were wide (n=94), wide contaminated (n=22), marginal (n=7), and intralesional (n=6). Oncologic outcomes were as follows: 75 patients were continuously disease free, 6 were disease free after treatment of relapse, 13 were alive with disease, 28 were dead of disease, and 5 were dead of other causes. Survival was 66% at 10 years. Local recurrence rate of malignant tumors was 22.1% and was not statistically influenced by margins (P=.140) or site (P=.933). Metastasis rate was 32.8%. Deep infection was observed in 30 (23.6%) cases, with no statistical difference between reconstructions with and without allograft (P=.09). Final external hemipelvectomy was performed in 16 cases. Newer techniques of reconstruction using stemmed acetabular cups or porous metal components combined with allograft are now available. Local control and satisfactory survival is achievable long term in patients with pelvic tumors, but this surgery implies a high rate of complications. Infection is a major complication, not influenced by the use of allografts. Amputation is rarely needed.

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses

BackgroundKnee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them.Questions/purposesOur objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap.MethodsWe present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap.ResultsSurvivorship of arthrodeses with modular endoprostheses was 50% and 25% at 5 and 10 years, respectively. There were nine infections (29%) and one implant fracture (3%). Amputation as final surgery was required in 8 patients (six owing to infection and two to oncologic failures). There was no significant difference in survivorship between arthrodeses done for primary tumor resection and as a salvage procedure for failed implants. No differences were found between patients with and without prior infection or with and without a gastrocnemius flap.ConclusionsSurvivorship of a modular arthrodesis implant was 50% at 5 years owing to a high complication rate. Infection is the most common cause of failure of oncologic and revision implants. Implant fracture is a rare occurrence. Modular segmental arthrodesis provides a stable construct for patients in whom limb preservation is possible but a hinged device is contraindicated as a result of major muscle resection.Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Treatment of Osteoid Osteomas of the Foot: A Review of 100 Cases

Objectives: Osteoid osteoma (OO) is a small, benign, osteogenic bone tumor, with less than 11% of cases located in the feet. We review our experience in OO of the foot bones in order to characterize its prevalence, treatment, and recurrence rate at long term follow up. Methods: The medical records of 100 cases of osteoid osteoma of the foot treated between 1975 and 2009 were reviewed retrospectively. There were 73 male and 27 female patients, with a mean age of 23.4 years (7-61 years). The lesions were located in the talus (n=59), calcaneus (n=14), metatarsal bones (n=9), cuneiform bones (n=5), phalanges (n=4), cuboid (n=4), navicular (n=2) and tarsal bones, not otherwise specified (n=3). None of the patients had received prior percutaneous or surgical treatment for the tumor. Twelve tumors were intra-articular and 88 extraarticular. All patients were taking routine analgesics including anti-inflammatory medications. Results: Treatment consisted of radiofrequency ablation (RFA) in 43 patients, excisional CT-guided trocar biopsy, or percutaneous drill resection (PDR) in 21 patients, intra-lesional curettage in 43 patients, and wide resection alone as well as wide resection with total ankle arthroplasty in one patient each. Adequate follow-up was available for all patients. One patient treated with RFA reported recurrent pain after 2 months and was successfully treated with a second RFA. The overall recurrence rate was 1%; however, it was 2.3% in those patients treated with RFA. No adverse events related to treatment or to the anatomical location were recorded. Conclusion: RFA is a safe and effective alternative to surgical resection of osteoid osteomas of the foot. Caution should be taken when performing this procedure on lesions less than 1 cm from neurovascular structures or in superficial locations, due to risk for soft tissue injury from thermal necrosis.

Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Current megaprostheses options

The introduction of a multidisciplinary approach with chemotherapy and radiotherapy, and the advances and improvements in surgical and diagnostic techniques now allow limb salvage surgery in most patients with bone sarcomas instead of amputation. Megaprostheses have been used more frequently in the last 3 decades and are now the most common method of reconstruction after segmental resection of the long bones in extremities. Several types of megaprosthetic implants are currently available for limb salvage surgery. The aim of this study was to report the advantages and disadvantages of the most frequently used current megaprosthesis systems to date.