Femoral Tumor Research Articles

Comparative Analysis of Extended Curettage with Plate Fixation and Extended Curettage with Intramedullary Nail Fixation for Campanacci Grade Ⅱ and International Society of Limb Salvage Zone H2 Giant Cell Tumors of the Proximal Femur: A Retrospective Study.

BACKGROUND The objective of this study was to compare and evaluate the oncological and functional outcomes of 2 surgical treatments: extended curettage with plate fixation (EC-PF) and extended curettage with intramedullary nail fixation (EC-INF) for primary giant cell tumor (GCT) of the proximal femur. MATERIAL AND METHODS In a retrospective study, we reviewed 19 patients with Campanacci grade II and International Society of Limb Salvage zone H2 GCT of the proximal femur. All patients underwent either EC-PF (n=11) or EC-INF (n=8) surgery. The Mankin scoring system was used to evaluate the surgical effect, and the Musculoskeletal Tumor Society score was used to evaluate the limb salvage function of the patients. The between-group differences were analyzed at the end of follow-up. RESULTS During the follow-up period, there were no cases of recurrence or metastasis in both groups, and the EC-INF group had a higher rate of nononcological complications than the EC-PF group (62.5% vs 9.1%, respectively). Bone graft resorption and atrophy was the most frequent nononcological complication in the EC-INF group. According to the Mankin scoring system, the degree of hip joint function recovery in the EC-PF group was higher than that in the EC-INF group (P<0.05). Meanwhile, the EC-PF group had shorter hospital stays and higher Musculoskeletal Tumor Society scores (P<0.05). CONCLUSIONS Due to the high incidence of nononcological complications associated with intramedullary nailing as a method of internal fixation following extended curettage of the proximal femur GCT, this approach is generally not recommended.

Parathyroid Adenoma Presenting as Femoral Tumor Lesion in a 27-Year-Old Woman.

Metabolic bone diseases should be considered in the differential diagnosis of osteolytic lesions. Here, we describe a case of primary hyperparathyroidism with multiple osteolytic lesions that improved following parathyroidectomy.

Locking plate augmentation of polymethylmethacrylate-filled distal femoral defects: A biomechanical study.

Benign, locally aggressive tumors of the distal femur are typically treated with intralesional curettage and polymethylmethacrylate (PMMA) cementation. However, it is not known whether plate fixation should be added to biomechanically augment these PMMA-filled defects. The purpose of this study was to evaluate the performance of two competing techniques for reconstruction of a distal femoral defect. For this biomechanical study, we used 12 composite femurs with properties comparable to bone. In nine femurs, identical contained medial distal femoral defects were created using a robotic arm. Group A contained three intact femurs, Group B three femurs with an unfilled defect, Group C three femurs reconstructed with PMMA alone, and Group D three femurs reconstructed with PMMA plus a medial locking plate. Locations of greatest stress concentration were determined by PhotoStress analysis, then three strain gauges were applied to each specimen at these high-stress locations. Specimens were loaded within a physiologic range followed by loading to failure. Outcome measures included construct stiffness, strain along the distal femur, and load at failure. Results showed that stiffness and strain were not significantly different between reconstructive techniques; however, both techniques reduced tensile strain along the popliteal surface by approximately 40% compared to non-reconstructed specimens. All specimens failed at the femoral neck before failing at the distal femur. These findings suggest that plate augmentation of PMMA-filled distal femoral defects like the one in this study offers insignificant biomechanical benefit within physiologic loads and therefore may be unnecessary.

What Abductor Repair Technique Provides the Best Functional Outcomes after Proximal Femur Endoprosthetic Reconstruction for Oncologic Indications? A Systematic Review

There is conflicting data regarding the optimal abductor mechanism (AM) repair technique after resection of proximal femur tumors. We sought to compare functional outcomes following tumor resection and reconstruction with proximal femoral replacement based on the AM repair technique utilized. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We established two study groups based on AM repair technique as follows: soft-tissue reattachment (STr) and greater trochanter preservation (GTp). In the STr group, the gluteus medius and minimus muscles were reattached to the endoprosthesis, whereas in the GTp group, the greater trochanter and gluteal tendons were preserved. The STr group was further subdivided into direct and indirect reattachments. Weighted means adjusting for sample size were calculated. A total of 658 patients from 12 articles were included. Patients who had STr displayed higher Musculoskeletal Tumor Society scores (75 versus 67.3%, P < 0.001), lower rates of Trendelenburg gait (33.9 versus 52.4%, P < 0.01), and ambulation with assistive devices (30.4 versus 54.9%, P < 0.001) compared to the GTp group. Within the STr group, indirect reattachment was associated with higher Musculoskeletal Tumor Society scores (87.2 versus 70.1%, P < 0.001) and lower rates of Trendelenburg gait (3.8 versus 36.3%, P < 0.001) and ambulation with assistive devices (0 versus 42.4%, P < 0.001) compared to direct reattachment. The reattachment hardware failure rate in GTp was 15%. A STr provided superior functional outcomes compared to GTp in tumor-related proximal femoral replacement. From a functional outcome perspective, the use of indirect STr was better compared to direct STr. III.

An enhanced AlexNet-Based model for femoral bone tumor classification and diagnosis using magnetic resonance imaging

ObjectiveBone tumors, known for their infrequent occurrence and diverse imaging characteristics, require precise differentiation into benign and malignant categories. Existing diagnostic approaches heavily depend on the laborious and variable manual delineation of tumor regions. Deep learning methods, particularly convolutional neural networks (CNNs), have emerged as a promising solution to tackle these issues. This paper introduces an enhanced deep-learning model based on AlexNet to classify femoral bone tumors accurately. MethodsThis study involved 500 femoral tumor patients from July 2020 to January 2023, with 500 imaging cases (335 benign and 165 malignant). A CNN was employed for automated classification. The model framework encompassed training and testing stages, with 8 layers (5 Conv and 3 FC) and ReLU activation. Essential architectural modifications included Batch Normalization (BN) after the first and second convolutional filters. Comparative experiments with various existing methods were conducted to assess algorithm performance in tumor staging. Evaluation metrics encompassed accuracy, precision, sensitivity, specificity, F-measure, ROC curves, and AUC values. ResultsThe analysis of precision, sensitivity, specificity, and F1 score from the results demonstrates that the method introduced in this paper offers several advantages, including a low feature dimension and robust generalization (with an accuracy of 98.34 %, sensitivity of 97.26 %, specificity of 95.74 %, and an F1 score of 96.37). These findings underscore its exceptional overall detection capabilities. Notably, when comparing various algorithms, they generally exhibit similar classification performance. However, the algorithm presented in this paper stands out with a higher AUC value (AUC=0.848), signifying enhanced sensitivity and more robust specificity. ConclusionThis study presents an optimized AlexNet model for classifying femoral bone tumor images based on convolutional neural networks. This algorithm demonstrates higher accuracy, precision, sensitivity, specificity, and F1-score than other methods. Furthermore, the AUC value further confirms the outstanding performance of this algorithm in terms of sensitivity and specificity. This research makes a significant contribution to the field of medical image classification, offering an efficient automated classification solution, and holds the potential to advance the application of artificial intelligence in bone tumor classification.

Cemented and Press-fit Femoral Stems for the Management of Oncologic Femoral Tumors.

Stem fixation in reconstruction after resection of femoral tumors is debated. Cemented stems offer immediate stability but risk aseptic loosening, while press-fit stems allow bone ingrowth but risk stress shielding and subsidence. Our retrospective review aimed to determine implant failure rates and their associated factors, as well as the rates of infection, debridement, and mortality for both fixation groups (cemented or press-fit stems) used in patients undergoing resection of femoral tumor disease and subsequent arthroplasty. We retrospectively studied 252 patients who underwent resection of femoral tumors and subsequent arthroplasty using cemented (n = 173; 69%) or press-fit (noncemented) (n = 79; 31%) stems between 1999 and 2020. Implant failure was the primary outcome, with secondary outcomes including rates of implant infection, debridement, and mortality. Multivariable regression was done to assess risk factors for implant failures. The study found implant failure rates of 11% and 18% for cemented stems and press-fit stems, respectively. Lower stem to diaphyseal ratios ( P = 0.024) and younger patients ( P = 0.008) were associated with a higher risk of implant failure in cemented stems. The infection rates were 14% and 10% for cemented and press-fit stems, respectively. Debridement rates were 16% and 13% for cemented and press-fit stems, respectively, while the 1-year mortality rate was 16% for cemented stems and 1.5% for press-fit stems. This study is the largest of its kind, providing patient characteristics and outcomes in both cemented and press-fit stems in the setting of reconstruction for femoral tumors. Both methods can be effective, with outcomes dependent on patient-specific factors, such as life expectancy, activity level, and body habitus, as well as proper implant fit. Additional studies of both implants and longer follow-up are required to elucidate the optimal fixation method for each individual patient. Level III, retrospective noncomparative study.

Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing

Abstract Background: Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis. Questions/Purposes: Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee? Patients and Methods: Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score. Results: We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337). Conclusions: Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.

Clinical Perspectives on Surgical Reconstruction of Eccentric Tumors at the Distal Femur with Unicondylar Resection.

The distal femur is one of the most common sites for primary bone tumors. As the tumor progresses and bone destruction worsens, it can severely affect knee function and even pose a threat to life. In cases where only one condyle is affected and requires resection, preserving the healthy contralateral condyle can substantially enhance the biomechanics of the knee. Furthermore, preserving bone stock may enable future salvage procedures in the event of initial surgery failure, be it from fractures or osteoarthritis. Distal femoral unicondyle resection can offer better functional outcomes in select cases. However, it is essential to prioritize oncological safety with adequate margins over short-term knee function. Currently, the primary methods for reconstruction after the excision of a unicondylar tumor include allograft transplantation (bi- or uni-condylar) and prosthetic or allograft-prosthesis composite replacement (APC). However, there is currently some controversy regarding the optimal surgical reconstruction method, and a consensus within the academic community has yet to be reached. Moreover, due to the rarity of bone tumors, extensive clinical data from a single center is limited. Current studies are mainly retrospective and single-center, lacking sufficient cases and follow-up duration. This article reviews surgical reconstruction after solitary condylar excision in distal femoral tumors. It summarizes, compares, and analyzes mainstream reconstruction methods, exploring their technical details and clinical outcomes to highlight their potential in bone oncology.

Automatic segmentation of femoral tumors by nnU-net

BackgroundMetastatic femoral tumors may lead to pathological fractures during daily activities. A CT-based finite element analysis of a patient's femurs was shown to assist orthopedic surgeons in making informed decisions about the risk of fracture and the need for a prophylactic fixation. Improving the accuracy of such analyses ruqires an automatic and accurate segmentation of the tumors and their automatic inclusion in the finite element model. We present herein a deep learning algorithm (nnU-Net) to automatically segment lytic tumors within the femur. MethodA dataset consisting of fifty CT scans of patients with manually annotated femoral tumors was created. Forty of them, chosen randomly, were used for training the nnU-Net, while the remaining ten CT scans were used for testing. The deep learning model's performance was compared to two experienced radiologists. FindingsThe proposed algorithm outperformed the current state-of-the-art solutions, achieving dice similarity scores of 0.67 and 0.68 on the test data when compared to two experienced radiologists, while the dice similarity score for inter-individual variability between the radiologists was 0.73. InterpretationThe automatic algorithm may segment lytic femoral tumors in CT scans as accurately as experienced radiologists with similar dice similarity scores. The influence of the realistic tumors inclusion in an autonomous finite element algorithm is presented in (Rachmil et al., "The Influence of Femoral Lytic Tumors Segmentation on Autonomous Finite Element Analyses", Clinical Biomechanics, 112, paper 106192, (2024)).

3D-printed Multifunctional Guide Plate for Fenestration and Screws Drill in Proximal Femoral Benign Tumor.

The accurate fenestration, screw implantation and assisting stabilizing-plate placement in surgery of benign tumors in the proximal femur needs be defined easily. The aim of this study was to investigate the value of 3D printed multifunctional guides plate (3D-MGP) based on computer aided design. Between January 2020 and June 2022, 17 patients (nine females and eight males) with benign proximal femoral tumor had lesion curettage and allograft combined with internal plate fixation using 3D-MGP. In this study, the patients had CT scans and a technician reconstructed the 3D images of tumor and the femur, a doctor designed the location and margin of the fenestration and screws, and integrated different functions into MGP for benign proximal femoral lesions, which assisted in precise localization, fenestration and screw drilling. Musculoskeletal Tumor Society (MSTS) scoring was used to evaluate lower extremity function. Bone healing and the screws location was assessed with the radiographs. All patients underwent successful surgery with complete resection of the tumor and internal fixation with using the 3D-MGP. The mean follow-up was 16.4 months. The operative time was 126.47 ± 18.44 min, intraoperative bleeding was 198.23 ± 67.94 mL, intraoperative fluoroscopy was 6.47 ± 0.62, postoperative drainage was 223.82 ± 119.51 mL, and MSTS score was 27.29 ± 1.31 points. There were no unplanned fenestration and improper screw fixation. The 3D-MGP enabled personalized and accurate location of tumor, fenestration, screw placement and assisted stabilizing-plate placement for the treatment of benign tumor of the proximal femur. This technique has the potential to shorten operative times, decrease intraoperative bleeding, and reduce radiation exposure to patients.

Clinical application of LARS tumor tube in joint function reconstruction of tumor type artificial hip replacement.

Proximal femur tumor resection often leads to hip joint instability and functional loss. Various methods have been clinically applied to repair hip joint soft tissue function, but deficiencies remain. This study aims to evaluate the advantages and disadvantages of the ligament advanced reinforcement system (LARS) tumor tube in assisting soft tissue function reconstruction in patients undergoing tumor type artificial hip replacement surgery. This study included 85 patients (41 males, 44 females) with proximal femoral tumors treated at the Xiangya Bone Tumor Treatment Center from January 2012 to January 2022, aged 10 to 79 (38.5±18.2) years. Among them, 13 cases had benign aggressive tumors, 45 had primary malignant bone tumors, and 27 had bone metastases. Clinical data, imaging data, and intraoperative photos were collected. Patients were followed up and postoperative functional evaluations were conducted using the Musculoskeletal Tumor Society (MSTS) scoring system and Harris hip joint scoring system to assess limb function and hip joint function. Preoperative pathological fractures were present in 37 cases (43.5%), with a lesion length of (9.4±2.9) cm. Among non-metastatic tumor patients, 7 experienced postoperative recurrence, including 6 cases of osteosarcoma and 1 case of fibrosarcoma. Pulmonary metastases occurred in 9 osteosarcoma patients. Five patients required reoperation due to postoperative complications, including 3 cases of deep vein thrombosis, 1 case of giant cell granuloma, and 1 case of prosthesis infection. Postoperatively, 5 patients exhibited Trendelenburg gait, and 6 had leg length discrepancies. The postoperative MSTS score was 26.7±1.4, and the Harris score was 89.6±5.3. The LARS tumor tube can effectively assist in reconstructing the soft tissue function of the hip joint and greatly reduce postoperative complications, making it an effective technical improvement in joint function reconstruction in tumor type artificial hip replacement surgery.

Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur

To illustrate the surgical technique and explore clinical outcomes of the reconstruction for the malignant and metastatic bone tumour of proximal femur with metallic modular intercalary prosthesis. Sixteen patients who underwent modular intercalary prosthetic reconstruction after tumour resection were included from April 2012 and October 2020. Prosthesis and screws parameters, resected bone length and residual bone length, clinical outcomes and survivorship were analyzed. All patients were followed up for an average of 19 months (range 1–74). In our series, 12 patients died of the progression of the primary disease at the final follow-up. The cumulative survivorship since the treatment of proximal femoral metastasis was 78.6% (11 patients) at 6 months and 38.5% (5 patients) at 1 year. The mean MSTS score was 22.25 ± 4.55 among all patients. There were no cases of loosening or breakage of the prostheses, plates or screws, despite the various measurements of prostheses and residual bones. Modular intercalary prosthetic reconstruction was an effective method for malignant tumour of the proximal femur, including the advantages of providing early pain relief, quickly restoring postoperative function, required a short operation time, and preserving the adjacent joints.

Coverage of lateral soft tissue defects with sartorius muscle flap after distal femoral replacement for malignant bone tumors.

To prevent infection after limb-sparing surgery for primary malignant bone tumors, it is important to cover the megaprosthesis with muscle tissue that has sufficient blood flow. Coverage with a lateral gastrocnemius flap has been reported in cases of distal femoral replacement in which the vastus lateralis and vastus intermedius muscles have been resected; however, the risk of peroneal nerve palsy is reportedly high because the muscle flap passes near the peroneal head. This study was performed to examine the postoperative outcomes of patients with primary malignant bone tumors of the distal femur who underwent wide resection (including the vastus lateralis and vastus intermedius muscles) followed by reconstruction with a megaprosthesis and coverage of the lateral side of the prosthesis with a sartorius muscle flap. We retrospectively analyzed three patients who underwent reconstruction with a megaprosthesis after wide resection of a primary malignant bone tumor of the distal femur involving the vastus lateralis and vastus intermedius muscles and reconstruction of the soft tissue defect on the lateral side of the prosthesis with a sartorius muscle flap. The average defect size was 6×13cm, the average time required for a sartorius muscle flap was 100min, and the average implant coverage was 93%. The average postoperative follow-up period was 35 months, during which no postoperative complications such as infection, skin necrosis, or nerve palsy occurred. The distally based sartorius muscle flap is easy to elevate in the supine position, has minimal functional loss after harvesting, and has minimal risk of nerve palsy. It can be advocated as the first option for coverage of soft tissue defects lateral to distal femoral replacement.

Assessing the influence of gastrocnemius reconstruction on stress distribution of femoral tumor rotating hinge knee prosthesis via finite element analysis.

After femoral oncological knee arthroplasty, some patients suffer from rotating axis fracture, which significantly impacts the life span of the rotating hinge knee (RHK) prosthesis. This research aimed to analyze the biomechanical response of anatomical gastrocnemius reconstruction and assess whether it could reduce the risk of rotating axis breakage by finite element (FE) analysis. A femur-prosthesis-tibia FE model was established using the data from CT scans. The mechanical properties of the RHK implant were quantitatively compared before and after gastrocnemius reconstruction at 6 angles: 10°, 20°, 30°, 40°, 50°, and 60°. Our results showed that gastrocnemius reconstruction effectively altered the stress distribution around the rotating axis, considerably relieving the stress in the fracture-prone region. In addition, the peak stress in the rotating axis, bending axis, prosthesis stem, and femoral condyles decreased variably. In distal femoral resection knee arthroplasty, the rebuilding of gastrocnemius substantially improved the stress distribution within the prosthesis, thereby having the potential to reduce the risk of prosthetic fracture and prolong the overall durability of the prosthesis.

The Functional Outcome of Limb Salvage of Proximal Femur Tumors With Modular Endoprosthesis: A Prospective Study.

Introduction The proximal femur is a common siteforprimary bone sarcomas, includingEwing's sarcoma, chondrosarcoma, osteosarcoma, and giant celltumors (GCT). Extensive resections arechallengingto reconstruct because the size of the tumormay necessitate an extensive resection ofthefemur to achieve adequate oncologic clearance. The resection of the proximal femur can result inhip jointinstabilitydue totheloss of the strong native hipcapsule orhip abductor strength. With a wide range of reconstruction options,such asresection arthrodesis, allograft-prosthetic composite (APC),andendoprosthesis,we can achieve limb salvage with good functionaloutcomes. Objective The objective of this case series isto evaluate the clinical outcomes and complications associatedwith endoprosthesis replacement in patients with proximal femur tumors. Methods A prospective analysis was conducted with 32 patients who underwent modular endoprosthesis replacement for proximal femoral tumors at our institution. Patient data, tumor characteristics, surgicaldetails, and postoperative outcomes were collected and analyzed. Results The study involved 32 patientswho met theinclusion criteria.Theywere assessed usingthe MusculoskeletalTumor Society Score (MSTS), which showedgoodfunctional outcomesin72.84%of the patients. The study highlights the functionaloutcomes and potential complications associated with the use of modular prostheses. Conclusion Endoprosthesis replacement in proximal femur tumors is a viable treatment option, providinggood functional outcomes and an acceptable method for limb salvage, which enhances the quality of life.

Long-term effectiveness of uncemented allograft-prosthesis composite for reconstruction of bone defects after proximal femur tumor resection

To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection. Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded. All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients. Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.

Retracted: Clinical Application of Artificial Intelligence: Auto-Discerning the Effectiveness of Lidocaine Concentration Levels in Osteosarcoma Femoral Tumor Segment Resection.

[This retracts the article DOI: 10.1155/2022/7069348.].

Proximal femoral tumor resection followed by joint prosthesis replacement: a systematic review and meta-analysis

BackgroundThis study aimed to determine the prognostic outcome of hip joint replacement after resection of proximal femoral tumors by reviewing original studies.MethodsTwo researchers independently searched PubMed, Embase, Cochrane Library, and Web of Science databases from inception to July 17, 2022. Then, the literature was screened by inclusion criteria. The basic information, primary outcomes, and secondary outcomes were extracted for weighted combined analysis. The quality of the included literature was evaluated using the Newcastle–Ottawa scale.ResultsTwenty-four retrospective cohort studies comprising 2081 patients were included. The limb salvage rate was 98%. The survival rates at 1, 2, 3, 4, and 5 years were 80, 72, 65, 64, and 55% for patients with primary tumors and the rate at 1, 2, 3, 4, and 5 years were 44, 25, 17, 14, and 11% for patients with bone metastases, respectively.ConclusionAs chemotherapy and radiotherapy treatment progressed, joint reconstruction after proximal femoral tumor resection improved patients' function and quality of life.

Outcomes of Vascular Surgery Performed Jointly With Other Departments.

The purpose of this study is to evaluate the results of vascular surgery performed at our hospital, a tertiary emergency general hospital, in patients undergoing surgery in other departments. The results of the study were reviewed. The study included cases in which cardiovascular surgery was performed at the request of other departments over a 15-year period from January 2006 to October 2022. Patient backgrounds, departments that requested surgery, surgical procedures, use of extracorporeal circulation, and surgical techniques were reviewed. Patients with femoral artery exposure or ECMO removal during transcatheter aortic valve implantation (TAVI) requested by cardiology were excluded. There were 58 vascular surgery cases requested by other departments during the study period. The age was 63±14 years, 43 (74%) were male and 15 (26%) were female. The departments of the patients were urology in 29 (50%), gastroenterology in 18 (31%), orthopedics in seven (12%), emergency department in three (5%), and obstetrics and gynecology in one (2%). The following surgical procedures were performed: tumor resection and reconstruction due to tumor invasion of the inferior vena cava in 27 cases (47%), bypass to secure intraperitoneal arterial blood flow in 15 cases (26%), bypass during resection of the femoral tumor in four cases (7%), hemostasis due to trauma in three cases (5%), intraperitoneal hemostasis in three cases (5%), thrombectomy in two cases (3%), and others in four cases (7%). Extracorporeal circulation was used in six (10%) of the patients. A 15-year case study of vascular surgery supports operations requested by other departments at our hospital. All reconstructed sites were open at the time of discharge.

Comparison of the clinical outcomes of intramedullary nailing between impending and completed pathological fractures caused by metastatic femoral tumors from solid cancers

BackgroundWe examined the treatment outcomes following intramedullary nailing in patients with metastatic femoral tumors, excluding those from hematological malignancies. MethodsWe retrospectively evaluated treatment outcomes following intramedullary nailing between patients who underwent preventative surgery compared with those who had surgery following pathological fracture. Patients who underwent preventative surgery (Mirels’ score ≥8) were allocated to the impending fracture group (n = 11) and those who underwent surgery after pathological fracture were allocated to the completed fracture group (n = 20). ResultsDuration of surgery was significantly shorter in the impending fracture group than in the completed fracture group. Median blood loss was significantly less, and the median duration of hospital stay was significantly shorter in the impending fracture group than in the completed fracture group. Among patients who died following surgery, the median postoperative survival duration was significantly longer in the impending fracture group than in the completed fracture group. Significantly more patients regained walking function in the impending fracture group than in the completed fracture group. Regarding complications, infection occurred in one patient in the completed fracture group. No implant damage was observed in either group. ConclusionsPatients with metastatic femoral tumors who underwent intramedullary nailing in the impending fracture group had better postoperative survival and gait function, less blood loss, and shorter durations of surgery and hospital stay than those in the completed fracture group. These findings indicate the importance of early diagnosis and treatment and value of treatment prior to fracture occurrence.