Musculoskeletal Tumor Research Articles

Similar risks of complications and reoperation rates in proximal femur megaprostheses for oncological and non-oncological indications.

Proximal femur megaprostheses (PFMPs) are used to manage large bone defects in both non-oncological indications (NOI) and oncological indications (OI). However, little is known about the comparative risks of reoperation and functional outcomes between these groups. This study aimed to evaluate the cumulative incidences of reoperation and functional results of PFMPs between NOI and OI. This retrospective, monocentric cohort study included 109 implants between 2005 and 2020 (NOI, n = 42; OI, n = 67). Competing risk analysis was used to estimate and compare cumulative incidence of reoperation and complications, with death as a competing event. The Musculoskeletal Tumour Society Score (MSTS) was retrospectively assessed to compare functional outcomes. The estimated cumulative incidence of reoperation at ten years did not statistically differ: 33.5% for NOI vs. 32.7% for OI (HR = 0.90, 95% CI (0.42-0.95), p = 0.791). The estimated cumulative incidence of complications at ten years did not statistically differ (HR = 1.50, 95%CI (0.80-2.80), p = 0.204). The MSTS score at ten years was significantly higher in the OI group (78.2% ± 19.5) compared to the NOI group (48.3% ± 10.9) (p = 0.012). PFMPs for NOI demonstrate a comparable risk of reoperation to OI, but with lower long-term functional outcomes.

Case Report: Winkelmann hip rotationplasty as a last-resort solution

BackgroundRotationplasty, an invasive surgery, serves as an alternative to amputation in pediatric orthopedic oncology. It is currently applied in broader cases (e.g., infection, trauma, or malignant tumors). Winkelmann Type BII rotationplasty is a rare procedure with limited literature. Furthermore, no description of rotationplasties where the femur is attached to the sacroiliac joint has been published to date.MethodsBetween September 2022 and March 2023, three patients underwent Type BII rotationplasty. We used the Clavien-Dindo classification to describe postoperative complications and the musculoskeletal tumor society score (MSTS) for functional result assessments.ResultsOne patient suffered from multiple complications during the first 6 months postoperatively, one presented a single complication, and one had no complications after 4 and 3 months postoperatively, respectively. Two patients could walk pain-free with the help of crutches. One patient developed a crack on the femur, which did not require surgical revision. They all achieved satisfactory joint amplitudes of at least 50° in passive hip flexion. Unfortunately, one of the patients suffered from lung metastases.ConclusionsWinkelmann's Type BII rotationplasty is a reliable alternative to hindquarter amputation. Furthermore, we demonstrated that complete resection of the iliac wing and femur fixation through the sacroiliac joint is feasible.

Do Unresectable Giant Cell Tumors of Bone Treated With Denosumab Progress After Discontinuation of Treatment?

Denosumab represents a valuable treatment option for unresectable giant cell tumors of the bone (GCTBs). However, no standardized protocols exist determining the length of administration, with few studies having been published on patients who reached the end of treatment. To analyze the outcomes of patients diagnosed with GCTB and who had finished single treatment with denosumab. This is a multicenter, retrospective, descriptive study carried out in seven Spanish hospitals with multidisciplinary sarcoma and musculoskeletal tumor boards, between 2009 and 2019. Sixteen patients diagnosed with unresectable GCTBs and treated with denosumab who had reached the end of their treatment were recruited for the study and had been followed up for a minimum of 2 years. Fifty percent of patients discontinued denosumab after showing signs of tumor control. The disease remained stable in 69% of patients (n = 11), with a median recurrence-free survival time of 46 months (20-157 months) after being treated for a median period of 19 months (5-83 months). Four patients experienced local progression, and one presented multifocal progression. These five patients were treated for a median period of 46 months (14-76 months), with a median recurrence-free survival time of 9 months (5-25 months). The findings of the present study suggest that discontinuation of denosumab in patients with unresectable GCTB is not necessarily associated with the progression of the disease. Further research is needed to determine how long denosumab should be administered to minimize the risk of recurrence.

Functional outcomes of lower limb reconstruction using vascularised fibula following oncological resection

Objectives: To assess the functional outcomes of patients undergoing lower limb reconstruction with vascularised fibula following tumour resection in a tertiary care setting. Method: The single-centre, retrospective, observational study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised data from January 1, 2017, to December 31, 2022, of patients who underwent lower limb reconstruction with vascularised fibula following oncological resection. Functional outcome was assessed using Musculoskeletal Tumour Society score. Data was analysed using SPSS 26. Results: Of the 31 patients with mean age 18.2+9.9 years, 18(58%) were females and 13(42%) were males. Mean follow-up time was 3.8+3.4 years. Mean length of bony defect was 15.3+5.1cm. Mean length of fibular graft harvested was 20.0+5.9cm. The mean Musculoskeletal Tumour Society score was 26.7+2.8. Mean score was higher in foot defects recreated with single barrel fibula 29.3+1.0 compared to tibial defects 27.2+3.3. Minor wound-related complications were encountered in 5(16.1%) patients. Conclusion: Vascularised fibula was found to be an ideal option for the reconstruction of post-oncological treatment defects in the lower limb. Key Words: Lower extremity, Fibula, Free tissue flaps, Limb salvage, Autografts.

Evaluating functional outcomes and quality of life in musculoskeletal tumor patients with distal femoral megaprostheses: a case-control study

BackgroundEndoprosthetic knee replacement using megaprostheses has become a common strategy for preserving joint function in patients with distal femur tumors. While existing literature has primarily focused on surgical techniques, complications, and implants, recent improvements in patient survival rates have sparked increased interest in the long-term functional outcomes associated with this treatment.MethodsThis case-control study evaluated functional outcomes—Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), knee flexor and extensor muscle strength, and sagittal knee range of motion—and health-related quality of life (SF-36) between patients with distal femoral megaprostheses (n = 31) and healthy controls (n = 48). Participants performed the TUG and 6MWT equipped with an inertial measurement unit. Additionally, bivariate Spearman correlations were calculated within the patient group to assess relationships between Musculoskeletal Tumour Society (MSTS) scores and functional outcomes.ResultsPatients performed significantly worse than controls in the TUG test, with longer completion times (Mean Difference: -3.3 s; 95% CI: -5.7 to -0.9; p = 0.008), reduced rotational speed during the middle turn (Mean Difference: 16°/s; 95% CI: 7 to 25; p < 0.001) and final turn (Mean Difference: 22°/s; 95% CI: 9 to 34; p < 0.001), and lower vertical acceleration during the Sit-to-Stand phase (Mean Difference: 1.3 m/s²; 95% CI: 0.1 to 2.5; p = 0.032). In the 6MWT, patients walked 86 m less on average than controls (95% CI: 35 to 136; p = 0.002). Knee range of motion was significantly reduced, with median flexion of 90.2° (range: 5–125) in patients versus 136.4° (range: 115–150) in controls (p < 0.001, Z = -7.268). Muscle strength was also markedly lower in patients (p < 0.001). The SF-36 revealed significant differences in the Physical Component Summary (Mean Difference 95% CI: 15.5 [10.0 to 20.9]; p < 0.001), while no significant differences were found in the Mental Component Summary (p > 0.05). In patient group, bivariate Spearman correlations indicated a very strong positive association between MSTS scores and knee extension strength (ρ = 0.710; p < 0.001), and strong positive correlations with sagittal knee range of motion (ρ = 0.472; p = 0.015), total walking distance in 6MWT (ρ = 0.474; p = 0.019), and final turn rotational speed in TUG (ρ = 0.439; p = 0.032).ConclusionOur findings demonstrate a strong association between knee extensor strength and range of motion with overall functional performance, as reflected in MSTS scores. While nearly 75% of patients achieved scores classified as “good” to “excellent,” objective measures from the TUG and 6MWT revealed significant performance deficits compared to healthy controls, likely due to limitations in knee extensor strength and range of motion. These results highlight the need for targeted rehabilitation strategies focused on enhancing muscle strength and range of motion to optimize long-term functional recovery in these patients.

Outcomes of oncologic arthroplasty in children and adolescents with malignant limb tumors: a systematic review

Background. Amputation was historically the primary surgical intervention for children with limb bone sarcomas. However, the development and refinement of chemotherapy and radiotherapy protocols, along with advances in surgical techniques and implants, have significantly altered the treatment landscape for these patients. Currently, limb-sparing oncologic arthroplasty is the preferred surgical approach for treating limb sarcomas in children. The aim of the systematic review is to analyse the outcomes of oncologic arthroplasty in children and adolescents. Methods. A comprehensive literature search was performed in Google Scholar, PubMed, ScienceDirect, and eLIBRARY databases focusing on the keywords “endoprostheses, tumors, children”, from 2000 to 2024. Data collection included patient demographics (number of patients, gender, age), follow-up period, disease diagnosis, tumor location, type of endoprosthesis, complications, functional outcomes based on the Musculoskeletal Tumor Society score (MSTS) in percentage, overall survival rates, and prosthesis survival rates. Results. The review included the data from 30 articles on a total of 792 patients aged 2 to 18 years, with 422 males and 370 females. The average age was 11.4 years, and the average follow-up period was 6.5 years. Osteosarcoma was the most common diagnosis, accounting for 716 (88.8%) cases, followed by Ewing sarcoma with 67 (8.3%) cases. Distal femoral arthroplasties were performed most frequently (573 cases, 71.1%), followed by proximal tibial arthroplasty (148 cases, 18.3%). The most commonly used type of endoprosthesis was the non-invasively extendable type (540 cases, 67%). A total of 756 complications were recorded, resulting in a complication rate of 96%. The complications were predominantly oncologic (188 cases, 25%) and pediatric orthopedic (166 cases, 22%). The 5-year and 10-year overall survival rates were 81.68% and 77.63%, respectively, with an average prosthesis survival rate of 53.93%. Conclusion. The data obtained indicate an extremely high frequency of complications during oncologic arthroplasty in children, mainly of an orthopedic profile, which requires analysis and development of measures to prevent them, as well as organizational solutions for the correction of these disorders.

Clinical results of knee juxta-articular giant-cell tumors treated with bone cement filling and internal fixation after extensive curettage.

This study was to evaluate the radiological and clinical outcomes of patients with juxta-articular giant-cell tumors (GCTs) around the knee treated with bone cement filling and internal fixation after extensive curettage. A total of 15 patients (6 males, 9 females; mean age: 35.3±8.4 years; range, 24 to 53 years) with juxta-articular GCTs around the knee were retrospectively reviewed between January 2010 and June 2020. Wound healing, functional status as assessed by the Musculoskeletal Tumor Society (MSTS) scores, local recurrence, metastasis, and complications were evaluated. The mean follow-up was 41.3±9.9 (range, 24 to 69) months with an overall survival of 93.3%. The mean distance between tumor and cartilage was 6.29±3.73 mm. Five patients underwent reconstruction with cancellous allografts and the mean distance between tumor and cartilage was 2.20±1.48 mm in these patients. At the final follow-up, three patients had Kellgren-Lawrence Grade 2 tibiofemoral osteoarthritis in the operated knee. Lucent zones around the bone cement with no further progression were found in five patients. One patient experienced recurrence 17 months after surgery and was treated by en-bloc resection and reconstructed with a tumor endoprosthesis. The remaining 14 patients had a mean MSTS score of 26.86±2.11 (range, 23 to 30) at the final follow-up. The mean overall range of motion at the final follow-up was 109.20±14.20° (range, 85 to 130°). Bone cement filling and internal fixation after extensive curettage is a viable strategy for accessing juxta-articular GCTs around the knee. The choice of local adjuvants, subchondral bone grafting, and the thickness of subchondral bone require more attention to preserve the continuity of articular cartilage.

Joint-Sparing Resection of Juxta-Articular Primary Tumors of the Knee Using Titanium Alloy 3D-Printed Cutting Guides and Allograft Reconstruction.

Background: Joint-sparing resection of juxta-articular knee tumors is challenging. With the development of 3D printing technology, custom-made cutting guides were introduced with the aim to improve the accuracy of tumor resection margins and to shape the allograft for adequate matching in biological reconstruction. Materials and Methods: Between December 2017 and July 2023, 13 patients underwent joint-sparing juxta-articular resection of the knee for a primary bone tumor at our institution. Resection was performed using a custom-made 3D-printed titanium alloy cutting guide and reconstruction was performed using a custom-shaped allograft. The mean follow up was 50 months (min 14-max 81). The study of cutting accuracy was performed by digital examination of CT images of the resection specimen in eight patients. Results: The average cutting error was 2.3 mm. Surgical margins were wide in all patients. Four patients developed postoperative complications that led to the removal of the allograft in one case. The average functional result according to the Musculoskeletal Tumor Society Score was 26 (min 14-max 30), and according to the Oxford Knee Score it was 44 (min 22-max 48). Conclusions: Custom-made titanium cutting guides resulted effective in improving the accuracy of joint-sparing juxta-articular resection of the knee and allograft matching.

Postoperative Imaging of Bone and Soft Tissue Tumors in the Extremity: A Comprehensive Review.

Postoperative imaging of musculoskeletal tumors poses a significant diagnostic challenge for radiologists. The complexity arises from the need to differentiate between expected postoperative changes, potential complications, and local recurrence. The choice of imaging modality depends on the type of primary tumor. Standard radiological modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are widely utilized. Radiography and CT are especially valuable for assessing primary bone tumors, as they provide detailed views of bone structures and alignment, as well as revealing postoperative complications. MRIs are particularly effective for evaluating soft tissue tumors and identifying local recurrences due to its superior soft tissue contrast. The advanced imaging techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, have significantly improved diagnostic accuracy in detecting tumor recurrence. An in-depth understanding of surgery-specific imaging findings, as well as the ability to detect recurrent disease, is crucial for early diagnosis of complications and improved patient outcomes. Familiarity with normal postoperative changes helps radiologists distinguish them from abnormal findings indicative of complications or tumor recurrence. This review article aims to outline the surgical options for musculoskeletal tumors, detail the various imaging techniques used in postoperative surveillance, and discuss the potential complications. By understanding the role of different imaging modalities and their applications associated with various surgical procedures, clinicians and radiologists can provide accurate and timely diagnoses.

Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method.

Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications. A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function. Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases. The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.

Metatarsal Aneurysmal Bone Cysts Treated With En Bloc Resection and Reconstruction With Fibular Allograft.

Treatment of Primary metatarsal aneurysmal bone cyst (ABC) with curettage and bone grafting unfortunately has a high recurrence rate, particularly in short tubular bones. This study presents a 16-year experience treating ABCs in the bones of the foot at an orthopaedic oncology referral center. Treatment involved en bloc resection and reconstruction of the defect with fibular allograft in all cases. Retrospectively collected data were used to document the outcomes. This retrospective review includes patients with primary metatarsal ABC treated en bloc resection at a single center between 2004 and 2020. Information on the diagnosis, treatment, complications, and outcomes was collected from our database for all eligible patients. Radiologic healing was used as our primary outcome measure. The patient's function was assessed using the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score. The study included 19 subjects (11 women, 8 men) with a mean age of 18 years (SD 11-35). The average resected length was 4.24 cm (3-6 cm). The mean follow-up time was 79.26 months (28-160 months). The mean TESS score and MSTS were 94.52 and 28.42, respectively. The average healing time was 10.2 weeks. No patient had local recurrence. Arthrodesis was performed in 3 patients because of joint involvement. Repeat surgery was performed for 2 patients, debridement for one because of infection and bone graft for another because of nonunion. One patient had experienced an allograft fracture. Based on the Enneking classification, our experience has shown that a reasonable surgical approach for primary active and invasive metatarsal ABC is en bloc resection and reconstruction with fibula allograft. This method has a low risk of recurrence and does not result in significant functional impairment.

Who is the PROM King? Patient-reported Outcome Measures in Pediatric Musculoskeletal Oncology: A Systematic Review.

Patient-reported outcome measures (PROMs) are important companions to traditional, physician-reported measures. The purpose of this study was to systematically review and identify PROMs used in pediatric musculoskeletal oncology and evaluate these instruments. A systematic literature review was conducted for studies pertaining to pediatric musculoskeletal tumors from 2010 to 2024. Two experts selected eligible papers for inclusion through a systematic approach. PROMs used in the eligible papers were cataloged, and the top 10 most frequently used instruments were evaluated with Evaluating Measures of Patient-Reported Outcomes (EMPRO), which is a standardized evaluation tool for PROs. A total of 316 publications were included in the final analysis, reporting a total of 82 unique PROMs. Of the papers, 24% reported no PROMs, whereas 67% of the instruments were only reported once. Nine out of the 10 top PROMs scored over 50 on EMPRO, meeting the minimum acceptable criteria. Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, Disabilities of the Arm, Shoulder, and Hand (DASH), and Quick DASH were disease-specific instruments scoring high on EMPRO. Short Form-36, Pediatric Quality of Life Questionnaire, Quality of Life Questionnaire-30, BSI-18, and TNO AZL Child Quality Of Life met the requirements in the general instruments. Short Form-12 was the lowest-scored PROM. Our results show minimal consensus on the ideal PROM in pediatric musculoskeletal oncology. We recommend using instruments that are already in widespread use instead of obscure PROMs, which defy the purpose of reporting outcomes from a patient perspective. All 4 disease-specific instruments scored highly and are already widely used, including Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, DASH, and Quick DASH. However, we found no consensus on general instruments. With the development and increasing popularity of Patient-Reported Outcomes Measurement Information System, it may replace other general instruments that are proprietary, unreliable, or not developed with pediatric patients in mind. Level IV-systematic review of level II to IV studies.

Clinical and functional outcomes of utilising nail cement spacer as a frugal method of reconstruction for tumours of the proximal humerus

BackgroundThe shoulder girdle and proximal humerus are common sites for neoplastic lesions be it benign or malignant. We aimed to evaluate the outcomes of a frugal method of reconstruction of the proximal humerus for neoplastic lesions at short to medium term follow-up. MethodsData for this retrospective case series was collected from an electronic data base held at the primary authors institution. All patients who had resection of the proximal humerus for any neoplastic lesion and reconstructed with a nail cement spacer were included in the study from January 2016 to January 2023. The functional outcomes were measured by Musculoskeletal tumour society score (MSTS) and the Toronto extremity salvage score (TESS). The survivorship and post-operative complications were also reported. ResultsTwenty-two patients were available at final follow up with a mean follow-up time of 37 ± 18 months (range 12–81 months) with Ewing's sarcoma, giant cell tumour, osteosarcoma and metastatic disease as the commonest indications for surgery with a mean age of 29 ± 17 years. The Kaplan–Meier estimates indicated that the survival rate for 22 patients with endpoint (event) taken as death was 63.6 % and for endpoint taken (event) as implant failure was 95.5 % with mean survival time of 58.1 and 77 months respectively. At final follow up, the mean MSTS score was 23.6 ± 2.9 (78.7 %). One patient had superficial infection which settled with a short course of oral antibiotics and one patient had breakage of nail, which was revised. ConclusionThese results prove that this frugal method of reconstruction is comparable with endoprosthesis when considering clinical and functional outcomes but significantly cost effective and should be considered for the individual patient.

Impact of diffusion-weighted imaging on agreement between radiologists and non-radiologists in musculoskeletal tumor imaging using magnetic resonance.

BackgroundDiffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors. AimThis study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist. MethodsThirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet’s AC1 coefficients and interpreted according to Landis and Koch. ResultsThe lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772 to 0.965 among only radiologists indicating substantial to almost perfect agreement. ConclusionThe agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement.

Breaking barriers: The impact of telemedicine on improving soft tissue and bone tumor management in Armenia.

Musculoskeletal sarcomas are a rare group of malignant neoplasms, accounting for approximately 12 % of all malignant neoplasms among children. Childhood cancer outcomes vary between developed and developing countries due to financial and educational inequalities. Telemedicine programs have a huge impact on the quality of cancer care, helping to optimize resources for better cancer care in a resource-limited setting. In 2019, Armenia established multidisciplinary teams (MDT) with the guidance of international experts via telemedicine, significantly improving patients' management diagnosed with sarcomas. The musculoskeletal cancer working group, mentored by the University Hospital of Münster (UKM), conducted weekly virtual tumor boards to discuss cases, focusing on the review of pathological and radiological examinations. From August 2019 to December 2023, the musculoskeletal cancer MDT discussed 151 musculoskeletal tumor cases via 74 MDT meetings. Imaging studies of all discussed cases were reviewed, while the review of histology images was performed for 93 % of cases. The pathology review led to changes in previously established diagnoses in eleven cases, which subsequently changed management. These led to altered local control strategies for 32 patients, with 5 requiring treatment abroad, and changes in chemotherapy regimens for 17 patients. Notably, there were no cases of treatment refusal post-implementation, a reduction from the previous 3 % refusal rate. The successful telemedicine initiative, coupled with institutional support, improved the care of patients diagnosed with musculoskeletal tumors. The investment in telemedicine in developing countries not only enhances communications with international and local experts across various disciplines but also significantly improves the handling of patients diagnosed with sarcomas.

Cup and Cage Reconstruction for Metastatic Acetabular Lesions Provides Functional Improvement and Cost-efficiency

Objective: Pathologic acetabular lesions have multiple surgical options proposed and no clearly defined optimal solution at this time. In this study, we present our cage and cup reconstruction method and analyze postoperative outcomes against previously published studies. Patients and Methods: Twenty-four patients from 2014 to 2020 with acetabular pathologic lesions treated with an antiprotrusio cage and cup reconstruction were identified. Patient charts were reviewed for operative time, blood loss, Musculoskeletal Tumor Society functional scores, follow-up, and complications. Results: The average blood loss was 727 mL, and the average postoperative Musculoskeletal Tumor Society score was 70.3, with an average improvement of 35.2 points from preoperative scores. The average cost of our construct per year was $1177 for patients surviving &gt;1 year after surgery. Eleven (45%) patients had died of disease at an average survival time of 14.2 months. Conclusion: Our study compares well with historic reconstruction strategies for metastatic acetabular disease, showing that this cup/cage reconstruction provides a durable and perioperatively safe approach that provides functional improvement while remaining cost-efficient. Level of Evidence: Level IV.

IlluminOss photodynamic bone stabilization system improves pain and function in the treatment of humeral metastatic disease.

The aim of the LightFix Trial was to evaluate the clinical outcomes for one year after the treatment of impending and completed pathological fractures of the humerus using the IlluminOss System (IS), and to analyze the performance of this device. A total of 81 patients with an impending or completed pathological fracture were enrolled in a multicentre, open label single cohort study and treated with IS. Inclusion criteria were visual analogue scale (VAS) Pain Scores > 60 mm/100 mm and Mirels' Score ≥ 8. VAS pain, Musculoskeletal Tumor Society (MSTS) Upper Limb Function, and The European Organization for Research and Treatment of Cancer QoL Group Bone Metastases Module (QLQ-BM22) scores were all normalized to 100, and radiographs were obtained at baseline and at 14, 30, 90, 180, and 360 days postoperatively. The mean VAS pain score decreased significantly from 84 (SD 15) to 50 (SD 29), 38 (SD 30), 31 (SD 29), 31 (SD 29), and 21 (SD 23) between the baseline and follow-up times (p < 0.001). The mean MSTS function scores significantly increased from 27 (SD 19) to 52 (SD 22), 60 (23), 67 (SD 23), 72 (SD 26), and 83 (SD 14) (p < 0.001). The pain and functional subscales of the QLQ-BM22 also significantly improved at most times. A total of 12 devices broke, giving an unadjusted device fracture rate of 15%. Stabilization with the IS decreased pain and improved function with consistent results during the first postoperative year. IS is a new, minimally invasive type of internal fixation. The use of the IS alone may be better for impending rather than completed pathological fractures, and may be better in completed fractures if an added plate or more than the usual number of locking screws is required. Caution is warranted regarding its use alone in patients with a completed pathological fracture due to the rate of breakage of the device.

Clinical Outcome of Extended Curettage with Postoperative Denosumab Administration for the Treatment of Campanacci Grade III Giant Cell Tumors of the Extremities.

To investigate the local recurrence rate, joint preservation status, and functional outcomes after extended curettage and postoperative denosumab treatment for Campanacci Grade III giant cell tumors of the extremities. We retrospectively reviewed 23 patients with Campanacci Grade III GCTB of the extremities in our hospital between January 2017 and June 2023 who underwent extended curettage and postoperative denosumab administration alone, without preoperative denosumab treatment. Patients were followed-up for adverse events of denosumab, surgical outcomes, limb function of lesions, and local recurrence following extended curettage with postoperative denosumab. All incisions healed without deep infections or internal fixation failure. The mean age of the patients at surgery was 36.6 years, and the mean follow-up was 35.8 months (range, 6-72 months). There of the 3 patients experienced a postoperative local recurrence. The recurrence rate was found to be 13.0%. Two patients were treated with repeat intralesional surgery with no additional recurrence two years later, and the other was treated with en bloc resection and reconstruction with a vascularized fibular graft. One patient experienced knee osteoarthritis without oral analgesics. No patient developed pulmonary metastases or malignant transformation of the GCTB. The mean Musculoskeletal Tumor Society functional score at the last follow up was 27.3 30 (range, 25-29). No serious adverse events were observed after the denosumab treatment. Our observations suggest that extended curettage with postoperative denosumab administration is a reasonable option for treating Campanacci Grade III giant cell tumors of the extremities. Extended curettage with adjuvant denosumab therapy results in beneficial surgical downstaging, including a less morbid surgical procedure or delayed en bloc resection. Resection should be considered when the structural integrity cannot be regained after bone grafting or bone cement filling combined with internal fixation.

Wide-margin excision of diffuse ankle's tendon sheath giant cell tumor in 24 patients:A mid-term study

Giant cell tumour of tendon sheath (TSGCT) is an uncommon soft tissue tumor, especially in its diffuse subtype (D-TSGCT), which is rare and associated with a high recurrence rate after treatment. This condition significantly affects joint function and quality of life. This retrospective study evaluated the clinical characteristics, surgical outcomes, and long-term follow-up of 24 patients who underwent wide-margin resection for ankle D-TSGCT from 2011 to 2018. The average patient age was 36.5 years, with common symptoms including palpable masses and ankle swelling. All patients received wide-margin resection, with a mean follow-up period of 75.7 months. Tumor recurrence occurred in five patients (21%), with complications included postoperative infections, surgical site pain, ankle instability, and stiffness. There was a significant improvement in the Musculoskeletal Tumor Society (MSTS) scores post-surgery. Additionally, the Foot and Ankle Ability Measure (FAAM) showed improvements in daily living and physical activities, though Ankle Joint Functional Assessment Tool (AJFAT) scores did not demonstrate significant change. These findings indicate that wide-margin resection is an effective treatment for D-TSGCT, preserving ankle function and demonstrating a low recurrence rate, although it may lead to ankle instability requiring careful postoperative monitoring and rehabilitation.

[Translated article] Epidemiology of musculoskeletal tumors in a reference unit

Objective The objective of this study was to perform an epidemiological analysis of patients presented to the Musculoskeletal Tumors Committee of a reference hospital.Material and method A retrospective analysis of patients with sarcomas treated in a reference Sarcoma Unit between 2009 and 2022 was carried out.Results A total of 1978 patients were analyzed, of which 1477 (74.67%) were diagnosed as sarcomas. They were divided into 446 (30.20%) bone tumors and 1.031 (69.80%) soft tissue tumors. The most common benign bone tumor was enchondroma (27.23%), giant cell tumor (59.21%) was the most common tumor of intermediate malignancy and the malignant one was osteosarcoma (24.78%). The most frequently observed benign soft tissue tumor was lipoma (50.74%), the atypical lipomatous tumor (53.25%) was the most frequent tumor of intermediate malignancy and the malignant one was sarcoma of uncertain differentiation (38.10%).Conclusion Our study represents the first work on the epidemiology of sarcomas and other musculoskeletal tumors in our country, being very useful to adapt the resources destined for their diagnosis and treatment.