Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 468 | Issue 11 | Nov, 2010

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Does the Upward Migration Index Predict Function and Quality of Life in Arthroscopic Rotator Cuff Repair?

Peter C. Lapner MD, FRCSC, Yingua Su BSc (H), David Simon MD, Salah El-Fatori MD, Emilio Lopez-Vidriero MD, PhD

Although upward humeral head migration is a well-recognized phenomenon in patients with tears of the cuff, it is unclear whether it relates to patient function after cuff repair. The upward migration index (UMI) assesses proximal migration of the humeral head while controlling for patients’ bony morphologic features.

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Kevin L. Ong PhD, Edmund Lau MS, Jeremy Suggs ScD, Steven M. Kurtz PhD, Michael T. Manley FRSA, PhD

Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care.

Use of Morphometry to Quantify Osteolysis after Total Hip Arthroplasty

Lindsay K. Smith MSc, MCSP, Fiona Cramp PhD, MCSP, Shea Palmer PhD, MCSP, Nikki Coghill PhD, Robert F. Spencer MD, FRCS

Progressive osteolysis threatens the longevity of hip arthroplasties and radiographic review is recommended. Measurement of osteolytic lesions in a clinical setting has not been achieved easily in the past. Other radiologic investigations provide accurate information but cost and risk to the patient prohibit their use in routine review.

Osteolysis in Well-functioning Fixed- and Mobile-bearing TKAs in Younger Patients

Young-Hoo Kim MD, Yoowang Choi MD, Jun-Shik Kim MD

Periprosthetic osteolysis is an increasingly prevalent complication of TKA. To reduce the polyethylene wear and periprosthetic osteolysis, particularly in young patients, the design of the contemporary fixed-bearing TKAs has been modified and mobile-bearing TKAs have been introduced.

The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

Turlough O’Donnell MB, BCh, FRCSI, FRCS (Orth and Trauma), Michael J. Neil MB, BS, FRACS (Orth), FRCSEd (Orth), FAOrthA

Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. UKA using minimally invasive surgery (MIS) has the theoretical advantage of less bone resection and quicker rehabilitation. Whether the function of patients with UKA compares with that of patients with conventional TKA is unclear.

Analysis of Nondiagnostic Results after Image-guided Needle Biopsies of Musculoskeletal Lesions

Justin Yang MD, Frank J. Frassica MD, Laura Fayad MD, Douglas P. Clark MD, Kristy L. Weber MD

Image-guided needle biopsies are commonly used to diagnose musculoskeletal tumors, but nondiagnostic (ND) results can delay diagnosis and treatment. It is important to understand which factors or diagnoses predispose to a ND result so that appropriate patient education or a possible change in the clinical plan can be made. Currently it is unclear which factors or specific lesions are more likely to lead to a ND result after image-guided needle biopsy.

Increased Chondrocyte Death after Steroid and Local Anesthetic Combination

Boglárka Farkas MD, Krisztián Kvell MD, PhD, Tamás Czömpöly MD, PhD, Tamás Illés MD, PhD, Tamás Bárdos MD, PhD

Hyaline articular cartilage has limited repair and regeneration capacity. Intraarticular administration of glucocorticoid and local anesthetic injections play an important role in the therapy of osteoarthritis. Glucocorticoids and anesthetics reportedly enhance apoptosis in chondrocytes, but effects of the combined use of glucocorticoids and local anesthetics are unknown.

Case Report: Osteonecrosis of the Femoral Head after Hip Arthroscopy

Danielle L. Scher MD, Philip J. Belmont MD, Brett D. Owens MD

Hip arthroscopy is a common orthopaedic procedure used as a diagnostic and therapeutic tool with a multitude of surgical indications. The complication rate is reportedly between 1.3% and 23.3%. Major complications are related to traction, fluid extravasation, and iatrogenic chondral injury. Although osteonecrosis is a concern with any surgical procedure about the hip, this complication has been primarily a theoretical concern with hip arthroscopy.

Case Report: Neuropathic Arthropathy of the Hip as a Sequela of Undiagnosed Tertiary Syphilis

Nicholas A. Viens MD, Tyler Steven Watters BA, Emily N. Vinson MD, Brian E. Brigman MD, PhD

Neuropathic arthropathy is characterized by rapidly progressive bone destruction in the setting of impaired nociceptive and proprioceptive innervation to the involved joint. It is seen most commonly in the foot and ankle, secondary to peripheral neuropathy in patients with diabetes mellitus. Other less common sites of involvement may include the knee, hip, shoulder, and spine, depending on the underlying etiology. Neuropathic arthropathy can be associated with tabes dorsalis, a unique manifestation of late, tertiary neurosyphilis that may arise in individuals with untreated syphilis many years after initial infection, and usually involves the knee, or less commonly, the hip.

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