Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage 16 articles


MicroRNA Regulates Vascular Endothelial Growth Factor Expression in Chondrosarcoma Cells

Xiaojuan Sun MD, PhD, Lei Wei MD, PhD, Qian Chen PhD, Richard M. Terek MD

Systemic treatments to prevent or treat chondrosarcoma metastasis are lacking and targeted therapy has yet to be developed. Hypoxia develops in tumors as they grow and hypoxia-related alterations in gene expression underlie some of the traits of cancer. One critical trait is the ability to induce sustained angiogenesis, which is usually related to expression of vascular endothelial growth factor (VEGF). A potential hypoxia-related mechanism resulting in altered gene expression involves microRNA. Little is known about microRNA expression in chondrosarcoma and its potential role in regulation of VEGF expression.

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

George T. Calvert MD, Jennifer Wright MD, Jayant Agarwal MD, Kevin B. Jones MD, R. Lor Randall MD

There are several options for proximal humerus reconstruction in young children after resection of a malignant tumor and no one technique has been definitively shown to be superior to others, leaving the decision to surgeon and patient choice. Claviculo pro humeri (CPH) is a biologic reconstruction of the proximal humerus using the patient’s ipsilateral clavicle as a rotational osseous flap. CPH represents a potential option for this complicated clinical problem in very young children, but little is known about it because the indications for its use are so uncommon.

What Sports Activity Levels Are Achieved in Patients With Modular Tumor Endoprostheses of Osteosarcoma About the Knee?

Nikolaus W. Lang MD, Gerhard M. Hobusch MD, Philipp T. Funovics MD, Reinhard Windhager MD, Jochen G. Hofstaetter MD

Advances in multimodal treatment have improved survival of patients with nonmetastatic osteosarcoma. At the same time, implant design has improved the outcomes of limb salvage with modular endoprostheses. However, little is known about sports activity in long-term survivors with osteosarcoma.

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

Rodolfo Capanna MD, Guido Scoccianti MD, Filippo Frenos MD, Antonio Vilardi MD, Giovanni Beltrami MD, Domenico Andrea Campanacci MD

Prosthetic replacement is the most commonly used option for reconstruction of osteoarticular bone loss resulting from bone neoplasm resection or prosthetic failure. Starting in late 2001, we began exclusively using a single system for large-segment osteoarticular reconstruction after tumor resection; to our knowledge, there are no published series from one center evaluating the use of this implant.

What Are the 5-year Survivorship Outcomes of Compressive Endoprosthetic Osseointegration Fixation of the Femur?

Michael J. Monument MD, Nicholas M. Bernthal MD, Austin J. Bowles MS, Kevin B. Jones MD, R. Lor Randall MD

Aseptic complications such as stress shielding leading to bone loss are major problems associated with revision of cemented and uncemented long-stem tumor endoprostheses. Endoprosthetic reconstruction using compressive osseointegration fixation is a relatively new limb salvage technology designed to enhance osseointegration, prevent stress shielding, and provide fixation for short end-segments.

Does Competing Risk Analysis Give Useful Information About Endoprosthetic Survival in Extremity Osteosarcoma?

Reinhard Schuh MD, Alexandra Kaider MSc, Reinhard Windhager MD, Philipp T. Funovics MD

Conventional survival analysis for endoprosthetic complications does not consider competing events adequately. Patients who die of their disease are no longer at risk for complications; therefore, death as a competing event may alter survivorship estimates in the orthopaedic-oncological setting.

Survival of Modern Knee Tumor Megaprostheses: Failures, Functional Results, and a Comparative Statistical Analysis

Elisa Pala MD, Giulia Trovarelli MD, Teresa Calabrò MD, Andrea Angelini MD, Caterina N. Abati MD, Pietro Ruggieri MD, PhD

Modular megaprostheses are now the most common method of reconstruction after segmental resection of the long bones in the lower extremities. Previous studies reported variable outcome and failure rates after knee megaprosthetic reconstructions.

Should Fractures in Massive Intercalary Bone Allografts of the Lower Limb Be Treated With ORIF or With a New Allograft?

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

Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprostheses, although they have different outcomes and risks. There is no general consensus about when to use these alternatives, but when it is possible to save the native joints after the resection of a long bone tumor, intercalary allografts offer some advantages despite complications, such as fracture. The management and outcomes of this complication deserve more study.

What Are the Functional Outcomes of Endoprosthestic Reconstructions After Tumor Resection?

Nicholas M. Bernthal MD, Marcia Greenberg MS, PT, Kent Heberer MS, Jeffrey J. Eckardt MD, Eileen G. Fowler PhD, PT

The majority of published functional outcome data for tumor megaprostheses comes in the form of subjective functional outcome scores. Sparse objective data exist demonstrating functional results, activity levels, and efficiency of gait after endoprosthetic reconstruction in patients treated for orthopaedic tumors. Patients embarking on massive surgical operations, often in the setting of debilitating medical therapies, face mortality and a myriad of unknowns. Objective functional outcomes provide patients with reasonable expectations and a means to envision life after treatment. Objective outcomes also provide a means for surgeons to compare techniques, rehabilitation protocols, and implants.

What Is the Use of Imaging Before Referral to an Orthopaedic Oncologist? A Prospective, Multicenter Investigation

Benjamin J. Miller MD, MS, Raffi S. Avedian MD, Rajiv Rajani MD, Lee Leddy MD, Jeremy R. White MD, Judd Cummings MD, Tessa Balach MD, Kevin MacDonald MD

Patients often receive advanced imaging before referral to an orthopaedic oncologist. The few studies that have evaluated the value of these tests have been single-center studies, and there were large discrepancies in the estimated frequencies of unnecessary use of diagnostic tests.

Does Total Humeral Endoprosthetic Replacement Provide Reliable Reconstruction With Preservation of a Useful Extremity?

Hazem Wafa FRCSEd(Tr & Orth), Krishna Reddy FRCSEd(Tr & Orth), Robert Grimer DSc, Adesegun Abudu FRCS(Tr & Orth), Lee Jeys FRCS(Tr & Orth), Simon Carter FRCS, Roger Tillman FRCS(Tr & Orth)

Controversy exists regarding the ideal method of reconstruction after proximal humeral resection and several reconstructive techniques have been reported. The reconstructive options are very limited when resection of the entire humerus is required. One option is endoprosthetic reconstruction, but there have been few published studies on the outcome of total humeral endoprosthetic reconstruction.

Do Patients With Ewing’s Sarcoma Continue With Sports Activities After Limb Salvage Surgery of the Lower Extremity?

Gerhard Martin Hobusch MD, Nikolaus Lang MD, Reinhard Schuh MD, Reinhard Windhager MD, Jochen Gerhard Hofstaetter MD

Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions.

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Luis Aponte-Tinao MD, Lucas E. Ritacco MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Jose I. Albergo MD, Germán L. Farfall MD

Bone tumor resections for limb salvage have become standard treatment. Recently, computer-assisted navigation has been introduced to improve the accuracy of joint arthroplasty and possible tumor resection surgery; however, like with any new technology, its benefits and limitations need to be characterized for surgeons to make informed decisions about whether to use it.

Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But Rewarding

Alessandro Davide Luzzati MD, Sambhav Shah MS, Fabio Gagliano MD, Giuseppe Perrucchini MD, Gennaro Scotto MD, Marco Alloisio MD

Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms.