Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2010 Musculoskeletal Tumor Society 16 articles

Articles

Femoral Stress Fractures Associated With Long-term Bisphosphonate Treatment

William G. Ward MD, Christina J. Carter BS, Scott C. Wilson MD, Cynthia L. Emory MD

Recent studies have described unique clinical and radiographic characteristics of femoral stress fractures or low-energy fractures associated with long-term bisphosphonate therapy. However, it is unclear whether these fractures require subsequent surgery after the initial treatment.

Length of Symptoms Before Referral: Prognostic Variable for High-grade Soft Tissue Sarcoma?

Bruce T. Rougraff MD, Jackie Lawrence MA, Kenneth Davis MS

It is commonly assumed patients with high-grade soft tissue sarcomas who are diagnosed and treated quickly after the first onset of symptoms fare better than those with longer symptoms before treatment. The literature contains no substantive data to support this assumption for soft tissue sarcomas, particularly for high-grade lesions.

Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?

Thomas J. Kremen MD, Nicholas M. Bernthal MD, Mark A. Eckardt BS, Jeffrey J. Eckardt MD

There is no consensus as to which surgical approach to the treatment of giant cell tumor of bone is most appropriate or which patients are at a higher risk for recurrence or metastasis.

Extremity Soft Tissue Sarcoma Resections: How Wide Do You Need to Be?

David M. King MD, Donald A. Hackbarth MD, Andrew Kirkpatrick BS

Sarcomas require a wide margin of resection including a cuff of normal tissue to minimize the risk of local recurrence. The amount of tissue that constitutes a wide margin is unclear in the literature.

Does Adjunctive Chemotherapy Reduce Remission Rates Compared to Cortisone Alone in Unifocal or Multifocal Histiocytosis of Bone?

André Mathias Baptista MD, PhD, André Ferrari França Camargo MD, Olavo Pires Camargo MD, PhD, Vicente Odone Filho MD, PhD, Alejandro Enzo Cassone MD, PhD

Langerhans cell histiocytosis (LCH) is a rare disorder that can affect almost any organ, including bone. Treatment options include local corticosteroid infiltration in isolated bone lesions and oral corticosteroids and chemotherapy in multifocal bone lesions. Several studies show local corticosteroid injection in unifocal bone lesions heal in more than 75% of patients with minimal side effects. Therefore, it is unclear whether chemotherapy adds materially to the healing rate.

Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

Andrew C. Pedtke MD, Rosanna L. Wustrack MD, Andrew S. Fang MD, Robert J. Grimer FRCS, Richard J. O’Donnell MD

Failure of endoprosthetic reconstruction with conventional stems due to aseptic loosening remains a challenge for maintenance of limb integrity and function. The Compressimplant (Biomet Inc, Warsaw, IN, USA) attempts to avoid aseptic failure by means of a unique technologic innovation. Though the existing literature suggests survivorship of Compressand stemmed implants is similar in the short term, studies are limited by population size and followup duration.

Early Complications of High-dose-rate Brachytherapy in Soft Tissue Sarcoma: A Comparison With Traditional External-beam Radiotherapy

Cynthia L. Emory MD, Corey O. Montgomery MD, Benjamin K. Potter MD, Martin E. Keisch MD, Sheila A. Conway MD

Radiotherapy and surgery are routinely utilized to treat extremity soft tissue sarcoma. Multiple radiation modalities have been described, each with advantages and disadvantages, without one modality demonstrating clear superiority over the others.

Aseptic Loosening Rates in Distal Femoral Endoprostheses: Does Stem Size Matter?

Patrick F. Bergin MD, Jenna B. Noveau BS, James S. Jelinek MD, Robert M. Henshaw MD

Long-term survival of distal femoral endoprosthetic replacements is largely affected by aseptic loosening. It is unclear whether and to what degree surgical technique and component selection influence the risk of loosening.

Sixty Percent 10-year Survival of Patients With Chondrosarcoma After Local Recurrence

Patrick P. Lin MD, Mohammed D. Alfawareh MD, Akihiko Takeuchi MD, PhD, Bryan S. Moon MD, Valerae O. Lewis MD

Chondrosarcoma is treated primarily by surgery. The prognosis of patients after local recurrence is not well defined. Both the survival of patients and the risk of further local relapse after surgical treatment of local recurrence have yet to be established.

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Norah Harvey MD, Elke R. Ahlmann MD, Daniel C. Allison MD, MBA, Lingjun Wang PA, Lawrence R. Menendez MD, FACS

The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages.

What Are Risk Factors for Local Recurrence of Deep High-grade Soft-tissue Sarcomas?

Chigusa Sawamura MD, MPH, Seiichi Matsumoto MD, PhD, Takashi Shimoji MD, PhD, Taisuke Tanizawa MD, Keisuke Ae MD, PhD

Patients with local recurrence of soft-tissue sarcomas have a poor overall survival. High-grade, soft-tissue sarcomas in deep locations may have a poorer prognosis regarding local recurrence than low-grade sarcomas or those located superficially. Although previous reports evaluated tumors at various depths, it is unclear what factors influence recurrence of deep, high-grade sarcomas.

Survival, Local Recurrence, and Function After Pelvic Limb Salvage at 23 to 38 Years of Followup

Courtney E. Sherman MD, Mary I. O’Connor MD, Franklin H. Sim MD

Malignant pelvic tumors frequently pose challenges to surgeons owing to complex pelvic anatomy and local extension. External hemipelvectomy frequently allows adequate margins but is associated with substantial morbidity and reduced function. Limb salvage is an alternative approach when adequate margins can be achieved, but long-term function and survival are unclear.

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Luis Aponte-Tinao MD, Germán L. Farfalli MD, Lucas E. Ritacco MD, Miguel A. Ayerza MD, D. Luis Muscolo MD

With the improved survival for patients with malignant bone tumors, there is a trend to reconstruct defects using biologic techniques. While the use of an intercalary allograft is an option, the procedures are technically demanding and it is unclear whether the complication rates and survival are similar to other approaches.