Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Tumor 247 articles


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.

Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus

Xiaodong Tang MD, Wei Guo MD, PhD, Rongli Yang MD, Shun Tang MD, Tao Ji MD

Shoulder function often is limited after tumor resection and endoprosthetic replacement of the proximal humerus. This is partly attributable to the inability to reliably reattach rotator cuff tendons to the prosthesis and achieve adequate shoulder capsule repair with a metallic prosthesis. An option to attain these goals is to use synthetic mesh for the reconstruction, although the value of this method has not been well documented in the literature.

What is the Proportion of Patients With Multiple Hereditary Exostoses Who Undergo Malignant Degeneration?

Cory M. Czajka MD, Matthew R. DiCaprio MD

Multiple hereditary exostoses is an autosomal-dominant skeletal disorder that has a wide-ranging reported risk of malignant degeneration to chondrosarcoma.

Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Melanie J. Coathup BSc, PhD, Anish Sanghrajka MBBS, BS, William J. Aston BSc, MBBS, Panagiotis D. Gikas MBBS, BSc, MD, PhD, Robin C. Pollock MBBS, BSc, Stephen R. Cannon MA, MCh Orth, John A. Skinner MBBS, Timothy W. R. Briggs MBBS, MChOrth, Gordon W. Blunn BSc, PhD

Aseptic loosening of massive bone tumor implants is a major cause of prosthesis failure. Evidence suggests that an osteointegrated hydroxyapatite (HA)-coated collar would reduce the incidence of aseptic loosening around the cemented intramedullary stem in distal femoral bone tumor prostheses. Because these implants often are used in young patients with a tumor, such treatment might extend the longevity of tumor implants.We asked whether (1) HA-coated collars were more likely to osteointegrate; (2) HA collars were associated with fewer progressive radiolucent lines around the stem-cement interface; and (3) HA-coated collars were associated with less bone loss at the bone-shoulder implant junction?

Intramedullary Nailing of Femoral Diaphyseal Metastases: Is it Necessary to Protect the Femoral Neck?

Bryan Moon MD, Patrick Lin MD, Robert Satcher MD, PhD, Justin Bird MD, Valerae Lewis MD

Intramedullary nailing is the accepted form of treatment for impending or pathologic fractures of the femoral diaphysis. Traditional teaching promotes the use of a cephalomedullary nail so that stabilization is provided for the femoral neck in the event that a future femoral neck metastasis develops. However, that approach may add cost, surgical time, blood loss, and added radiation exposure to staff members, and there is limited evidence in the literature that supports this practice.

Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Robert W. Wysocki MD, Emily Soni MD, Walter W. Virkus MD, Mark T. Scarborough MD, Sue E. Leurgans PhD, Steven Gitelis MD

A giant cell tumor is a benign locally aggressive tumor commonly seen in the distal radius with reported recurrence rates higher than tumors at other sites. The dilemma for the treating surgeon is deciding whether intralesional treatment is adequate compared with resection of the primary tumor for oncologic and functional outcomes. More information would be helpful to guide shared decision-making.

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

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

Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed.

What Are the Functional Results and Complications From Allograft Reconstruction After Partial Hemipelvectomy of the Pubis?

S. Mohammed Karim MD, Matthew W. Colman MD, Santiago A. Lozano-Calderón MD, PhD, Kevin A. Raskin MD, Joseph H. Schwab MD, Francis J. Hornicek MD, PhD

In patients undergoing hemipelvectomies including resection either of a portion of the pubis or the entire pubis from the symphysis to the lateral margin of the obturator foramen while sparing the hip (so-called Dunham Type III hemipelvectomies), reconstructions typically are not performed given the preserved continuity of the weightbearing axis and the potential complications associated with reconstruction. Allograft reconstruction of the pelvic ring may, however, offer benefits for soft tissue reconstruction of the pelvic floor and hip stability, but little is known about these reconstructions.

How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?

Benjamin J. Miller MD, MS, Rajiv Rajani MD, Lee Leddy MD, Emily E. Carmody Soni MD, Jeremy R. White MD

There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions.

Locally Aggressive Fibrous Dysplasia Mimicking Malignancy: A Report of Four Cases and Review of the Literature

Saravanaraja Muthusamy MD, Ty Subhawong MD, Sheila A. Conway MD, H. Thomas Temple MD

Fibrous dysplasia is a benign fibroosseous bone tumor that accounts for 5% to 10% of benign bone tumors. It can present as monostotic fibrous dysplasia (70% to 80%), polyostotic fibrous dysplasia (20% to 30%), McCune-Albright syndrome (2% to 3%), or Mazabraud’s syndrome in rare cases. Bone lesions in fibrous dysplasia arise in the medullary canal and usually are confined to the bone. Cortical destruction and extension into soft tissue usually indicates malignant transformation or secondary aneurysmal bone cyst formation. Locally aggressive fibrous dysplasia with cortical destruction and extension into soft tissue in the absence of these two possibilities is extremely rare. It is important for the treating physician to distinguish this entity from more aggressive or malignant tumors to avoid overtreating the patient for a benign condition or inattention to a malignant tumor.