Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Highlights of the ISOLS/MSTS 2009 Meeting 31 articles


Local Recurrence After Initial Multidisciplinary Management of Soft Tissue Sarcoma: Is there a Way Out?

Sarantis Abatzoglou MD, Robert E. Turcotte MD, FRCSC, Abdurahman Adoubali MBBCh, FRCS-Glasg&Ed, Marc H. Isler MD, FRCSC, David Roberge MD, FRCPC

Multimodality treatment of primary soft tissue sarcoma by expert teams reportedly affords a low incidence of local recurrence. Despite advances, treatment of local recurrence remains difficult and is not standardized.

Morbidity and Functional Status of Patients With Pelvic Neurogenic Tumors After Wide Excision

Joseph Alderete MD, Eduardo N. Novais MD, Eric J. Dozois MD, Peter S. Rose MD, Franklin F. Sim MD

We previously reported that over the last 10 years our practice has evolved in the treatment of neurogenic tumors of the pelvis to include a multispecialty team of surgeons, a factor that might decrease morbidity and improve recurrence, survival, and function.

Local Recurrence, Survival and Function After Total Femur Resection and Megaprosthetic Reconstruction for Bone Sarcomas

Pietro Ruggieri MD, PhD, Giuseppe Bosco MD, Elisa Pala MD, Costantino Errani MD, Mario Mercuri MD

The choices of treatment for patients with extensive tumors of the femur include total femur megaprosthesis or large allograft-prosthetic composites. Previous reports suggest variable survival ranging from 60–70% at 1 to 2 years. However, these studies described earlier prostheses and techniques.

The Role of Surgery and Adjuvants to Survival in Pagetic Osteosarcoma

Pietro Ruggieri MD, PhD, Teresa Calabrò MD, Maurizio Montalti MD, Mario Mercuri MD

Osteosarcoma is a rare complication of Paget’s disease with a very poor prognosis. Treatment is controversial: the older age of the patients affected by Paget’s disease may limit the use of chemotherapy and axial involvement may limit the practicality of surgery.

Surgical Margins and Local Control in Resection of Sacral Chordomas

Pietro Ruggieri MD, PhD, Andrea Angelini MD, Giuseppe Ussia MD, Maurizio Montalti MD, Mario Mercuri MD

The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity.

Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?

Eduardo N. Novais MD, Bahtiyar Demiralp MD, Joseph Alderete MD, Melissa C. Larson BS, Peter S. Rose MD, Franklin H. Sim MD

Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial.

Distal Femoral Osteoarticular Allografts: Long-term Survival, But Frequent Complications

Patrick C. Toy MD, Jeremy R. White MD, Mark T. Scarborough MD, William F. Enneking MD, C. Parker Gibbs MD

Complications are frequent with osteoarticular allografts, and their long-term survivorship in the distal femur is unclear. Thus, the benefits of osteoarticular allografting remain controversial.

Computer-assisted Navigation in Bone Tumor Surgery: Seamless Workflow Model and Evolution of Technique

Timothy Y. C. So FHKCOS, FRACS, Ying-Lee Lam FHKCOS, Ka-Lok Mak FHKCOS, FRCSEd(Ortho)

Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching.

Surgical Management of 121 Benign Proximal Fibula Tumors

Matthew P. Abdel MD, Panayiotis J. Papagelopoulos MD, Dsc, Mark E. Morrey MD, Doris E. Wenger MD, Peter S. Rose MD, Franklin H. Sim MD

Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports.

Joint-sparing or Physeal-sparing Diaphyseal Resections: The Challenge of Holding Small Fragments

Manish Agarwal MS(Orth), Ajay Puri MS(Orth), Ashish Gulia MS(Orth), Kishore Reddy MS(Orth)

Joint-sparing or physeal-sparing diaphyseal resections are technically challenging when only a small length of bone is available for implant purchase.

What is the Emotional Acceptance After Limb Salvage with an Expandable Prosthesis?

Eric R. Henderson MD, Andrew M. Pepper BS, German A. Marulanda MD, Justin D. Millard MD, G. Douglas Letson MD

Limb preservation surgery for extremity sarcomas offers the promise of improved function and cosmesis over amputation. Application of limb salvage surgery for pediatric patients with expandable metallic endoprostheses is gaining acceptance. The few studies reporting these devices have focused on functional outcomes; one has addressed quality of life.

Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors

Ahmad Shehadeh MD, Jenna Noveau BS, Martin Malawer MD, FACS, Robert Henshaw MD

While complications following massive endoprosthetic reconstruction have been previously described, the incidence and effects of these complications over extended periods of time have not been well characterized in large series.

Recurrence After and Complications Associated With Adjuvant Treatments for Sacral Giant Cell Tumor

Pietro Ruggieri MD, PhD, Andreas F. Mavrogenis MD, Giuseppe Ussia MD, Andrea Angelini MD, Panayiotis J. Papagelopoulos MD, DSc, Mario Mercuri MD, PhD

The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity.

Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst

Claudia Bella MD, Barbara Dozza PhD, Tommaso Frisoni MD, Luca Cevolani MD, Davide Donati MD

Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure.

Does Increased Rate of Limb-sparing Surgery Affect Survival in Osteosarcoma?

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

The emergence of limb salvage surgery as an option for patients with osteosarcoma is attributable to preoperative chemotherapy and advancements in musculoskeletal imaging and surgical technique. While the indications for limb salvage have greatly expanded it is unclear whether limb salvage affects overall survival.

Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh

German A. Marulanda MD, Eric Henderson MD, David Cheong MD, G. Douglas Letson MD

The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction.

The Current Practice of Orthopaedic Oncology in North America

Jeremy White MD, Patrick Toy MD, Parker Gibbs MD, William Enneking MD, Mark Scarborough MD

The field of orthopaedic oncology in North America has been formalized over the past 30 years with the development of the Musculoskeletal Tumor Society (MSTS) and fellowship education opportunities.

Revision of Broken Knee Megaprostheses: New Solution to Old Problems

Manish Agarwal MS(Orth), Ashish Gulia MS(Orth), B. Ravi PhD, Rupesh Ghyar MS, Ajay Puri MS(Orth)

Low-cost indigenous megaprostheses used in the developing world are prone to mechanical failure but the frequency and causes are not well established.

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Han Jo Kim MD, John H. Healey MD, Carol D. Morris MD, Patrick J. Boland MD

High-dose radiation retards bone healing, compromising the surgical results of radiation-induced fractures. Prosthetic replacement has traditionally been reserved as a salvage option but may best achieve the clinical goals of eliminating pain, restoring function and avoiding complications.

A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses

Sina Kasraeian MD, Daniel C. Allison MD, MBA, Elke R. Ahlmann MD, Alexander N. Fedenko MD, Lawrence R. Menendez MD, FACS

Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass.

Factors Predicting Local Recurrence, Metastasis, and Survival in Pediatric Soft Tissue Sarcoma in Extremities

Chigusa Sawamura MD, MPH, Dempsey S. Springfield MD, Karen J. Marcus MD, Antonio R. Perez-Atayde MD, Mark C. Gebhardt MD

Pediatric soft tissue sarcomas are rare and differ from those in adults regarding the spectrum of diagnoses and treatment. Sarcomas in extremities may have different prognoses from those located elsewhere.

Clinicopathologic Prognostic Factors of Pure Myxoid Liposarcoma of the Extremities and Trunk Wall

Yoshihiro Nishida MD, PhD, Satoshi Tsukushi MD, PhD, Hiroatsu Nakashima MD, PhD, Naoki Ishiguro MD, PhD

Myxoid liposarcoma is generally considered a low grade tumor but the presence of areas of round cells exceeding 5% is reportedly associated with a worse prognosis. Whether “pure” tumors without round cells are low grade has not been confirmed. While radiotherapy has been used for patients’ myxoid liposarcoma it is unclear whether it reduces local recurrences.

Clinical and Treatment Outcomes of Planned and Unplanned Excisions of Soft Tissue Sarcomas

Eisuke Arai MD, Yoshihiro Nishida MD, PhD, Satoshi Tsukushi MD, PhD, Junji Wasa MD, Naoki Ishiguro MD, PhD

Soft tissue sarcomas are often inappropriately excised without adequate preoperative planning. Inappropriate (unplanned) excisions may adversely affect local recurrence, distant metastasis, patient survival, and /or postoperative function once properly evaluated.

The Survivorship of Protrusio Cages for Metastatic Disease Involving the Acetabulum

Mark Clayer MD

Metastatic disease commonly affects the proximal femur and occasionally the acetabulum. Surgical options include the use of a protrusio cage with a THA. However, the complications and survivorship of these cages for this indication is unknown.

Cemented Endoprosthetic Reconstruction of the Proximal Tibia: How Long Do They Last?

Adam J. Schwartz MD, J. Michael Kabo PhD, Fritz C. Eilber MD, Frederick R. Eilber MD, Jeffrey J. Eckardt MD

The few available studies documenting the long-term survival of cemented proximal tibial endoprostheses for musculoskeletal tumors do not differentiate between stem designs or patient diagnosis. There is wide variation in survival rates reported, possibly a result of this heterogeneity in patient population and implant design.

Double Ray Amputation for Tumors of the Hand

Mark E. Puhaindran MBBS, Edward A. Athanasian MD

Partial hand amputations for malignant tumors allow tumor resection with negative resection margins, which is associated with lower local recurrence rates and improved overall survival while preserving native tissue, which improves functional outcome.

How Long Do Endoprosthetic Reconstructions for Proximal Femoral Tumors Last?

Nicholas M. Bernthal MD, Adam J. Schwartz MD, Daniel A. Oakes MD, J. Michael Kabo PhD, Jeffrey J. Eckardt MD

As the life expectancy of patients with musculoskeletal tumors improves, long-term studies of endoprosthetic reconstructions are necessary to establish realistic expectations for the implants and compare them to other reconstruction approaches.

Chondrosarcoma of Bone: Lessons From 46 Operated Cases in a Single Institution

Olavo Pires Camargo MD, PhD, André Mathias Baptista MD, Marcelo Junqueira Atanásio, Daniel Reis Waisberg

Bone chondrosarcomas are rare malignant tumors that have variable biologic behavior, and their treatment is controversial. For low-grade tumors, there is no consensus on whether intralesional en bloc resections are the best treatment.