Musculoskeletal Tumor Research Articles

Clinical outcomes after extra-articular resection of hip joint tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis with posterior column preserved.

For rare cases when a tumour infiltrates into the hip joint, extra-articular resection is required to obtain a safe margin. Endoprosthetic reconstruction following tumour resection can effectively ensure local control and improve postoperative function. However, maximizing bone preservation without compromising surgical margin remains a challenge for surgeons due to the complexity of the procedure. The purpose of the current study was to report clinical outcomes of patients who underwent extra-articular resection of the hip joint using a custom-made osteotomy guide and 3D-printed endoprosthesis. We reviewed 15 patients over a five-year period (January 2017 to December 2022) who had undergone extra-articular resection of the hip joint due to malignant tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis. Each of the 15 patients had a single lesion, with six originating from the acetabulum side and nine from the proximal femur. All patients had their posterior column preserved according to the surgical plan. Postoperative pathological assessment revealed a negative surgical margin was achieved in all patients. At final follow-up, 13.3% (2/15) died and no recurrence occurred. The overall survival was 81.7% at five years. None of the patients showed any signs of aseptic loosening, and no wound healing issues were observed. In total, 20% (3/15) developed complications, with two cases of early hip dislocation and one case of deep infection. The cumulative incidence of mechanical and non-mechanical failure in this series was 13.7% and 9.3%, respectively, at five years. In this cohort, the mean time to full weightbearing was 5.89 (SD 0.92) weeks and the mean Musculoskeletal Tumor Society score was 24.1 (SD 4.4). For patients with a hip joint tumour who met the inclusion criteria and were deemed suitable for posterior column preservation, a custom-made osteotomy guide combined with 3D-printed endoprosthesis is worth performing when treating patients who require extra-articular resection of the hip joint, as it can achieve adequate margin for local control, maximize bone preservation to maintain pelvic ring integrity, reduce the risk of complications by simplifying the surgical procedure, and allow for more precise reconstruction for better function.

Musculoskeletal Tumor Society Member Survey: Intra-Operative Peripheral Margins in Soft Tissue Sarcoma.

Routine intraoperative peripheral margin sampling is often employed by musculoskeletal surgical oncologists. Several recommendations exist regarding this practice pattern. It is unknown what the practice patterns of Musculoskeletal Tumor Society (MSTS) members are. Evidence-based data to support or refute this practice is currently lacking. We developed an anonymous survey with two primary objectives. To determine the practice patterns of active MSTS members with respect to intraoperative peripheral margin sampling and to elucidate the most common rationale for routine sampling. An anonymous survey was distributed through the MSTS to 320 active members. Results were collected with a branching logic fashion via Microsoft Forms®. Surveys were sent to 320 MSTS members in 2021. A total of 108 responses were collected. A total of 55 (51%) respondents noted that they routinely send intraoperative peripheral margins. Primary reasons for margin assessment included concerns about adequacy of margins. Members who routinely send frozen margins sent on average 4-6 specimens. There is significant variability in this practice amongst MSTS members. Given there is no evidence to support or refute this practice, Further investigation is required to determine the clinical utility of routine intraoperative peripheral margin sampling.

Is intercalary frozen autograft augmented with intramedullary cement and bridging plates fixation a durable reconstruction?

AimsWe analysed the survival, complications, and function of frozen autograft augmented with intramedullary cement and bridging plates fixation for intercalary bone defect reconstruction in primary bone sarcomas.Patients and MethodsA retrospective cohort study was conducted on 72 patients with primary bone sarcomas (34 males, 38 females) between January 2016 and June 2023. The average age was 22.0 ± 13.6 years (6 to 61 years) and the pathological type included osteosarcoma (55), followed by adamantinoma (5), Ewing’s sarcoma (4), undifferentiated pleomorphic sarcoma (4), chondrosarcoma (3), and malignant tenosynovial giant cell tumor (1). The oncological outcomes included local control, metastasis, progression-free survival and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), and the motion of the joint.ResultsThe mean follow-up time was 50.0 ± 27.4 months (12 to 99 months). 10 patients died of the disease, 9 patients were alive with disease and 53 patients were alive with no evidence of disease. The average 5-year overall survival of autograft was 85.8% (95% CI, 72.1-93.1%). The average MSTS-93 score was 96% ( 67–100%) and the average TESS score was 98% (74–100%). Twenty-four patients (33.3%) had at least one complication in the follow-up period. The most common complications were nonunion (9.7%, 7/72) and local recurrence (9.7%, 7/72), followed by leg length discrepancy (6.9%, 5/72), infection (5.6%, 4/72), implant failure (4.2%, 3/72), delayed union (2.8%, 2/72), and graft fractures (1.4%, 1/72). Tumor site was an independent risk factor for bone nonunion (OR, 22.23; p = 0.006).ConclusionsWe presented a large technique series for preventing autograft-related complications (especially for autograft fractures) of intercalary frozen autograft reconstruction. This method showed promising functional outcomes and provided durable reconstruction.Level of evidencelevel IV therapeutic study.

Pediatric Bone Tumors: Location and Age Distribution of 420 Cases

Background/Objectives: One of the most important diagnostic tools in bone tumors is X-rays. Preliminary and, in the case of some benign lesions, definitive diagnoses are formed using this basic tool. Part of the decision making in this stage is based on statistical probability using the patient’s age, as well as the incidence and predilection sites of different entities. The information used today is based on older and fragmented data. To verify the underlying principles, we retrospectively evaluated all bone tumors in children and adolescents treated by our tertiary center in the last 20 years. Methods: For this retrospective study, patients under the age of 18 years suffering from histopathologically verified bone tumors were evaluated. Data were retrieved from our local musculoskeletal tumor database. Results: We were able to include 420 children treated for bone tumors in our tertiary center. The cohort consisted of 335 benign and 85 malignant lesions. The most common lesions were 137 osteochondromas; the malignant tumors consisted mainly of osteosarcomas (53) and Ewing’s sarcomas (28). The primary predilection sites were the metaphyses of long bones. Conclusions: We were able to confirm and supplement the fragmentary data of these rare diseases using our own cohort.

Postoperative Complications of Intramedullary Nailing for Impending and Pathologic Fractures of the Humerus Due to Bone Metastases-A Systematic Review of the Literature.

Intramedullary nailing (IMN) is a common option for managing impending or pathologic fractures of the humerus secondary to metastatic disease. We sought to assess the (1) early complications, (2) failure rates and mechanisms, and (3) functional outcomes. A systematic review using the PubMed, Embase, and Cochrane databases was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The study was registered on PROSERO (CRD42023406905). The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Studies describing postoperative outcomes of patients with impending or pathologic fractures of the humerus treated with IMN were included. Implant failure was classified into mechanical and nonmechanical causes. Functional outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) score. Overall, 41 studies comprising 1431 patients were included. Early complications occurred in 5.5% of patients, with 2.8% of patients having systemic complications. The overall implant failure rate was 4.9%, and the mean MSTS score at the last follow-up was 79.9%. IMN was associated with good postoperative functional outcomes and low implant failure rates. Systemic complications were the most common type of early complication, and tumor progression was the main cause of implant failure. LEVEL OF EVIDENCE: III.

Minimally invasive interventional guided imaging therapies of musculoskeletal tumors.

Historically, musculoskeletal (MSK) tumors, which include both bone and soft tissue tumors, have been managed as distinct entities. The incidence of metastases, particularly bone metastasis, in patients with MSK tumors can result in the emergence of significant complications such as pain, impairment of vital anatomical structures, or pathological fractures. Given these issues, a diverse team of experts is typically engaged in intricate treatment decision-making concerning the necessity of surgery, radiation, chemotherapy, or a mix of these methodologies. Nevertheless, percutaneous image-guided minimally invasive interventional therapy for MSK tumors represent a promising approach for treating such tumors. Over the past decade, significant progress has been made in this technique, leading to its growing acceptance in ordinary clinical practice. MSK tumors can be effectively treated by the use of ablation techniques, either as standalone procedures or in conjunction with other percutaneous treatments. Various image-guided techniques have been employed to observe the ablation zone and nearby structures, such as fluoroscopy, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). However, CT is the favored method due to its widespread availability and ability to visualize the tumor and its environs. The procedures employed include ethanol injection, radiofrequency ablation, microwave ablation, cryoablation, and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU). The technique can be performed in combination with cementation, with or without additional metallic stabilizing devices, depending on the location of the lesion. Improved local tumor control can be attained by combining ablation with bland embolization or transarterial chemoembolization. This article provides an overview of the fundamental elements of minimally invasive interventional guided imaging therapy for MSK malignancies.

Positron emission tomography-magnetic resonance imaging applications in pediatric musculoskeletal tumors.

The hybrid imaging positron emission tomography/magnetic resonance (PET/MR) is an important tool in the management of pediatric oncology patients, particularly in malignant musculoskeletal pathologies, because it combines the functional and metabolic information of tumor provided by PET with the high soft-tissue contrast and the functional information offered by magnetic resonance imaging (MRI). We performed an observational retrospective study that included pediatric patients diagnosed with primary bone or soft-tissue sarcomas in the Pediatric Hematology and Oncology Unit at the HM Montepríncipe University Hospital, Boadilla del Monte, Madrid (Spain) who underwent whole-body 18F-fluorodeoxyglucose (18F-FDG) PET/MRI as a staging study and for follow-up evaluation for treatment response from September 2017 to January 2023. This study explores the protocols, the practical application of the PET/MRI technique and our clinical experience at our center in the diagnosis and follow-up of primary bone tumors and soft-tissue sarcomas in children. Seventy-one 18F-PET/MR studies were performed on 39 patients. Most of them (55%) were initial extension studies and (45%) were follow-up studies. Most of the patients studied were male (74.4%) with a median age of 15 years. Of the 39 cases, 51% were primary bone tumors while 18% were Langerhans cell histiocytosis and 21% soft tissue tumors. Of the 71 studies, five showed metastases at the initial diagnosis, three presented lymph node involvement, one with local infiltration, and one with pulmonary metastasis. PET/MR has represented a significant advancement in the evaluation of pediatric malignant neoplasms, with specific applications in musculoskeletal tumors showing clear benefits over PET/CT. The primary advantage is the reduction in ionizing radiation doses and the assessment of soft tissues, making it an excellent option for malignant musculoskeletal pathologies in pediatric patients who often require long-term follow-up. It is particularly useful for early tumor detection and functional therapy monitoring in oncology. The development of new protocols is making studies increasingly faster and better tolerated, even without the need for anesthesia. PET/MRI has shown to increase diagnostic accuracy in primary bone and soft tissue tumors, as it allows for the comprehensive evaluation of their morpho-metabolic characteristics, locoregional, and distant involvement in a single study. It is also useful in surgical planning and post-treatment follow-up.

Reconstruction after proximal ulnar resection.

Reconstruction after osteoarticular resection of the proximal ulna for tumours is technically difficult and little has been written about the options that are available. We report a series of four patients who underwent radial neck to humeral trochlea transposition arthroplasty following proximal ulnar osteoarticular resection. Between July 2020 and July 2022, four patients with primary bone tumours of the ulna underwent radial neck to humeral trochlea transposition arthroplasty. Their mean age was 28 years (12 to 41). The functional outcome was assessed using the range of motion (ROM) of the elbow, rotation of the forearm and stability of the elbow, the Musculoskeletal Tumor Society score (MSTS), and the nine-item abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH-9) score. All patients were available for follow-up at a mean of 33 months (25 to 43) and were disease-free. The mean flexion arc was 0° to 105°. Three patients had complications. One had neuropraxia of the ulnar nerve. The symptoms resolved after three months. In one patient, the screw used for fixation of the triceps tendon became exposed and was removed, six months postoperatively. One patient with wound dehiscence required a local flap for soft-tissue cover, four months postoperatively. At a mean follow-up of 33 months (25 to 43), the mean flexion arc was 0° to 105°. All patients had full supination (85°) but none had any pronation. The mean MSTS score was 23.5 (23 to 24) and mean QuickDASH-9 score was 26.13 (16.5 to 35.75). Three patients had varus-valgus instability on examination, although only one had a sense of instability while working. Radial neck to humeral trochlea transposition offers a satisfactory and cost-effective biological reconstructive option after osteoarticular resection of the proximal ulna, in the short term. It provides good elbow function and, being a biological reconstruction option using native bone, is likely to provide long-term stability and durability.

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation.

The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases. Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis. In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow-up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively. In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Comparative analysis of synovectomy and total knee replacement in knee joint synovial chondromatosis: A case series

Synovial chondromatosis is a rare disorder characterized by cartilaginous growths within the joint lining, often confused with conditions like pigmented villonodular synovitis and rheumatoid arthritis. Primary treatment typically involves surgical synovectomy to remove the affected tissue and loose bodies. Documented cases are limited globally. The aim of this study was to present a case series of synovial chondromatosis and evaluate the functional outcomes by assessing the post-surgical Musculoskeletal Tumor Society (MSTS) score following different surgical interventions (synovectomy alone versus synovectomy with total knee replacement) in a resource-limited setting. Four cases of synovial chondromatosis were reported. A 61-year-old woman with a soft tissue tumor underwent synovectomy and total knee replacement on the right knee, then experienced a periprosthetic infection requiring revision arthroplasty, resulting in an MSTS score of 24. Another case was a 48-year-old woman who had a synovectomy for a lump on the right knee, also achieving an MSTS score of 24. Two additional cases involved women in their mid-to-late 60s who underwent synovectomy for knee lumps, with post-operative MSTS scores of 21 and 19, respectively. This case series underscores the diagnostic and management challenges of synovial chondromatosis in the knee joint, demonstrating various surgical interventions. This case series also suggested that the post-operative MSTS scores were slightly higher (indicating better outcomes) for synovectomy alone compared to synovectomy with total knee replacement, highlighting the need for further research to determine the most effective treatment approach.

Novel Clinical Practice Assessments: Informational Statements by the Musculoskeletal Tumor Society.

Musculoskeletal oncology involves rare diseases. As a result, there is a paucity of literature to guide practitioners. Studies are often clinical experience, retrospective reviews, noncomparative studies, and involve small numbers of patients. However, technological advances consistently arise in this field. This article represents the Musculoskeletal Tumor Society efforts to improve multispecialty collaboration and research credibility. It involves brief systematic reviews of novel ideas and suggests high-quality research needed to provide and standardize best practices within this field.

Distribution Patterns of Tumors and Tumor-Like Lesions of the Forefoot and Midfoot A 12.5-Year Study at a University Hospital.

Masses in the forefoot and midfoot are common reasons for medical presentation and can be caused by various pathological conditions. The challenge in clinical practice is to distinguish the multitude of trivialities from the few malignant entities and to arrive at a reliable clinical diagnosis in a reasonable amount of time with a moderate use of diagnostic tools. In a retrospective analysis, tumors, tumor-like lesions, and pseudotumors distal to the Chopart joint presented to our multidisciplinary university tumor board between January 2010 und June 2023 were analyzed concerning entity, location, age, and sex. Of the 167 cases included, 18 were osseous and 149 were soft tissue lesions. Overall, the metatarsal region was most frequently affected, accounting for 42.5% of all cases. Osseous lesions showed a preference for the phalanges and soft-tissue lesions occurring more frequently in the metatarsal region. In total, 88.0% of all cases were benign. All 20 malignant cases derived from soft tissue, occurred in all sections of the forefoot and midfoot and comprised 13 entities. Most lesions affected middle-aged patients, but cases occurred in almost every age group. In the examined patient population of a German university hospital, most cases were benign soft tissue lesions with a substantial share of pseudotumors and tumor-like lesions. However, the malignancy rate of 12.0% highlights the importance of differential diagnostic considerations. In cases of uncertain results, it is crucial to refer individuals with unclear masses to a specialized center for musculoskeletal tumor care early on in their treatment process. III.

What's New in Musculoskeletal Tumor Surgery.

What's New in Musculoskeletal Tumor Surgery.

3D-Printed Prosthesis with an Articular Interface for Anatomical Acetabular Reconstruction After Type I + II (+ III) Internal Hemipelvectomy

Background: Pelvic reconstruction after type I + II (or type I + II + III) internal hemipelvectomy with extensive ilium removal is a great challenge. In an attempt to anatomically reconstruct the hip rotation center (HRC) and achieve a low mechanical failure rate, a custom-made, 3D-printed prosthesis with a porous articular interface was developed. The aim of this study was to investigate the clinical outcomes of patients treated with this prosthesis. Methods: This retrospective cohort study included 28 patients with type I + II (+ III) internal hemipelvectomy through the articular interface of the sacroiliac joint and managed with a prosthesis at a single center between August 2016 and August 2021. Complications and oncological outcomes were analyzed. The position of the reconstructed HRC was assessed and lower-limb function was evaluated. Biomechanical analyses of different fixation modes of the prosthesis were conducted using finite element analysis. Results: The displacement distance of the HRC from preoperatively to postoperatively was a mean (and standard deviation) of 14.12 ± 8.75 mm. The rate of implant-related complications was 14.3% (4 of 28) for prosthetic breakage, 14.3% (4 of 28) for aseptic loosening, 7.1% (2 of 28) for dislocation, and 7.1% (2 of 28) for deep infection. The mean Musculoskeletal Tumor Society (MSTS)-93 score was 18.2. The aseptic loosening rate was significantly greater for prostheses fixed with 3 sacral screws (4 of 10, 40.0%) than for those fixed with 4 (0 of 10, 0%) or 5 screws (0 of 8, 0%) (p = 0.024). The prosthetic breakage rate was lower in patients who underwent lumbosacral fixation (0 of 13, 0%) than in those who did not (4 of 15, 26.7%), although the difference did not reach significance (p = 0.102). Biomechanical analyses suggested that the addition of lumbosacral fixation or increasing the number of sacral screws from 3 to 4 or 5 visibly reduced the peak stress of the sacral screws. Conclusions: The use of a 3D-printed prosthesis with an articular interface for pelvic reconstruction demonstrated stable prosthetic fixation, anatomical acetabular reconstruction, and acceptable early functional outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Efficacy of Surgical Intervention in Treating Pathological Fractures of the Upper Extremity: A Retrospective Case Series.

We conduct a retrospective analysis of patients with pathological fractures resulting from upper extremity malignancies, focusing on the evaluation of treatment strategies employed. We retrospectively studied 10 patients with metastatic bone tumors of the upper extremities. The study variables included tumor site, primary pathology, duration from the first diagnosis of the primary lesion to the occurrence of the pathological fracture, use of bone-modifying drugs, surgical technique, adjuvant therapy, postoperative functional assessment, Katagiri's score, American Society of Anesthesiologists physical status (ASA-PS), outcome, and correlations between the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Musculoskeletal Tumor Society (MSTS) score. The sites involved were the humerus and radius in eight and two patients, respectively. Primary pathologies were liver cancer in three patients, lung cancer and renal cancer in two patients each, and one patient each with multiple myeloma, plasmacytoma, and Hodgkin's lymphoma. Nine patients experienced pathological fractures, and one had an impending fracture. The median time from primary tumor diagnosis to fracture was 12.5 months. Bone-modifying drugs were administered in all cases. Surgical procedures included intramedullary nails in seven patients and plate fixation in two. Chemotherapy served as adjuvant therapy in nine cases. The mean MSTS score was 26.5, and Katagiri's score averaged 6. The median ASA-PS stood at 2. Outcomes showed seven patients alive with disease and three dead from disease. A significant association between the ECOG-PS and MSTS score was not observed. Pathological fractures caused by malignant bone tumors of the upper extremity should be treated proactively with surgery regardless of prognosis.

Is the clavicla pro humero a reliable reconstruction for paediatric proximal humerus sarcomas?

The proximal humeral reconstruction is challenging. This study aims to investigate the survival, function and complications of clavicla pro humero (CPH) for pediatric proximal humeral reconstruction. A retrospective cohort study was conducted on eight patients (4 males, and 4 females) who underwent clavicla pro humero reconstruction between January 2009 and December 2020 in our institution. The average age was 10.4 ± 2.7 years (range, 6 to 14 years). The functional outcomes were assessed by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), the American Shoulder and Elbow Surgeons (ASES) score and the range of motion (ROM) of the shoulder. The complications and overall survivorship of clavicla pro humero were recorded in the follow-up. The mean follow-up of all patients was 54.6 ± 23.9 months (range, 24 to 84 months) and 73.3 ± 8.5 months (range, 72 to 84 months) in all survivors. All patients had a bone union at an average of 3.8 months after the initial procedure. Only one patient had no complications in the follow-up. The most common complications were clavicle fracture (87.5%, 7/8), followed by pseudarthrosis (62.5%, 5/8), proximal clavicle osteolysis (37.5%, 3/8) and skin flap necrosis (12.5%, 1/8). The average MSTS-93 score was 79% (range, 73-86%), the average TESS was 82% (range, 76-86%) and the average ASES was 70% (68-73%), respectively. The clavicla pro humero procedure provides rapid bone union but has a high complication rate. Therefore, we do not recommend this technique as a routine surgical procedure for paediatric proximal humeral reconstruction when other methods are available. level IV therapeutic study.

The landscape of Functional Outcome Measures Used in Patients with Bone Sarcoma of the Lower Extremity or Pelvis: A Systematic Review.

This systematic review provides a structured overview of the measurement instruments of functional outcome used in lower extremity and pelvic bone sarcoma patients. We identified 42 unique instruments covering 18 distinct functional outcome constructs with most studies measuring constructs within the activity domain of the International Classification of Functioning, disability, and health. The MusculoSkeletal Tumor Society 1993 and 1987 score, Toronto Extremity Salvage Score, and range of motion instruments were the measurement instruments most commonly used.

Survival and functional outcomes after hemiarthroplasty in children with proximal tibial osteosarcoma

BackgroundTreatment options for correcting limb-length discrepancy after limb-salvage reconstruction for proximal tibial osteosarcoma in children have several limitations. Therefore, we aimed to evaluate the feasibility, complications, prognosis, and clinical outcomes of reconstruction using hemiarthroplasty after tumor resection in pediatric patients with proximal tibial osteosarcoma.MethodsWe conducted a comprehensive retrospective analysis of the data of pediatric patients with osteosarcoma of the proximal tibia who underwent surgery between December 2008 and November 2018 at our center. We enrolled 49 consecutive patients who underwent hemiarthroplasty. The cruciate ligaments of all patients were reconstructed using special spacers, and the medial and lateral collateral ligaments of the knee and joint capsule were reconstructed using a mesh. Postoperatively, if the unequal length of both lower limbs exceeded 4 cm or knee instability occurred, a second-stage surgery was performed for limb lengthening and replacing the distal femoral prosthesis. We analyzed the oncological prognosis, complications of hemiarthroplasty, postoperative stability, and postoperative function.ResultsThe follow-up period ranged between 11 and 159 months, with a median of 84 (62, 129) months. The overall 5-year survival rate was 83.2%. Thirty-nine patients survived at the end of the follow-up period with 34 prostheses (87.2%). The overall prosthesis survival rate was 87.4% after 5 years, indicating the long-term benefits of the procedure. Limb length was measured in 28 adult patients. The average limb-length discrepancy was 33 ± 15 mm with a median of 33 mm (21, 47); the femur and tibia caused a discrepancy of 8.5 ± 9.9 mm and 24.8 ± 15.5 mm, respectively. The patients had 30–135° of knee motion, with a mean of 82 ± 24°. The femoral tibial angle was greater on the affected side than on the healthy side, with a mean difference of 4.5°±3.6°. The Musculoskeletal Tumor Society (MSTS) score was 25 ± 3. Five patients underwent second-stage distal femoral prosthesis replacement, with mean MSTS scores of 24 ± 2 and 28 ± 1 before and after second-stage surgery, respectively.ConclusionsHemiarthroplasty in children reduces limb-length discrepancy in adulthood by rebuilding cruciate ligaments, lateral collateral ligaments, and the joint capsule, thereby improving knee stability.

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.

The Role of Perfusion Magnetic Resonance Imaging in the Discrimination of Benign vs Malign Character of Musculoskeletal Tumors

Purpose: There may be difficulties in diagnosing musculoskeletal system tumors with Magnetic Resonance Imaging (MRI). Advanced MRI imaging techniques may contribute to noninvasive diagnosis.The aim of our study was to evaluate the performance of perfusion magnetic resonance imaging quantitative data in the differentiation of benign and malignant musculoskeletal tumors. Material and Methods: Thirty-six histologically proven patients were included in the study retrospectively. All patients underwent 1.5-T perfusion MRI (magnetic resonance imaging) with T1 mapping and diffusion MRI. Four quantitative and one semiquantitative parameter were obtained for each tumor using the Toft pharmacokinetic model. ADCmean and ADCmin values were calculated from apparent diffusion coefficient (ADC) maps. Results: Eighteen of 36 patients (50%) had malignant tumors, and 18 had benign tumors. There were 26 soft tissue tumors and 10 bone tissue tumors. Among malignant and benign tumors, the best performance was found in the Ktrans, Kep, Ve values. (p=0.011, p=0.013, p=0,035). Conclusion: Ktrans and Kep values, which are indicators of increased permeability in the tumor, are noninvasive parameters for determining the malignant character of the tumor. The 'Ve' value is an indicator of the extracellular volume of the tumor. Ktrans, Kep and Ve maps can also guide the biopsy.