Mean Musculoskeletal Tumor Society Score Research Articles

Single-Centre Experience Regarding the Use of Fibular Graft for Reconstruction after Resection of Grade III GCT of Distal Radius.

Background: A giant cell tumour (GCT) is a locally invasive benign tumour of bone in young adults. Treatment includes surgical resection as first-line or denosumab pharmacotherapy in inoperable patients. However, surgical resection of distal radius GCT has produced debatable functional outcomes. Here we study the use of fibular grafts for reconstruction of surgically resected GCT of the distal radius. Methods: A total of 11 patients having Grade III GCT of the distal radius were recruited for a retrospective single-centred study. Five underwent arthrodesis with fibular shaft graft and six received arthroplasty with the proximal fibula. Functional outcomes at 6 weeks, 6 and 12 months were measured by Mayo wrist score (MWS) (>51% = good) and Revised Musculoskeletal tumor society (MSTS) score (>15 = good). Results: At 6 weeks, mean MSTS score and MWS were 23.64 and 58.64% respectively, and the length of the fibular graft was a predictor for both MSTS score (p = 0.014) and MWS (p = 0.006). At 6 months, the mean MSTS and MWS were 26.36 and 76.82%, respectively. At 6 months, the surgical procedure was a predictor in MSTS score (p = 0.02) while MWS was predicted by length of graft (p = 0.02). At 12 months, MSTS score was 28.73, and MWS remained 91.82%. Length of the fibular graft was an insignificant predictor, but a significant risk factor was surgical procedure for MWS (p = 0.04) at 12 months. No variable was found significant for MSTS score. Conclusions: Resection along with reconstruction of Grade III GCT of the radius with fibular graft was found an optimal treatment option. Also, use of the fibular head grafts and shorter length grafts are predictors for better outcomes after surgery. Level of Evidence: Level IV (Therapeutic).

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas

(1) Background: Resection of soft-tissue sarcomas (STS) of the upper extremity can result in substantial functional impairment with limited options for functional reconstruction. Free functional latissimus flaps have been utilized to restore function of the thigh; however, there is limited data on the use of latissimus flaps for functional reconstruction in the upper extremity. As such, we sought to evaluate our institutional experience with these flaps. (2) Methods: We reviewed ten (seven male; three female; and a mean age of 63 years) patients undergoing soft-tissue sarcoma resection involving the triceps (n = 4), biceps (n = 4), and deltoid (n = 2) reconstructed with a pedicled functional latissimus flap. All surviving patients had at least 1 year of follow-up, with a mean follow-up of 5 years. (3) Results: The mean elbow range of motion and shoulder elevation were 105° and 150°. The mean Musculoskeletal Tumor Society score was 88%, and the muscle strength was four. Four patients had a recipient site wound complication. There were no flap losses. One patient sustained a radiation-associated humerus fracture 5 years postoperatively, treated nonoperatively. (4) Conclusions: Although early complications are high, pedicled functional latissimus flaps allow for wound coverage, potential space obliteration, and restoration of function in the upper extremity following resection of large soft tissue sarcomas.

GMRS Oncological Prosthesis with a Porous Coating Collar: A Good Option for Revision of Aseptic Loosening in the Lower Extremity.

Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) prosthesis after revision? and (2) what are the long-term functional outcomes of these patients? We retrospectively reviewed 16 patients who developed aseptic loosening of a lower extremity prosthesis. There were nine males and seven females with a mean age of 28 years (range, 14-55 years). The 5-year and 8-year survivorship of the prosthesis were calculated. Function outcome was evaluated according to the score of the Musculoskeletal Tumor Society (MSTS). At a mean of 90 months follow-up (range, 52-118 months), the cumulative survival of all revision prosthesis was 94% at both 5 and 8 years. There were two prosthesis failures including one infection and one repeated aseptic loosening. At the last follow-up, except for the infection case, 93.3% (14/15) of the patients did not develop repeated aseptic loosening. The mean MSTS score was 27.7 (range, 24-30). GMRS prosthesis demonstrated significant satisfactory long-term outcomes for revisions of lower extremity oncological prosthesis.

Scapular Osteosarcoma Treated by Scapulectomy with or Without Scapular Allograft: A Retrospective Case Series.

Osteosarcoma of the scapula is extremely rare. Hence, there is no consensus regarding its optimal management. In this study, we report the demographics, characteristic features, and outcomes of scapulectomy with or without scapular allograft reconstruction in a series of patients with primary scapular osteosarcoma. Twelve patients with primary scapular osteosarcoma who were treated by scapulectomy with or without scapular allograft reconstruction (five and seven patients, respectively) were included. The allograft was fixed in place using a dacron tape without a plate or screw. The function of the shoulder was evaluated using the Musculoskeletal Tumor Society (MSTS) score for the upper extremity and Toronto Extremity Salvage Score (TESS). The study population included seven (58.3%) males and five (41.7%) females with a mean age of 30 ± 8.2years. The histologic type of the tumor was osteoblastic in the majority of patients (n = 8, 66.7%). At an average follow-up of 6.5 ± 2.3years, only one local recurrence (8.3%) occurred in our patients that coincided with lung metastasis. The mean MSTS score was 78.7 ± 3.8% and 66.2 ± 4% in patients with and without scapular allograft, respectively (P = 0.006).‏ The mean TESS was 78.6 ± 5.6 and 68.4 ± 2.4 in patients with and without scapular allograft, respectively (P = 0.005).‏ The overall 5-year survival of the patients was 85.7%. ‏ Osteosarcoma of scapula more frequently occurs in the fourth decade of life, mainly presented with a sclerotic radiologic appearance. Patients with scapular allograft impaction after scapulectomy have better functional outcomes compared to those without boney reconstruction.

A case study on recurrent giant cell tumor of distal end radius

Abstract Background: Based on location distal end radius is the second most common for giant cell tumors (GCTs) followed by the knee. Like at any other location, they are treated with extended curettage or resection but reports of recurrence are increasingly coming up. In this study, we aim to treat the recurrent distal end radius GCTs and their outcome after Index surgeries. Materials and Methods: This case report was done in the year 2022–2023 on a patient with recurrent distal end radius GCT of age of 30 years. Recurrence had occurred after curettage and even after resection as index surgery. The recurrent lesion was treated with resection, excisional biopsy, fibula strut grafting, and wrist arthrodesis. The follow-up period was 12 months. Results: In various studies, when the patients with joint preservation were treated with curettage and those with resection of soft tissue recurrences were done with salvage of joint had better functional outcomes with a mean musculoskeletal tumor society (MSTS) score. In our case with arthrodesis using fibular strut grafting had a low MSTS score. The overall functional outcome was satisfactory. Conclusions: We conclude that local recurrence of GCT after curettage in long bones if contained within the bone and/or extending into the soft tissue, can be successfully treated with further more extensive surgery in an attempt to obtain wide margins with minimal risk of increased morbidity. It does increase some morbidity but there is significant gain with respect to the cure of the disease.

Use of Three-Column Reconstruction and Free Vascularized Fibular Grafts for the Repair of Large Tibial Defects after Tumor Resection.

This study aimed to evaluate the clinical outcomes of three-column reconstruction of the lower leg using a single-barrel contralateral vascularized fibular graft (VFG), medial locking plate, and the ipsilateral fibula for the repair of large tibial defects after tumor resection. In this retrospective study, we reviewed 12 patients who underwent three-column reconstruction using a single-barrel contralateral VFG, medial locking plate, and the ipsilateral fibula between June 1996 and May 2020. These patients had large tibial bone defects following tumor resection. The mean age of the patients was 26.3 years (range, 11-63 years), and 7 of them were women. The mean follow-up period was 104.8 months (range, 26-284 months). The mean size of the tibial bone defect after tumor resection was 17.8 cm (range, 11-26.8 cm). The clinical and radiological outcomes were evaluated at the final follow-up. All patients survived beyond the final follow-up without recurrence of the primary bone tumor. The mean time from reconstruction to bony union at both host-graft junctions was 12.9 months (range, 4-36 months). The mean Musculoskeletal Tumor Society score was 82.3% (range, 60%-97%). All tibial defects were reconstructed with adequate bone healing. There were 4 cases of stress fracture and graft failure; these were resolved by using longer plates and more screws. All patients were ambulatory without assistance and showed no permanent complications. Large tibial defects that occur after tumoral resection can be effectively reconstructed by three-column reconstruction using a medial locking plate, an inlay single-barrel VFG harvested from the contralateral side, and the intact ipsilateral fibula. This technique permits early weight-bearing before fibular hypertrophy and bony union.

Total Synovectomy and Bone Grafting/Cementation after Curettage of the Bone Lesion in Diffuse‏ Type ‏of Tenosynovial‏ Giant Cell Tumor‎: A Retrospective Cohort Study.

Although the diffuse type of tenosynovial giant cell tumor (D-TGCT) is rare, bone involvement is common in such lesions. However, the optimal management of bone lesions in D-TGCT is not well-described. In this study, we reported the outcomes of total synovectomy, curettage, and bone grafting/cementation in the treatment of D-TGCT with subchondral bone involvement. We also described the prevalence, demographic, and characteristic features of the lesions. In a retrospective study, we included 13 patients with D-TGCT of large joints and associated subchondral cyst/cyst-like bone lesions of ≥ 5 mm that were managed with total synovectomy and curettage. Cavities with a bone defect of ≤ 30 mm (n=12) were filled with bone grafts. Cavities of > 30 mm (n=1) were augmented with bone cement. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score. The study population consisted of 6 (46.1%) males and 7 (53.9%) females with a mean age of 30 ± 7.9 years. The most frequent sites of involvement were the knees and ankle joints (n=5 each, 38.5%). The mean follow-up of the patients was 69.2 ± 32.9 months. The mean MSTS score of the patients was obtained at 98.2 ± 3.2 (range 90-100). The D-TGCT recurred in two patients, both of which were in the synovium. Postoperative complications were three cases of transient pain and one case of knee joint stiffness. While no patient had an osteoarthritic change in preoperative radiographs, two patients had osteoarthritic change (grade II) in the last follow-up, one in the knee and one in the hip. Curettage and filling the defect with bone graft or cement are adequate treatments for managing bone lesions in D-TGCT.

Intraosseous Ganglion Cyst of the Talus Treated With Curettage and Bone Grafting Through a Medial Malleolus Osteotomy.

Intraosseous ganglion cyst (IGC) of the talus is a rare entity. There is no consensus regarding the best surgical approach to the talus. In this study, we evaluated the outcomes of curettage and bone grafting of the talus IGC via medial malleolus osteotomy. Seventeen patients with talus IGC who were treated between 2002 and 2020 using curettage and bone grafting through a medial malleolus osteotomy were included. The outcome measures were ankle range of motion (ROM), pain, and function. The ankle pain was evaluated by the visual analog scale (VAS). The ankle function was evaluated by the Toronto extremity salvage score (TESS) and Musculoskeletal Tumor Society (MSTS) score. The study population included 10 men and 7 women with a mean age of 34.9 ± 18.8 years and a mean follow-up of 5.4 ± 3 years. The mean size of the lesion was 2.6 ± 0.8 cm. Postoperatively, mean ankle dorsiflexion and plantar flexion were 19.4 ± 5.8 degrees and 36.7 ± 5.3 degrees, respectively. The mean VAS was 0.9 ± 1.1. The mean MSTS score and TESS were 96.2 ± 3.5 and 94.5 ± 4.1, respectively. Two patients developed ankle osteoarthritis after 3 years (1 stage I and 1 stage II). One of these patients (stage II) also had recurrence after 6 months (recurrence rate: 6.7%). Talus IGC could be adequately managed with curettage and bone grafting through a medial malleolus osteotomy. Even so, mild pain and reduced ankle ROM remain in some patients. Level IV, retrospective cohort study.

Clinical Outcomes of Soft Tissue Sarcoma around the Elbow Joint: A Retrospective Single Institution Study.

We report a retrospective case series analysis of clinical outcomes of patients with soft tissue sarcoma around the elbow. Twenty-two patients underwent surgical tumor excision between January 1999 and May 2017, with a mean follow-up of 85.2 months. Six tumors were localized in the upper arm, nine in the elbow, and seven in the forearm. Sixteen tumors were deep-seated, and six were superficially located. Fifteen patients underwent wide excision, including one amputation, and 18 achieved (81.8%) negative margins histologically. Two local recurrences and four distant metastases developed. The mean Musculoskeletal Tumor Society score was 92.0% (range, 33.3-100). The 5-year local recurrence-free survival rate, metastasis-free survival rate, and overall survival rate were 90.0%, 77.0%, and 79.7%, respectively. Local control and limb function can have favorable outcomes when the tumor excised has a histologically negative margin without sacrificing the major structure.

Reconstruction after Talar Tumor Resection: A Systematic Review

This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases identified 156 studies, of which 20 (23 patients) were ultimately included. The mean Musculoskeletal Tumor Society scores in the groups reconstructed using tibiocalcaneal fusion (n = 17), frozen autograft (n = 1), and talar prosthesis (n = 5) were 77.6 (range 66-90), 70, and 90 (range 87-93), respectively. Regarding complications, sensory deficits were observed in one patient (6%) and venous thrombosis in two patients (12%) in the tibiocalcaneal fusion group, while osteoarthritis was observed in one patient (100%) in the frozen autograft group. No complications were observed in the talar prosthesis group. Reconstruction with talar prosthesis seems preferable to conventional tibiocalcaneal fusion after talar tumor resection because it offers better function and fewer complications. However, as this systematic review included only retrospective studies with a small number of patients, its results require re-evaluation in future randomized controlled trials with larger numbers of patients.

Functional Outcome Following Proximal Tibial Osteosarcoma Resection and Reconstruction by Modular Endoprosthesis

PurposeThe proximal tibia is a common location for osteosarcoma. Modular endoprosthesis is a popular reconstructive option, yet it has been associated with many complications. Our study aimed to evaluate the functional outcome and complications of proximal tibial osteosarcoma patients treated by limb salvage using modular endoprosthesis.MethodsA retrospective study of a prospective database was performed during the period between January 2000 and July 2017. Fifty-five patients with proximal tibial osteosarcoma underwent resection and modular endoprosthetic reconstruction. The functional outcome was evaluated using the Musculoskeletal tumor society scoring system and knee range of motion. Postoperative complications were classified according to Henderson classification; Type 1 (soft tissue failure), Type 2 (aseptic loosening), Type 3 (structural failure), Type 4 (infection) and Type 5 (local tumor progression).ResultsThe mean follow-up period was 71.69 ± 49.76 months. The mean musculoskeletal tumor society score was 26.5 ± 2.22; the mean range of motion was 72.63 ± 25.07, and the mean extension lag was 15.09 ± 15.38. Type 1, type 2, type 3, type 4, and type 5 complications occurred in 7.3%, 14.5%, 21.8%, 23.6%, and 5.5%, respectively. Chest metastasis developed in 10 patients (18.2%). The estimated 5-year and 10-year survival rates for the treated patients were 83.6% and 79.9%.ConclusionsProximal tibial osteosarcoma reconstruction with a modular endoprosthesis is a reliable treatment option for retaining limb function. Most complications are manageable.

Free Fibula Reconstruction for Bone Tumors Involving Humerus: Our Experience

Background Malignant primary bone tumors constitute only 0.2% of all malignancies in adults and approximately 5% of childhood malignancies. The humerus is a common site for malignancies like chondrosarcoma, osteosarcoma, Ewing sarcoma, and metastatic carcinomas. Management consists of multimodality treatment including chemotherapy, radiotherapy, and surgery depending on histology of the tumor and response to therapy. Reconstruction of humerus following oncological resection is a challenging procedure and the surgical options include endoprosthesis, plates, avascular bone grafts, and vascularized autologous bone using microvascular surgery. Materials and Methods This was a single institutional, retrospective observational study conducted at a tertiary cancer center in Northeast India from June 2018 to March 2020. All the reconstructions were done with free fibular osseous flap. Postoperative outcome was measured with Musculoskeletal Tumor Society (MSTS) scoring. Data was collected from patient records and hospital online reporting system. All data were analyzed using Statistical Package for Social Sciences, version 21. Histograms were used for descriptive statistics; Spearman's correlation was run to determine the relationship between MSTS score and age. Rest of the data was checked with Mann–Whitney and Kruskal–Wallis test. A p-value less than 0.05 was considered as statistically significant at 5% level of significance. Results Six patients were included in our study (n = 6), three of Ewing sarcoma and one each of osteosarcoma, angiosarcoma, and chondrosarcoma. Mean age was 21.7 ± 18.6 years; there was no flap necrosis in the series. One old lady developed nonunion and fracture at the native humerus in follow-up. At the end of 1 year the mean MSTS score of the series was 24.7/30. From data analysis a significant decrease in mean MSTS score was by 0.134 times (p = 0.035), been observed with increasing age. The correlation between gender and MSTS score (p = 0.325), type of tumor and MSTS score (p = 0.490), and location of the tumor and MSTS score (p = 0.351) was statistically not significant. Conclusion Free vascularized fibular graft is an important option for bony reconstruction following tumor resection. In our small series we find it very effective for reconstruction of proximal humerus, particularly in younger patients, when microvascular expertise is present. Following a positive initial experience in humerus reconstruction with free fibular osseus flap a large study population will be considered in near future.

Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma around the Knee in Children.

Survival and reconstruction in osteosarcoma is quite challenging. The study aimed to investigate the prognosis in patients treated with neoadjuvant chemotherapy and determine the clinical outcomes of expandable endoprosthesis reconstruction in children. From January 2009 to December 2014, we retrospectively analyzed 29 skeletally immature children (mean age, 10.5 years; range, 6-15 years) with osteosarcoma around the knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, an expandable prosthesis was implanted for reconstruction. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, and lengthening procedures. The survivorship and recurrence were assessed by GraphPad Software, and the function was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system. A mean follow-up time was 8.9 years (range, 6-12 years), and the overall 5-year survival was 89.1% based on Kaplan-Meier analysis. Three patients suffered a relapse and one underwent amputation. Lung metastasis developed in one patient. At 6 months after the operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery, one for implant infection and one for aseptic loosening. Prognosis is correlated with alkaline phosphatase change after treatment. Chemotherapy scheme and limb salvage can achieve high survival rates. This expandable prosthesis was associated with good function and low complication rates. The character of expandability could be a method to overcome discrepancies in the growth period.

What is the patient acceptance when only scapulectomy is possible in case of malignant tumor? A case series.

Scapulectomy is one of the surgical options in the case of malignant lesions in the scapula with an indication of surgical removal. Very few series in the literature have looked at postoperative quality of life and emotional acceptance, particularly in the case of scapulectomy without reconstruction. The objective is to assess the midterm results of scapulectomies in terms of function, quality of life, and acceptance for the patient. With a mean follow-up of 85 months (range 42 months-180 months), 11 scapulectomies for malignant tumors were performed with a mean age of 50 years: 5 partial scapulectomies, 4 total scapulectomies, and 2 subtotal scapulectomies. There were 6 chondrosarcomas, 2 high-grade osteosarcomas, 1 malignant peripheral nerve sheath tumor, and 1 low-grade atypical epithelioid sarcoma. The radio-clinical analysis was focused on functional results and mental health evaluation. The mean Musculoskeletal Tumor Society score of 11 scapulectomies was 20 ± 5 at 66% of normal, with the Disabilities of the Arm, Shoulder and Hand (DASH) score of 35 ± 26, and the Toronto Extremity Salvage Score of 76%. Patients had controlled pain (mean visual analog scale 1/10). Mobilities of the 11 scapulectomies were correct: average active anterior elevation of 89.5 ± 43 degrees, average abduction of 81 ± 42 degrees, average external rotation of 30 ± 25 degrees, and average internal rotation was at L5. Scapulectomy results in impaired physical and mental health compared with the general population (PCS-12=-9; MCS-12=-7). Partial scapulectomy, compared to total scapulectomy, gave better results: Musculoskeletal Tumor Society score (14±1 vs. 24±1 P=.0175), acceptance (45±9 vs. 92±16, P=.0184), mental health (MCS-12: 29±1 vs. 55±4, P=.0175), and Toronto Extremity Salvage Score (84±5 vs. 68±7, P=.0195). Partial and subtotal scapulectomies were better accepted (45±9 vs. 86±23, P=.0323) and tolerated (MCS-12: 29±1 vs. 52±6, P=.0099) by the patient compared to total scapulectomy. Total or partial scapulectomies without scapula reconstruction remain a disabling procedure performed with consequences on the physical and mental health of the patients. Partial or subtotal scapulectomy should be performed whenever possible because it seems to be associated with a better functional prognosis as well as less poor mental health and emotional acceptance of the patients, even though total scapulectomy may be necessary to obtain a complete curative tumor resection, which is the main goal.

Femoral Discrepancy After Childhood Bone Sarcoma Surgery Can Be Treated With Magnetic Intramedullary Nails.

This study aims to determine whether femoral lengthening with a magnetic motorized intramedullary nail (PRECICE; NuVasive) is safe and effective in patients with discrepancy due to limb salvage performed for bone sarcomas before skeletal maturity. Six patients (male, 4; female, 2) with a mean age of 9.3 years (range, 4.8-12.8 years) at the time of index limb salvage surgery were retrospectively analyzed. Four patients had undergone biological reconstruction with liquid-nitrogen recycled frozen autograft shell and inlaid vascular fibula combination and 2 had undergone nonbiological reconstruction with distal femur modular tumor endoprosthesis. The mean age at PRECICE operation was 16.1 years (range, 13.4-20.1 years). The mean prelengthening femoral discrepancy was measured as 60 mm (range, 39-80 mm). Lengthening was achieved in 5 of these 6 patients. Although the PRECICE nail was successfully implanted in the sixth patient, lengthening could never be performed owing to failure to overcome the chronic diaphyseal nonunion first, as intended with compressive use of the nail. For the other 5 patients, in whom lengthening was performed, the mean lengthening was 45 mm (range, 35-52 mm), the mean ratio of achieved to planned lengthening was 93% (range, 74%-100%), and the mean bone-healing index was 41 days per cm (range, 24-69 days per cm). Mean Musculoskeletal Tumor Society score improved from 25.6 to 27.2 after lengthening. No major complications occurred. The outcomes of this study demonstrate that the PRECICE implant can safely and effectively correct femoral length discrepancy caused by limb salvage performed for osteosarcoma before skeletal maturity. [Orthopedics. 2023;46(1):27-34.].

Can low-grade chondrosarcoma in flat bones be treated with intralesional curettage and cryotherapy?

Chondrosarcomas in flat bones are thought to be more aggressive in their behavior, and little is known about intralesional treatment outcomes of low-grade chondrosarcoma in these locations. We tried to find the differences between patients who had low-grade chondrosarcoma in their flat bones versus those with long bone involvement with regard to (1) disease outcome, (2) functional outcome, and (3) treatment complications. We retrospectively reviewed 44 patients with primary low-grade chondrosarcoma who were treated with intralesional curettage and cryotherapy. The patients were divided by location of tumor, group I (flat bones, sevenpatients) and group II (long bones, 37 patients). The local recurrence rate was higher in group I with 5 years disease-free survival of 80.0% in group I and 97.0% in group II (p = 0.001). All recurrent cases were noted to have initially presented with soft tissue extension (Enneking stage IB). The mean Musculoskeletal Tumor Society score at the last follow-up was 21.7 in group I and 27.9 in group II (p = 0.045). Intralesional curettage and cryotherapy for low-grade chondrosarcoma appear to be a safe and reasonable surgical option for patients with lesions confined to bone (Enneking stage IA). Level III, retrospective cohort study. See the Guidelines for Authors for a complete description of levels of evidence.

Patient survival after surgical resection of pelvic bone sarcomas: A nationwide cohort study

Background: Pelvic bone sarcomas are extremely rare malignant tumours. Patients require a multidisciplinary approach to plan the treatment and complex surgical resections and limb-sparing reconstructions associated with complications, revisions, and functional limitations. The presented nationwide study in the Republic of Slovenia aims to analyse the oncological survival and functional outcomes of patients after primary resection of pelvic bone sarcomas.
 Methods: The retrospective observational cohort included 21 consecutive patients who underwent limb-sparing pelvic resection at a specialized orthopaedic oncology centre in the Republic of Slovenia between 2004-2022. Patient survival, complication rates, and functional outcomes were analysed according to to the primary diagnosis.
 Results: Wide margins with R0 resection were achieved in 16 (76%) cases. After a median follow-up of 5.7 (0.6-18.1) years, 7 (33%) patients died of oncological disease, 3 (14%) patients were alive with oncological disease, and 11 (53%) patients were alive with no evidence of disease. The estimated Kaplan-Meier survival probability at 2 years, 5 years, and 10 years after pelvic resection was 85%, 73%, and 45%, respectively. The major complication rate was 29%. The mean Musculoskeletal Tumour Society Score was 17.5 (range 2-29).
 Conclusions: Patient survival after resection of pelvic bone sarcomas in Slovenia between 2004-2022 is comparable to previously published reports of European and North American countries. Wide resection of tumours with reconstruction provides a relatively good survival rate, although complications are common and functional outcomes are often poor.

Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities

BackgroundFor patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction.MethodsWe reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.ResultsThe cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14–76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12–127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6–25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4–18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70–100%).ConclusionLiquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.

A Retrospective Cohort Analysis of Limb Salvage Surgery Using Mega Prosthesis in Bone Tumours at a Tertiary Care Centre in Eastern India.

BackgroundThe method known as "limb salvage surgery" (LSS) aids in the removal of extremity tumours, and reconstruction is completed with satisfactory oncologic, functional, and cosmetic outcomes. Oncologic clearance is given first priority, followed by functional outcomes. Worldwide, the trend has already shifted away from amputations and toward limb salvage surgery for eligible patients due to efficient chemotherapy regimens, improved imaging techniques, precise administration of enhanced radiation, better reconstructive choices, and developments in bio-engineering. The purpose of the present study was to determine the clinicopathological characteristics, surgical techniques, functional outcome, and prognostic factors of limb salvage surgery performed using mega prosthesis in primary malignant or benign resectable tumours.MethodsOur retrospective cohort study was carried out over a period of two years and included 28 patients who received care for bone tumours. The data gathered comprised the demographic profile, clinical characteristics, histological characteristics, treatments given, functional results, and survival. LSS was performed on all patients by orthopaedics oncologists trained in the surgical oncology department. Following surgery, during the first two years, patients were examined at every three-month interval, then every six months until the fifth year, and then once a year after that. The Kaplan-Meier method was utilized to determine the median follow-up and recurrence-free survival (RFS).ResultsIn our study, the mean age of study subjects was 30.0±10.9 years. Almost all of the subjects included in the study had lower limb bone tumours (96.4%). The most common site for the tumour was the distal femur (57.1%) followed by the proximal femur (32.2%). The most common type of benign tumour was giant cell tumour (GCT) (53.6%), including recurrences of giant cell tumour (GCT), and among malignant tumours, osteosarcoma was the most common (25.0%). The mean surgical resection of bone in limb salvage surgery was 125.2±24.2 mm. The most common post-operative complication was leg length discrepancy (LLD) among 25.0% of subjects, which was managed by shoe raise. The overall mean musculoskeletal tumour society (MTSS) score after LSS was 25.0±4.3. Using the Kaplan-Meier method analysis, we found that relapse-free survival was 83.7% among enrolled subjects at a median follow-up period of 80 months.ConclusionIt can be difficult to surgically treat patients who have malignant bone tumours. In limb-sparing surgery for bone tumours, the modular segmental-replacement system prosthesis that we preferred produced satisfactory results in terms of tumour control and limb function. To get good long-term results, the case selection must be appropriate.

Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction

There have been no studies comparing the outcomes of nonvascularized autograft (NA) and allograft after resection of primary bone tumors. This study compares the clinical, functional outcomes of NA and allograft reconstruction and analyzes the risk factors for failure after these procedures. A retrospective study of patients with primary bone tumors of the extremities who underwent NA (n = 50) and allograft reconstruction (n = 47). The minimum follow up time was 24 months. The mean time to union for the NA and allograft group was 9.8 ± 2.9 months and 11.5 ± 2.8 months, respectively (p = 0.002). Reconstruction failure in the NA and allograft group was 19 (38%) and 26 (55.3%), respectively. Nonunion (30%) was the most common complication found in the NA group, while structural failure (29.8%) was the most common in the allograft group. There was no significant difference in functional outcome in terms of the mean Musculoskeletal Tumor Society score between the NA and allograft groups (23.5 ± 2.8 and 23.9 ± 2.1, respectively, p = 0.42). Age, sex, tumor location, graft length, method of reconstruction did not significantly influence failure of reconstruction. Chemotherapy was the only significant risk factor affecting outcomes (HR = 3.49, 95% CI = 1.59–7.63, p = 0.002). In the subgroup analysis, the use of chemotherapy affected graft-host nonunion (p < 0.001) and structural failure in both the NA and allograft groups (p = 0.02). Both NA and allograft reconstruction methods provide acceptable clinical and functional outcomes. Chemotherapy is a risk factor for failure of both reconstructions, particularly graft-host nonunion and structural failure.