Matteo Romantini

Outcome of expandable prostheses in children.

Background: Expandable prostheses offer the advantages of limb-salvage and limb-length equality at skeletal maturity. However, what is the cost for achieving that goal, and in how many children this is achieved? Materials and Methods: We present 32 children (16 boys and 16 girls; mean age, 9 y) with bone sarcomas of the femur treated with limb salvage using expandable prostheses. The Kotz Growing prosthesis and the noninvasive Repiphysis and Stanmore expandable prostheses were used. The mean follow-up was 49 months. Survival analysis of the children and primary implants and functional evaluation were performed. Results: Survival of the children was 94% and 84% at 48 and 72 months. Survival of the primary prostheses was 78% and 66% at 48 and 72 months; survival was significantly higher only for the Kotz when compared with the Repiphysis prostheses (P=0.026). The rate of implant-related complications was 51.3%; 9 prostheses (23%) were revised because of aseptic loosening, infection, and breakage. A mean total lengthening of 28 mm (4 to 165 mm) was achieved by 84 procedures (2.6 procedures/patient). Three of the 9 children who reached skeletal maturity had limb-length equality and 6 discrepancy of 15 to 30 mm. The mean Musculoskeletal Tumor Society score was excellent (79%) without a significant difference between the type of prostheses (P=0.934). Conclusions: The Kotz Growing prosthesis, although it requires an open lengthening procedure, has shown higher survival when compared with the noninvasive Repiphysis prosthesis. However, the total lengthening remains small, and the complications rates are high even with the noninvasive prostheses.

Survival analysis of patients with femoral metastases

Previous studies reported on surgical indications for patients with femoral metastases. However, few studies analyzed the spectrum of femoral metastatic presentation. We performed this study to evaluate the survival of patients with femoral metastases, and clarify the treatment of femoral impending and actual pathological fractures.

Infected Prostheses after Lower-Extremity Bone Tumor Resection: Clinical Outcomes of 100 Patients

BACKGROUND Infection of megaprostheses after bone tumor resection is a major concern; management is challenging. This study evaluated the survivability from such infections, the microbial isolates, treatment tactics, and outcome of megaprosthesis reconstructions. MATERIALS AND METHODS We studied 1,161 patients retrospectively who underwent megaprosthesis reconstruction for limb salvage after a sarcoma from 1983 to 2010. The mean followup was 9 y (range 3-20 y). We evaluated the overall survival of the megaprosthesis reconstructions in patients with infection and the survival with respect to the type of megaprosthesis, site of reconstruction, cemented or cementless fixation, type of tumor, adjuvant treatments, microbial isolate(s), treatment tactics, and outcome. RESULTS The incidence of infection was 8.6%. The most common microbial isolate was Staphylococcus epidermidis (47%). Overall survival with definitive management of infection was 88% at 10 y and 84% at 20 y. Survival was higher for cementless reconstructions and not different with respect to the type of megaprosthesis, site of reconstruction, or adjuvant therapy. Infections resolved completely with one- or two-stage surgery in 75% of patients. The rate of amputation because of infection was 21%. CONCLUSIONS Megaprosthesis reconstructions may be infected in 8.6% of cases. Infections more commonly occur late, caused usually by S. epidermidis. The survival rate is higher with cementless megaprosthesis reconstructions and no different with respect to the type of tumor or megaprosthesis or the adjuvant treatments. One-stage revision is effective for acute post-operative infections; however, two-stage revision surgery is necessary for early and late infections. The rate of amputation because of occurrence or persistence of megaprosthesis infection is 21%.

Tumours of the atlas and axis: a 37-year experience with diagnosis and management

PurposeThis paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.Materials and methodsWe searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.ResultsBenign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.ConclusionsBone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.RiassuntoObiettivoVogliamo riportare l’esperienza raccolta presso un unico istituto in un lungo arco di tempo sull’incidenza e la gestione delle neoplasie dell’atlante e dell’epistrofeo, analizzandone riscontri clinici e radiologici, e le opzioni terapeutiche.Materiali e metodiRicercando nell’archivio dell’Istituto Ortopedico Rizzoli tutta la documentazione relativa ai pazienti trattati per neoplasie del rachide cervicale superiore, sono stati individuati 62 pazienti in un arco di tempo di 37 anni (da luglio 1973 ad ottobre 2010), 39 uomini e 23 donne, con età media di 39,5 anni (5–77 anni). Di ogni paziente sono stati raccolti i dati circa le manifestazioni cliniche al momento del ricovero, la documentazione radiologica ed il trattamento eseguito. Il tempo di controllo medio è stato di 10 anni.RisultatiIn 24 casi (39%) è stata diagnosticata una neoplasia benigna, in 38 (61%) una neoplasia maligna. Metastasi ossee, osteomi osteoidi e cordomi sono stati rispettivamente gli istotipi più frequenti. In 6 pazienti la neoplasia interessava l’atlante e in 52 l’epistrofeo; in 4 pazienti la neoplasia interessava sia l’atlante che l’epistrofeo. Le manifestazioni cliniche più frequenti comprendevano dolore, torcicollo, disfagia e deficit neurologici. Il trattamento chirurgico è stato eseguito in 35 casi, mentre nei rimanenti casi è stato eseguito trattamento conservativo mediante infiltrazioni intralesionali di metilprednisolone ed immobilizzazione con halo vest, associato o meno a chemioterapia, radioterapia o embolizzazione. Un paziente con osteoblastoma dell’atlante ha avuto recidiva locale; tutti i pazienti con metastasi hanno sviluppato recidive locali. Degli 8 pazienti con diagnosi di plasmocitoma solitario, per 4 c’è stata la progressione a mieloma multiplo in un tempo compreso tra 1 e 4 anni. I pazienti con diagnosi di cordoma hanno sviluppato dalle 2 alle 4 recidive locali. I pazienti con diagnosi di osteosarcoma e condrosarcoma sono deceduti per la progressione locale e a distanza della malattia.ConclusioniI tumori ossei del rachide cervicale sono rari. Non possono tuttavia essere esclusi nei casi di cervicalgia e sintomatologia neurologica periferica. In molti casi il trattamento chirurgico può essere soltanto a margini intralesionali. Per determinati istotipi è indicata l’associazione con chemio e radioterapia.

Side effects of radiation in musculoskeletal oncology: clinical evaluation of radiation-induced fractures.

Radiation therapy and chemotherapy, while they remain an essential part of the multidisciplinary treatment of cancers, they have led to unwanted complications. Radiation-induced complications include wound and bone, growth, nervous system, tumorigenic, lung, gastrointestinal, hepatic and other complications. In this article we review the side effects of radiation therapy in musculoskeletal oncology emphasizing on bone, present our long experience, and discuss the current literature regarding radiation-induced bone complications and their management and outcome.

Tumori dell'atlante e dell'epistrofeo: 37 anni di esperienza nella diagnosi e trattamento

PurposeThis paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.Materials and methodsWe searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.ResultsBenign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.ConclusionsBone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.RiassuntoObiettivoVogliamo riportare l’esperienza raccolta presso un unico istituto in un lungo arco di tempo sull’incidenza e la gestione delle neoplasie dell’atlante e dell’epistrofeo, analizzandone riscontri clinici e radiologici, e le opzioni terapeutiche.Materiali e metodiRicercando nell’archivio dell’Istituto Ortopedico Rizzoli tutta la documentazione relativa ai pazienti trattati per neoplasie del rachide cervicale superiore, sono stati individuati 62 pazienti in un arco di tempo di 37 anni (da luglio 1973 ad ottobre 2010), 39 uomini e 23 donne, con età media di 39,5 anni (5–77 anni). Di ogni paziente sono stati raccolti i dati circa le manifestazioni cliniche al momento del ricovero, la documentazione radiologica ed il trattamento eseguito. Il tempo di controllo medio è stato di 10 anni.RisultatiIn 24 casi (39%) è stata diagnosticata una neoplasia benigna, in 38 (61%) una neoplasia maligna. Metastasi ossee, osteomi osteoidi e cordomi sono stati rispettivamente gli istotipi più frequenti. In 6 pazienti la neoplasia interessava l’atlante e in 52 l’epistrofeo; in 4 pazienti la neoplasia interessava sia l’atlante che l’epistrofeo. Le manifestazioni cliniche più frequenti comprendevano dolore, torcicollo, disfagia e deficit neurologici. Il trattamento chirurgico è stato eseguito in 35 casi, mentre nei rimanenti casi è stato eseguito trattamento conservativo mediante infiltrazioni intralesionali di metilprednisolone ed immobilizzazione con halo vest, associato o meno a chemioterapia, radioterapia o embolizzazione. Un paziente con osteoblastoma dell’atlante ha avuto recidiva locale; tutti i pazienti con metastasi hanno sviluppato recidive locali. Degli 8 pazienti con diagnosi di plasmocitoma solitario, per 4 c’è stata la progressione a mieloma multiplo in un tempo compreso tra 1 e 4 anni. I pazienti con diagnosi di cordoma hanno sviluppato dalle 2 alle 4 recidive locali. I pazienti con diagnosi di osteosarcoma e condrosarcoma sono deceduti per la progressione locale e a distanza della malattia.ConclusioniI tumori ossei del rachide cervicale sono rari. Non possono tuttavia essere esclusi nei casi di cervicalgia e sintomatologia neurologica periferica. In molti casi il trattamento chirurgico può essere soltanto a margini intralesionali. Per determinati istotipi è indicata l’associazione con chemio e radioterapia.

Tumours of the atlas and axis: a 37-year experience with diagnosis and management@@@Tumori dell’atlante e dell’epistrofeo: 37 anni di esperienza nella diagnosi e trattamento

PurposeThis paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.Materials and methodsWe searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.ResultsBenign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.ConclusionsBone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.RiassuntoObiettivoVogliamo riportare l’esperienza raccolta presso un unico istituto in un lungo arco di tempo sull’incidenza e la gestione delle neoplasie dell’atlante e dell’epistrofeo, analizzandone riscontri clinici e radiologici, e le opzioni terapeutiche.Materiali e metodiRicercando nell’archivio dell’Istituto Ortopedico Rizzoli tutta la documentazione relativa ai pazienti trattati per neoplasie del rachide cervicale superiore, sono stati individuati 62 pazienti in un arco di tempo di 37 anni (da luglio 1973 ad ottobre 2010), 39 uomini e 23 donne, con età media di 39,5 anni (5–77 anni). Di ogni paziente sono stati raccolti i dati circa le manifestazioni cliniche al momento del ricovero, la documentazione radiologica ed il trattamento eseguito. Il tempo di controllo medio è stato di 10 anni.RisultatiIn 24 casi (39%) è stata diagnosticata una neoplasia benigna, in 38 (61%) una neoplasia maligna. Metastasi ossee, osteomi osteoidi e cordomi sono stati rispettivamente gli istotipi più frequenti. In 6 pazienti la neoplasia interessava l’atlante e in 52 l’epistrofeo; in 4 pazienti la neoplasia interessava sia l’atlante che l’epistrofeo. Le manifestazioni cliniche più frequenti comprendevano dolore, torcicollo, disfagia e deficit neurologici. Il trattamento chirurgico è stato eseguito in 35 casi, mentre nei rimanenti casi è stato eseguito trattamento conservativo mediante infiltrazioni intralesionali di metilprednisolone ed immobilizzazione con halo vest, associato o meno a chemioterapia, radioterapia o embolizzazione. Un paziente con osteoblastoma dell’atlante ha avuto recidiva locale; tutti i pazienti con metastasi hanno sviluppato recidive locali. Degli 8 pazienti con diagnosi di plasmocitoma solitario, per 4 c’è stata la progressione a mieloma multiplo in un tempo compreso tra 1 e 4 anni. I pazienti con diagnosi di cordoma hanno sviluppato dalle 2 alle 4 recidive locali. I pazienti con diagnosi di osteosarcoma e condrosarcoma sono deceduti per la progressione locale e a distanza della malattia.ConclusioniI tumori ossei del rachide cervicale sono rari. Non possono tuttavia essere esclusi nei casi di cervicalgia e sintomatologia neurologica periferica. In molti casi il trattamento chirurgico può essere soltanto a margini intralesionali. Per determinati istotipi è indicata l’associazione con chemio e radioterapia.