Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2015 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage 24 articles

Articles

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cara Cipriano MD, Anthony M. Griffin MSc, Peter C. Ferguson MD, Jay S. Wunder MD

The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed.

Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

Alex K. Freeman BSc, MBChB, Chris J. Thorne MBChB, C. Louie Gaston MD, Richard Shellard FRCA, Tom Neal FRCA, Michael C. Parry MD, FRCS, Robert J. Grimer FRCS, Lee Jeys MSc, FRCS

Resection of pelvic and sacral tumors can cause severe blood loss, complications, and even postoperative death. Hypotensive epidural anesthesia has been used to mitigate blood loss after elective arthroplasty, but to our knowledge, it has not been studied as an approach that might make resection of pelvic and sacral tumors safer.

A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification

Lee M. Jeys MSc, FRCS, Chris J. Thorne MBChB, Michael Parry MD, FRCS, Czar Louie L. Gaston MD, Vaiyapuri P. Sumathi MD, FRCPath, J. Robert Grimer FRCS

Chemotherapy response and surgical margins have been shown to be associated with the risk of local recurrence in patients with osteosarcoma. However, existing surgical staging systems fail to reflect the response to chemotherapy or define an appropriate safe metric distance from the tumor that will allow complete excision and closely predict the chance of disease recurrence. We therefore sought to review a group of patients with primary high-grade osteosarcoma treated with neoadjuvant chemotherapy and surgical resection and analyzed margins and chemotherapy response in terms of local recurrence.

Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

Jose I. Albergo MD, Czar L. Gaston MD, Luis A. Aponte-Tinao MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Germán L. Farfalli MD, Lee M. Jeys FRCS, Simon R. Carter FRCS, Roger M. Tillman FRCS, Adesegun T. Abudu FRCS, Robert J. Grimer FRCS

The proximal tibia is one of the most challenging anatomic sites for extremity reconstructions after bone tumor resection. Because bone tumors are rare and large case series of reconstructions of the proximal tibia are lacking, we undertook this study to compare two major reconstructive approaches at two large sarcoma centers.

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

Joel R. Peterson MA, Alexander P. Decilveo BA, Ian T. O’Connor BS, Ivan Golub BS, James C. Wittig MD

Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty.

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

Bastiaan C. J. Majoor MD, Marleen J. M. Peeters-Boef MD, Michiel A. J. Sande MD, PhD, Natasha M. Appelman-Dijkstra MD, PhD, Neveen A. T. Hamdy MD, PhD, P. D. S. Dijkstra MD, PhD

Management of fibrous dysplasia of the proximal femur is a progressive, often recurrent condition of bone that can cause skeletal deformity, fractures, and pain. Allogeneic cortical strut grafting to minimize the risk of fracture or as part of fracture treatment is a promising treatment option, but evidence is scarce on the intermediate- to long-term results of this procedure and there are no data on factors associated with graft failure.

LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

Michaël P. A. Bus MSc, Andrzej Szafranski MD, PhD, Simen Sellevold MD, Tomasz Goryn MD, PhD, Paul C. Jutte MD, PhD, Jos A. M. Bramer MD, PhD, M. Fiocco PhD, Arne Streitbürger MD, PhD, Daniel Kotrych MD, PhD, Michiel A. J. Sande MD, PhD, P. D. Sander Dijkstra MD, PhD

Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiCprosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiCprosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated.

How Does the Level of Nerve Root Resection in En Bloc Sacrectomy Influence Patient-Reported Outcomes?

Olivier D. R. Wulfften Palthe MD, Matthew T. Houdek MD, Peter S. Rose MD, Michael J. Yaszemski MD, PhD, Franklin H. Sim MD, Patrick J. Boland MD, John H. Healey MD, Francis J. Hornicek MD, MS, PhD, Joseph H. Schwab MD, MS

For patients with sacral tumors, who are well enough for surgery, en bloc resection is the preferred treatment. Survival, postoperative complications, and recurrent rates have been described, but patient-reported outcomes often are not included in these studies.

Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Ying-lee Lam FHKAM, Raymond Yau FHKAM, Kenneth W. Y. Ho FHKAM, Ka-lok Mak FHKAM, Sin-tak Fong FHKAM, Timothy Y. C. So FHKAM

Primary malignant tumors located near the acetabulum are usually managed by resection of the tumor with wide margins that include the acetabulum. These resections are deemed P2 resections by the Enneking and Dunham classification. There are various methods to perform the subsequent hip reconstruction. Unfortunately, there is no consensus as to the best management. In general, patients undergoing resection at this level will have substantial levels of pain and disability as measured by the Musculoskeletal Tumor Society (MSTS) scoring system. We believe there is a subset of patients whose tumors in this location can be resected while preserving all or most of the weightbearing acetabulum using navigation and careful surgical planning.

What Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma?

Gerhard M. Hobusch MD, Jakob Bollmann CM, Stephan E. Puchner MD, Nikolaus W. Lang MD, Jochen G. Hofstaetter MD, Philipp T. Funovics MD, MSc, Reinhard Windhager MD

Limited information is available about sports activities of survivors after resection and reconstruction of primary malignant bone tumors with megaprostheses. Because patients often ask what activities are possible after treatment, objective knowledge about sports activities is needed to help assess the risks of sports participation and to help guide patients’ expectations.

Survival in Mesenchymal Chondrosarcoma Varies Based on Age and Tumor Location: A Survival Analysis of the SEER Database

Brian A. Schneiderman MD, Stephanie A. Kliethermes PhD, Lukas M. Nystrom MD

Studies suggest that mesenchymal chondrosarcoma is associated with a poorer prognosis and a higher proportion of extraskeletal tumors than conventional chondrosarcoma. However, these investigations have been small heterogeneous cohorts, limiting analysis of prognostic factors.

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Tao Ji MD, Wei Guo MD, PhD, Rongli Yang MD, Xiaodong Tang MD, Yifei Wang MD, Lin Huang MD

Conditional survival is a measure of prognosis for patients who have already survived for a specific period of time; however, data on conditional survival after sacrectomy in patients with sacral chordoma are lacking. In addition, because sacral tumors are rare and heterogeneous, classifying them in a way that allows physicians to predict functional outcomes after sacrectomy remains a challenge.

What Factors Are Associated With Failure of Compressive Osseointegration Fixation?

Ryland Kagan MD, Jacob Adams MD, Caroline Schulman BE, Rachel Laursen BS, Karina Espana BS, Jung Yoo MD, Yee-Cheen Doung MD, James Hayden MD, PhD

Compressive osseointegration is as an alternative to traditional intramedullary fixation. Two- to 10-year survivorship and modes of failure have been reported; however, as a result of relatively small numbers, these studies are limited in their ability to identify risk factors for failure.

Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?

Daniel M. Lerman MD, Matthew G. Cable MD, Patrick Thornley BHSc, Nathan Evaniew MD, Gerard P. Slobogean MD, Mohit Bhandari MD, MSc, PhD, John H. Healey MD, R. Lor Randall MD, Michelle Ghert MD

Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind.

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

Germán L. Farfalli MD, José I. Albergo MD, Lucas E. Ritacco MD, Miguel A. Ayerza MD, Federico E. Milano MSC, Luis A. Aponte-Tinao MD

Computer navigation during surgery can help oncologic surgeons perform more accurate resections. However, some navigation studies suggest that this tool may result in unique intraoperative problems and increased surgical time. The degree to which these problems might diminish with experience–the learning curve–has not, to our knowledge, been evaluated for navigation-assisted tumor resections.

Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

Joseph Benevenia MD, Steven M. Rivero MD, Jeffrey Moore MD, Joseph A. Ippolito BA, Daniel A. Siegerman MD, Kathleen S. Beebe MD, Francis R. Patterson MD

Giant cell tumors (GCTs) are treated with resection curettage and adjuvants followed by stabilization. Complications include recurrence, fracture, and joint degeneration. Studies have shown treatment with polymethylmethacrylate (PMMA) may increase the risk of joint degeneration and fracture. Other studies have suggested that subchondral bone grafting may reduce these risks.

Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results?

Irene Barrientos-Ruiz MD, Eduardo José Ortiz-Cruz MD, Manuel Peleteiro-Pensado MD

Reconstruction after internal hemipelvectomy resection likely provides better function than hindquarter amputation. However, many reconstruction methods have been used, complications with these approaches are common, and function often is poor; because of these issues, it seems important to investigate alternative implants and surgical techniques.

Is Needle Biopsy Clinically Useful in Preoperative Grading of Central Chondrosarcoma of the Pelvis and Long Bones?

Pablo D. Roitman MD, Germán L. Farfalli MD, Miguel A. Ayerza MD, D. Luis Múscolo MD, Federico E. Milano MSC, Luis A. Aponte-Tinao MD

Central chondrosarcoma of bone is graded on a scale of 1 to 3 according to histological criteria. Clinically, these tumors can be divided into low-grade (Grade 1) and high-grade (Grade 2, Grade 3, and dedifferentiated) chondrosarcomas. Although en bloc resection has been the most widely used treatment, it has become generally accepted that in selected patients with low-grade chondrosarcomas of long bones, curettage is safe and effective. This approach requires an accurate preoperative estimation of grade to avoid under- or overtreatment, but prior reports have indicated that both imaging and biopsy do not always give an accurate prediction of grade.

What Are the Functional Outcomes After Total Sacrectomy Without Spinopelvic Reconstruction?

Piya Kiatisevi MD, Chaiwat Piyaskulkaew MD, Sombat Kunakornsawat MD, Bhasanan Sukunthanak MD

After total sacrectomy, many types of spinopelvic reconstruction have been described with good functional results. However, complications associated with reconstruction are not uncommon and usually result in further surgical interventions. Moreover, less is known about patient function after total sacrectomy without spinopelvic reconstruction, which may be indicated when malignant or aggressive benign bone and soft tissue tumors involved the entire sacrum.

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty

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

Chondroblastoma is an uncommon, benign, but locally aggressive bone tumor that occurs in the apophyses or epiphyses of long bones, primarily in young patients. Although some are treated with large resections, aggressive curettage and bone grafting are more commonly performed to preserve the involved joint. Such intralesional resection may result in damage to the growth plate and articular cartilage, which can result in painful arthritis. Prior studies have focused primarily on oncologic outcomes rather than long-term joint status and functional outcomes.

Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

German A. Norambuena MD, Robin Patel MD, Melissa Karau MT, Cody C. Wyles BS, Paul J. Jannetto PhD, Kevin E. Bennet BSChE, MBA, Arlen D. Hanssen MD, Rafael J. Sierra MD

Periprosthetic infections are devastating for patients and more efficacious preventive strategies are needed. Surface-modified implants using antibacterial coatings represent an option to cope with this problem; however, manufacturing limitations and cytotoxicity have curbed clinical translation. Among metals with antibacterial properties, copper has shown superior in vitro antibacterial performance while maintaining an acceptable cytotoxicity profile. A thin film containing copper could prevent early biofilm formation to limit periprosthetic infections. This pilot study presents the in vitro antibacterial effect, cytotoxicity, and copper ion elution pattern of a thin film of titanium-copper oxide (TiCuO).

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Tao Wang MD, Chung Ming Chan MBBS, Feng Yu MD, Yuan Li MD, Xiaohui Niu MD

Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported.

What Are the Long-term Results of MUTARS® Modular Endoprostheses for Reconstruction of Tumor Resection of the Distal Femur and Proximal Tibia?

Michaël P. A. Bus MSc, Michiel A. J. Sande MD, PhD, Marta Fiocco PhD, Gerard R. Schaap MD, PhD, Jos A. M. Bramer MD, PhD, P. D. Sander Dijkstra MD, PhD

Modular endoprostheses are commonly used to reconstruct defects of the distal femur and proximal tibia after bone tumor resection. Because limb salvage surgery for bone sarcomas is relatively new, becoming more frequently used since the 1980s, studies focusing on the long-term results of such prostheses in treatment of primary tumors are scarce.