Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Tumor 246 articles

Articles

Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?

Todd E. Bertrand MD, Alex Cruz BS, Odion Binitie MD, David Cheong MD, G. Douglas Letson MD

Long-term survival for all patients with osteosarcoma using current aggressive adjuvant chemotherapy and surgical resection is between 60% and 70%. In patients who present with nonmetastatic, high-grade extremity osteosarcoma of bone, limb salvage surgery is favored, when appropriate, over amputation to preserve the limb, because limb salvage may lead to a superior quality of life compared with amputation. However, concern remains that in the attempt to preserve the limb, close or microscopically positive surgical margins may have an adverse effect on event-free survival.

Are Complications Associated With the Repiphysis® Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use?

Eric L. Staals MD, Marco Colangeli MD, Nikolin Ali MD, José M. Casanova MD, PhD, Davide M. Donati MD, PhD, Marco Manfrini MD

Reconstruction of the distal femur after resection for malignant bone tumors in skeletally immature children is challenging. The use of megaprostheses has become increasingly popular in this patient group since the introduction of custom-made, expandable devices that do not require surgery for lengthening, such as the RepiphysisLimb Salvage System. Early reports on the device were positive but more recently, a high complication rate and associated bone loss have been reported.

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

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 endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important.

Is Radiation Necessary for Treatment of Non-Hodgkin’s Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ishaq Ibrahim BS, Bryan D. Haughom MD, Yale Fillingham MD, Steven Gitelis MD

Non-Hodgkin’s lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.

An Unusual Cause of Lumbar Radiculopathy

Jesse Even MD, Gregory Gasbarro MD, Liron Pantanowitz MD, James Kang MD, Kurt Weiss MD

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Florian Sevelda MD, Reinhard Schuh MD, Jochen Gerhard Hofstaetter MD, Martina Schinhan MD, Reinhard Windhager MD, Philipp Theodor Funovics MD

Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures.

A High-grade Sarcoma Arising in a Patient With Recurrent Benign Giant Cell Tumor of the Proximal Tibia While Receiving Treatment With Denosumab

Luis A. Aponte-Tinao MD, Nicolas S. Piuzzi MD, Pablo Roitman MD, German L. Farfalli MD

A giant cell tumor of bone is a primary benign but locally aggressive neoplasm. Malignant transformation in a histologically typical giant cell tumor of bone, without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Although surgery is the standard initial treatment, denosumab, a monoclonal antibody drug that inhibits receptor activator of nuclear factor-κB ligand (RANKL), has shown considerable activity regarding disease and control of symptoms in patients with recurrence, unresectable, and metastatic giant cell tumors of bone.

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

Matthew T. Houdek MD, Eric R. Wagner MD, Anthony A. Stans MD, Alexander Y. Shin MD, Allen T. Bishop MD, Franklin H. Sim MD, Steven L. Moran MD

After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations.

Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Stein J. Janssen MD, Yvonne Braun MD, John E. Ready MD, Kevin A. Raskin MD, Marco L. Ferrone MD, Francis J. Hornicek MD, MS, PhD, Joseph H. Schwab MD, MS

Previous studies have shown that perioperative blood transfusion increases cancer recurrence and decreases patient survival after resection of primary malignancies. The question arises whether this association also exists in patients with already disseminated disease undergoing surgery for metastatic long-bone fractures.