Resection Of Chondrosarcoma Research Articles

Evaluation of Local Recurrence and Diagnostic Discordance in Chondrosarcoma Patients Undergoing Preoperative Biopsy.

Preoperative biopsy of chondroid lesions has demonstrated discordance between biopsy grade and surgical resection grade. Furthermore, there is evidence to suggest risk of tumor contamination during biopsy. We evaluated our large chondrosarcoma institutional cohort to compare the rates of local recurrence based on pre-surgical biopsy, as well as other tumor characteristics and disease-related outcomes. This was a retrospective review of patients who underwent surgical resection for chondrosarcoma at our Institution between 2005 and 2020. Outcomes included rates of local recurrence, metastasis, and overall survival. No significant differences were found in local recurrence and recurrence-free survival in cases of pre-operative biopsy. Thirteen (28.2%) patients had discordance between histological grade on biopsy and resection. Seven (63.6%) patients with dedifferentiation present on final resection were not identified on biopsy. The only independent predictor of recurrence-free survival and metastasis-free survival was the presence of dedifferentiation on resection. To our knowledge, this is the first study evaluating risk of local recurrence in the setting of pre-surgical biopsy in chondrosarcoma patients. Although pre-operative biopsy may contaminate biopsy tracts, appropriate surgical planning and final resection results in no difference in local recurrence rates in this cohort. However, discordance rates between preoperative biopsy and resected specimen must be considered while determining clinical treatment.

A versatile 3D-printable hydrogel for antichondrosarcoma, antibacterial, and tissue repair

• A novel hydrogel with biological activity and photothermal effect was synthesized. • The hydrogel can exert anti-tumor and antibacterial effect through photothermal effect. • The hydrogel can effectively promote the repair of articular cartilage defects in vivo . Following operative treatment of chondrosarcoma, post-surgery tissue reconstruction may be confronted with daunting challenges, including the delayed self-repair of defective tissue, tumor recurrence, and bacterial infection. To overcome these challenges, a methacrylic anhydride (MA) modified sericin (SerMA) solution mixed with procyanidins (PC) loaded polydopamine (PDA) modified ZIF-8 (PC@ZIF-8@PDA) nanoparticles to form a multifunctional PC@ZIF-8@PDA/SerMA hydrogel after exposure under blue light. Hydrogel products with pre-designed shapes were printed out by using the SerMA solution carrying PC@ZIF-8@PDA nanoparticles and chondrocytes, indicating that PC@ZIF-8@PDA/SerMA hydrogels with personalized shapes can be fabricated via 3D printing. Photocrosslinked PC@ZIF-8@PDA/SerMA hydrogel is able to kill chondrosarcoma cells and bacteria, like Staphylococcus aureus (S. aureus) , and Escherichia coli (E. coli) , by its photothermal activity combined with near-infrared radiation (NIR). The PC@ZIF-8@PDA/SerMA hydrogel exhibited an antioxidative activity and a good biocompatibility and was easily monitored by its florescent and photoacoustic properties. Rabbit articular cartilage defects were efficiently repaired by PC@ZIF-8@PDA/SerMA hydrogels with encapsulated corresponding autologous chondrocytes, and mice skin burning wounds were swiftly regenerated by applying this hydrogel. Hence, the PC@ZIF-8@PDA/SerMA hydrogel can be potentially applied to the clinic treatment of chondrosarcoma and tissue defect repair after chondrosarcoma resection due to its multifunction in the future.

EZH2/hSULF1 axis mediates receptor tyrosine kinase signaling to shape cartilage tumor progression.

Chondrosarcomas are primary cancers of cartilaginous tissue and capable of alteration to highly aggressive, metastatic, and treatment-refractory states, leading to a poor prognosis with a five-year survival rate at 11 months for dedifferentiated subtype. At present, the surgical resection of chondrosarcoma is the only effective treatment, and no other treatment options including targeted therapies, conventional chemotherapies, or immunotherapies are available for these patients. Here, we identify a signal pathway way involving EZH2/SULF1/cMET axis that contributes to malignancy of chondrosarcoma and provides a potential therapeutic option for the disease. A non-biased chromatin immunoprecipitation sequence, cDNA microarray analysis, and validation of chondrosarcoma cell lines identified sulfatase 1 (SULF1) as the top EZH2-targeted gene to regulate chondrosarcoma progression. Overexpressed EZH2 resulted in downregulation of SULF1 in chondrosarcoma cell lines, which in turn activated cMET pathway. Pharmaceutical inhibition of cMET or genetically silenced cMET pathway significantly retards the chondrosarcoma growth and extends mice survival. The regulation of EZH2/SULF1/cMET axis were further validated in patient samples with chondrosarcoma. The results not only established a signal pathway promoting malignancy of chondrosarcoma but also provided a therapeutic potential for further development of effective target therapy to treat chondrosarcoma.

One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis.

Study designRetrospective case series.ObjectiveTo describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.Summary of background dataTotal en bloc spondylectomy (TES) technique is conventionally based on the single posterior approach or combined anterior-posterior approach. However, the single posterior approach imposes a high technical demand on the surgeon due to the narrow field of vision, limited surgical space and the delicate spinal cord, while the combined anterior-posterior approach not only requires greater patient tolerance but is time consuming and runs the risk of more blood loss and injury to the visceral pleura and large blood vessels during surgery. In addition, it is difficult to completely remove the thoracic CHS with paravertebral mass through simple en bloc resection when it involves the aorta, vena cava, costa and lung.Material and methodsBetween August 2010 and January 2016, we performed a retrospective study to evaluate the clinical characteristics and outcomes of en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. Postoperative recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. P values less than 0.05 were considered statistically significant.ResultsAltogether 15 patients received en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. The mean age of these patients was 37.0 ± 12.8 years (median 36; range 15–64). This combination approach provided more extensive exposure and wider marginal resection of the tumor within a mean operation duration of 288 ± 96 min (median 280; range 140–480) and mean intraoperative blood loss of 1,966 ± 830 ml (median 2,000; range 300–3,000). Of the 15 patients, 5 experienced local recurrence of the disease; the mean time from surgery to recurrence was 22 ± 9.85 months (median 17, range 13–35). RFS in patients with recurrent CHS was significantly lower than that in patients with primary CHS on admission (p = 0.05).ConclusionsThe combined posterior median and Wiltse approach is a technically viable option for en bloc resection of thoracic spinal CHS with huge paravertebral mass, and can give a favorable local control of CHS.Level of evidenceLevel V.

Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study

ObjectivesTo evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma.Materials and methodsTwenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively.ResultsAt a mean follow-up of 62.6 months (range, 13–123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05).ConclusionsSurgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments.

Asymptomatic Chondrosarcoma of the Skull base: A Case Report.

Chondrosarcoma of the skull base is a malignant tumor of cartilage origin. Clinical manifestations are nonspecific, early can be asymptomatic. We report a case of asymptomatic chondrosarcoma of the skull base which is difficult to confirm the diagnosis. The patient underwent Type A resection of chondrosarcoma of the skull base through the left subtemporal fossa approach, with postoperative radiotherapy. And the patient achieved good postoperative recovery. Therefore, chondrosarcoma of the skull base is a rare malignant tumor with slow growth. Early detection, excision, and postoperative radiotherapy can achieve a good therapeutic effect.

“In-house” Design and Use of 3-dimensional Printed Patient-specific Bone Tumor Resection Guides for Geometric Osteotomies in Sarcoma Surgery

Three-dimensional printing technology has rapidly advanced as a promising technology for preoperative planning, education, and surgical execution in orthopedic surgery. Use of patient-specific instrumentation in orthopedic oncology sarcoma cases can streamline complex osteotomies while providing safe margins based on predetermined osteotomy levels. We describe use of an “in-house” protocol to create patient-specific bone tumor resection guides for use in orthopedic oncology cases. The described protocol bypasses expensive outsourcing options and facilitates use of preoperative surgical simulation and intimate involvement of the surgical team in the guide design. We report on the successful design and use of three-dimensional printed patient-specific bone tissue resection guides in a case of proximal tibial parosteal osteosarcoma resection and reconstruction with a size-matched allograft, and in a case of a secondary pelvic chondrosarcoma resection.

Resection arthroplasty of the proximal humerus following chondrosarcoma removal and reconstructive failure: A case report with 22 year follow-up

Introduction: Proximal humeral reconstructive alternatives in orthopedic oncology are well described, but the literature regarding post-failure salvage is sparse. This report details a multiply failed humeral reconstruction that ultimately resulted in resection arthroplasty. Although initial tumor resection was treated with an intercalary reconstruction, this case is unique in that its sequelae are equally applicable to failures of proximal humeral reconstruction. Case presentation: We report a 61-year-old Caucasian woman with ultimate removal of a second proximal humeral reconstruction twenty-two years after initial grade I chondrosarcoma resection, leaving essentially a shoulder resection arthroplasty Conclusion: The patient’s acceptance of resection arthroplasty in this case suggests that not all failures of proximal humeral major reconstructive procedures need to be revised to another reconstruction. Resection arthroplasty is much less complex than revision surgery, requires little healing time, expedites recovery, minimizes subsequent further complications and allows for excellent pain relief. Resection arthroplasty may be a plausible approach after failed orthopedic oncology humeral reconstruction in carefully selected patients. Keywords: chondrosarcoma; resection arthroplasty; reconstruction; musculoskeletal tumor; intercalary allograft; proximal humerus; shoulder; shoulder arthroplasty

Giant Ossified Clival Chondrosarcoma Resection: 2-Dimensional Operative Video.

Chondrosarcomas are a spectrum of tumors with variable clinical behavior, histologically classified as grades I, II, and III.1 Maximal surgical resection with adjuvant radiation is the gold standard for grade III malignant tumors.2,3 Lower-grade skull base chondrosarcomas have a slow progressive local growth pattern with an overall benign profile.1,4 In these grade I and II tumors, radical resection can be sufficient in achieving long-term control of the disease without the need for adjuvant therapy, thus avoiding the long-term side effects of irradiation in relatively young patients.4,5 As a slow-growing tumor, skull base chondrosarcoma might reach a giant size with progressive neurological deficits prior to diagnosis. In these cases, to achieve maximal resection, skull base approaches tailored to the patient's anatomy are essential.4,6 Cranial approach is frequently needed due to the calcified nature of part of the tumor that is not amenable to resection through the endonasal approach. The endoscope is extremely helpful combined with the microscopic resection. We demonstrate these techniques through in the surgery of a 39-yr-old female who presented with progressive neurological deficits from a giant ossified chondrosarcoma and underwent a combined petrosal approach for the resection of her tumor. A postoperative small enhancement remained stable on the 4-yr follow-up exam. The pathology confirmed grade II chondrosarcoma, with the patient recovering from her neurological deficit except the third nerve. The patient consented to the surgery and publication of images. Image at 1:36 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998.

Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Chondrosarcoma: A National Cancer Database Study

Limited data are available to inform the risk of readmission and short-term mortality in musculoskeletal oncology. The goal of this study was to identify factors independently associated with 30-day readmission and 90-day mortality following surgical resection of chondrosarcoma. We retrospectively reviewed 6653 patients following surgical resection of primary chondrosarcoma in the National Cancer Database (2004-2017). Both demographic and clinicopathologic variables were assessed for correlation with readmission and short-term mortality utilizing univariate and multivariate logistic regression modeling. Of 220 readmissions (3.26%), risk factors independently associated with an increased risk of unplanned 30-day readmission included Charlson-Deyo Comorbidity Index (CDCC) (odds ratio [OR] 1.31; p=0.027), increasing American Joint Committee on Cancer (AJCC) stage (OR 1.31; p=0.004), undergoing major amputation (OR 2.38; p=0.001), and axial skeletal location (OR 1.51; p=0.028). A total of 137 patients died within 90days of surgery (2.25%). Risk factors associated with increased mortality included the CDCC (OR 1.60; p=0.001), increasing age (OR 1.06; p<0.001), having Medicaid insurance status (OR 3.453; p=0.005), living in a zip code with a higher educational attainment (OR 1.59; p=0.003), increasing AJCC stage (OR 2.32; p<0.001), longer postoperative length of stay (OR 1.015; p=0.033), and positive surgical margins (OR 2.75; p=0.001). Although a majority of the cohort did not receive radiation therapy (88.8%), receiving radiotherapy (OR 0.132; p=0.010) was associated with a decreased risk of short-term mortality. Several tumor, treatment, and patient factors can help inform the risk of readmission and short-term mortality in patients with surgically treated chondrosarcoma.

A Modified Reconstruction Technique of Chest Wall after Radical Resection of Chondrosarcoma Underlying the Breast

Chest wall tumors are uncommon and include a variety of Cartilaginous, bony, and soft tissue lesions. The clinical presentation varies from asymptomatic to chest pain or ulcerating chest mass. Retro mammary chondrosarcoma of the chest wall can present as a painless breast mass and may be mistaken for a breast tumor. A careful clinical examination and relevant investigations are a cornerstone to plan an appropriate surgical procedure.

Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance.

Chondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem ( Fig. 1 ). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection ( Fig. 2 ). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors. The link to the video can be found at: https://youtu.be/WlmCP_-i57s .

Reconstruction of forearm support with ulnar translocation after resection of chondrosarcoma in the proximal radius.

This is areport of the reconstructive surgery of apatient with chondrosarcoma in the proximal radius. After extensive resection of the proximal radius that contained the tumor, the skeleton of the forearm was reconstructed by ulnar translocation. This patient was followed for 2years, no recurrence of the tumor was found and the function of the forearm was nearly normal. This case is reported and discussed and aliterature review is presented.

Sternocondral resection for chondrosarcoma and reconstruction with cadaveric allograft

Sternocondral resection for chondrosarcoma and reconstruction with cadaveric allograft

Hemipelvectomy for pelvic sarcomas

Hemipelvectomy is an important technique for the treatment of pelvic sarcomas. Presentation of the technical overview, as well as surgical and oncological outcomes of sarcoma patients treated with pelvic tumor resections and treatment recommendations. Retrospective analysis of 160 patients treated by pelvic tumor resection for chondrosarcoma between 1977 and 2014. Chondrosarcoma was the most common diagnosis leading to pelvic tumor resection in this collective (38%). The mean patient age at operation was 49years. 44patients were treated for G1, 83patients for G2 and 33patients for G3 or dedifferentiated chondrosarcoma. The mean tumor diameter was ≥10 cm in 76.1% of cases. Limb salvaging operations were possible in 82.5% of patients. The most common reconstruction technique was hip transposition (38.7%). Clear resection margins were achieved in 86.9% (R0). Local recurrence was observed in 22.5%. Distant pulmonal metastasis was diagnosed in 25% of patients. Grading-specific survival was 81.8% for G1, 59% for G2 and 24.2% for G3 or dedifferentiated chondrosarcoma with amean survival of 84.4, 89 and 69.4 months respectively. Pelvic tumor resection with clear margins is the most important known positive predictive local factor affecting overall outcomes, in addition to uncontrollable factors such as grading and tumor size. Defect reconstruction depends on multiple factors such as patient age and adjuvant therapy. The stage of the disease has the greatest impact on overall survival rates and should be considered when contemplating pelvic tumor resections in sarcoma patients.

Surgical treatment of low-grade chondrosarcoma involving the appendicular skeleton: long-term functional and oncological outcomes.

The traditional treatment for chondrosarcoma is wide local excision (WLE), as these tumors are resistant to chemotherapy and radiation treatment. While achieving negative margins has traditionally been the goal of chondrosarcoma resection, multiple studies have demonstrated good short-term results after intralesional procedures for low-grade chondrosarcomas (LGCS) with curettage and adjuvant treatments (phenol application, cauterization or cryotherapy) followed by either cementation or bone grafting. Due to the rarity of this diagnosis and the recent application of this surgical treatment modality to chondrosarcoma, most of the information regarding treatment outcomes is retrospective, with short or intermediate-term follow-up. The aim of this study was to assess the long-term results of patients with LGCS of bone treated with intralesional curettage (IC) treatment versus WLE. This retrospective analysis aims to characterize the oncologic outcomes (local recurrence, metastases) and functional outcomes in these two treatment groups at a single institution. Using an institutional musculoskeletal oncologic database, we retrospectively reviewed medical records of all patients with LGCS of the appendicular skeleton that underwent surgical treatment between 1985 and 2007. Thirty-two patients (33 tumors) were identified with LGCS; 17 treated with IC and 15 with WLE. Seventeen patients (18 tumors) with a minimum clinical and radiologic follow-up of 10years were included. Nine patients were treated with IC (four with no adjuvant, three with additional phenol, one with liquid nitrogen and one with H2O2) with either bone graft or cement augmentation, and nine others were treated with WLE and reconstruction with intercalary/osteoarticular allograft or megaprosthesis. The mean age at surgery was 41years (range 14-66years) with no difference (p = 0.51) between treatment cohorts. There was a mean follow-up of 13.5years in the intralesional cohort (range 10-19years) and 15.9years in the WLE cohort (range 10-28years, p = 0.36). Tumor size varied significantly between groups and was larger in patients treated with WLE (8.2 ± 3.1cm versus 5.4 ± 1.2cm, at the greatest dimension, p = 0.021). There were two local recurrences (LR), one in the intralesional group and one in the wide local excision group, occurring at 3.5months and 2.9years, respectively, and both required revision. No further LR could be detected with long-term follow-up. The MSTS score at final follow-up was significantly higher for patients managed with intralesional procedures (28.7 ± 1.7 versus 25.7 ± 3.4, p = 0.033). There were less complications requiring reoperation in the intralesional group compared with the wide local excision group, although this difference was not found to be statistically significant (one versus four patients, respectively; p = 0.3). This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Complications were infrequent and minor and MSTS functional scores were excellent. Wide resection of LGCS was associated with lower MSTS score and more complications. In our series, the LR in both groups were detected within the first 3.5years following the index procedure, and none were detected in the late surveillance period.

Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma.

Study Design:Retrospective cohort study.Objectives:(1) To assess patient-reported outcomes—physical function, pain, and quality of life—in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status.Methods:Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were—minimally 6 months after surgery—the EuroQol 5 Dimensions (EQ5D), PROMIS–Physical Function, PROMIS–Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients.Results:After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate.Conclusions:Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes.

Humeral Head Replacement With Wrapping Reconstruction of the Rotator Cuff After Resection of Chondrosarcoma With Long-Term Shoulder Function: A Case Report

A 30-year-old woman with chondrosarcoma of the left proximal humerus was treated by humeral head replacement with wrapping reconstruction of the rotator cuff after resection. The dissected tendons of the rotator cuff were each sutured to the stump of the long head of the biceps brachii tendon. At the final follow-up 41 years after surgery, the patient had no difficulty in daily living and no pain, and her shoulder range of motion was successfully maintained. Although the proximal humerus is a common location for bone tumors, reconstruction and stabilization of the shoulder after tumor resection are still challenging. Wrapping reconstruction of the rotator cuff appeared to provide a dynamic force couple of the shoulder for more than 40 years. This reconstructive method is a viable treatment option for young patients with low-grade malignant tumors occurring in the proximal humerus. J Med Cases. 2019;10(2):53-57 doi: https://doi.org/10.14740/jmc3252

Pelvic reconstruction with bone cement and total hip prosthesis after resection of chondrosarcoma. Case Report

Abstract Introduction. Chondrosarcoma is a malignant tumor of cartilaginous origin representing approximately 20-30% of all bone malignant tumors and occupying the second place in terms of their incidence. It usually affects adults between 40 and 60 years old, but can be encountered at older ages as well. Materials and methods. We report the case of a 55-year-old male patient who presented to our department with 2 weeks-long right hip pain and partial loss of functionality in right limb. We performed X-rays, magnetic resonance imaging, computed tomography, bone scintigraphy, and angiography, which established the diagnosis of pelvic tumor. Biopsy of the tumor was performed by iliofemoral approach and its result showed moderately differentiated chondrosarcoma. Orthopaedic surgery was performed, with tumoral removal within oncological limits, pelvic reconstruction using acrylic bone cement impregnated with Vancomycin and total hip arthroplasty. Results were assessed using the Musculoskeletal Tumor Rating Scale and a score of 23 out of 35 was obtained (the higher the better). Postoperative complications consisted in flap-skin necrosis that resolved within 2 months after surgery. Conclusion. Bone defects repair using antibiotic impregnated cement drastically reduced the rate of postoperative infections, thus decreasing both morbidity and mortality. In spite of technological advancement, long-term prognosis remains reserved in chondrosarcoma, due to its specific aggressivity, resistance to chemo- and radiotherapy and high rate of recurrence.

Custom Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty (rTSA) initially faltered because of glenoid component failure. Modern design utilizes a large glenosphere component and relies upon a functional deltoid for arm elevation. We report novel use of rTSA to revise a chronically dislocating TSA. The patient underwent proximal humeral resection for chondrosarcoma, requiring sacrifice of the deltoid and all proximal insertions including the latissimus dorsi. Twoyears post-operatively, he had good stability, no pain, and was using his arm more than he had in years. rTSA is a salvage option for failed TSA, even with absent deltoid function and lack of a latissimus.