Treatment Of Bone Tumors Research Articles

Rehabilitation Management of a Pediatric Patient with Modified Van Nes Prosthesis after Type B-IIIA Hip Rotationplasty: A Case Report

Van Nes rotationplasty has gained popularity as a surgical treatment for malignant bone tumors without resorting to amputation. However, the nature of the surgery poses unique challenges in the rehabilitation management in order to optimize safety and functional mobility. We describe a case of a 6-year-old female with Ewing’s sarcoma of the right femur who underwent Van Nes Type BIIIA rotationplasty. This procedure involved a complete femoral resection, with the tibia and the foot rotated by 180 degrees and the lateral tibial plateau placed into the acetabulum that is expected to remodel to form a neo-hip joint. The patient was referred to rehabilitation medicine and was eventually admitted due to impairment in mobility secondary to the surgery. The goal was to achieve K-1 level of function. This case demonstrates that the rehabilitation management of a child with Type B-IIIA rotationplasty using a modified Van Nes prosthesis requires a comprehensive multidisciplinary approach.

Plating after tumor curettage in human femora does not efficiently improve torsional stability ex vivo

BackgroundSurgical treatments of benign primary bone tumors of the femur face the challenge of limiting tissue damage and contamination while providing sufficient stabilization to avoid fracture. While no clear treatment guidelines exist, surgical treatment commonly consists of femoral fenestration and curettage with optional filling and plating of the defect. Mono- or bicortical plating of distal femoral defects aim to reduce fracture risk and have been shown to increase axial stability. However, it remains unclear whether plating increases torsional stability of the affected femur. Questions/purposesThis biomechanical study aimed to determine how much additional stability can be achieved by mono- or bicortical plating of femoral defects after fenestration. The following hypotheses were investigated: 1. Preventive plating of distal femur bone defects enhances torsional stability when compared to femoral fenestration alone. 2. A condition close to the intact (nonpathological) bone can be achieved by bone plating. 3. Defect shape influences torsional stability. Patients and methodsThiel embalmed human femora (n = 24) were left intact or subjected to the following surgical treatments (A) defect creation via fenestration, (B) defect with short monocortical plating, (C) defect with long bicortical plating. All femora were torsion tested in midstance position using pre-cycling and testing until failure. Quantitative computed tomography pre and post testing allowed bone mineral density calculation and crack path analysis. Finite element analysis provided insight into defect shape variations. ResultsTorsion experiments showed no relevant enhancement of torsional stability due to mono- or bicortical plating. There were no significant differences in maximum torque between unplated and plated femora with defect (defect: 35.38 ± 7.53 Nm, monocortical plating: 37.77 ± 9.82 Nm, bicortical plating: 50.27 ± 9.72 Nm, p > 0.05). Maximum torque for all treatment groups was significantly lower compared to intact femora (155–200 Nm, p < 0.001). Cracks originated predominantly from the proximal posterior corner of the defect and intersected with screw holes in plated femora. The influence of variations of the defect corner shapes had no significant influence on maximum torque and angle. ConclusionThis biomechanical study shows that mono- or bicortical plating is not an effective preventive treatment against torsional failure of femora with distal defects as the resulting maximum torque was drastically reduced compared to intact femora. Thus, the initial hypotheses have to be rejected. As habitual loading of the femur includes a combination of axial and torsional loading, the observed lack of prevention against torsional failure might help to explain the occurrence of fractures despite plating. Future research towards ameliorating clinical outcome should address the role of defect filling with bone cement or bone grafts regarding the improvement of torsional stability after primary bone tumor treatment in the femur.

Nonviral genetic manipulation system with microenvironmental cascade sensitivity for the treatment of TNBC-associated metastatic bone tumor

Gene therapy is an efficacious therapeutic modality for triple negative breast cancer (TNBC). However, the practicable applicability is strictly confined in TNBC-associated metastatic bone tumor due to the low blood flow and poor accumulation in bone tissue, as well as the vicious cycle of mutual promotion between tumor growth and bone erosion. To address those problems, a versatile nonviral genetic manipulation system PSMCA/miR-34a, with caveolae-activated endocytosis and microenvironmental cascade-responsive release profile was exploited. In vitro and in vivo experiments confirmed that PSMCA/miR-34a not only possessed bone-targeting properties to accumulate at bone tumor tissue, also could respond to the bone tumor microacidic environment to release alendronate to inhibit the bone erosion. After internalized into cells mainly through caveolae-mediated endocytosis, it was spurred to disassemble for controlling release the miR-34a by high intracellular GSH environment, generating an effective anti-tumor effect. Moreover, due to the synergistic effect, PSMCA/miR-34a could breakdown the vicious cycle between bone destruction and tumor growth in the tumor microenvironment, showing high potential in the clinical gene therapy for TNBC-associated metastatic bone tumor.

Impact of Psychological and Socioeconomic Factors on Management of Bone Tumours with Custom-made Endoprosthesis Reconstruction

Objectives: In the past few decades, the definitive treatment for bone tumours has evolved considerably. Resection followed by custom-made endoprosthesis reconstruction has become the standard of care. The main objective of this study is to analyse the psychological and socioeconomic factors impacting the treatment of bone tumours. Materials and Methods: Among the 53 patients who underwent bone resection with custom mega prosthesis (CMP) reconstruction between 2013 and 2022, 22 patients are in regular follow-up, 16 patients are lost in follow-up, and the remaining 15 are dead. We prepared a questionnaire which included 22 questions to assess the impact of psycho-social and economic factors on the treatment of bone tumours. Results: We included 22 patients in our study. The average total duration of disease before surgery was 95 days. The average days of in-hospital stay was 53 days. The average number of days of hospital stay after surgery was 14 days. The average amount spent during the hospital stay was about 240 Indian national rupees/day. The average loss of work was about 90 days. The average days of leave availed in school/college was 135 days. About 69.2% of patients had to go for a change of occupation. About 90.9% of patients had a fear of recurrence. About 77.2% of patients found it difficult to indulge themselves in recreational/sports activities. About 45.4% of patients felt it was difficult for their partner/family to empathise with their situation. About 59% of patients had sleep difficulties. About 36.3% of patients were well satisfied with their prosthesis. Conclusion: Being predominantly a disease of the young population, the need for comprehensive management, including psychological counselling and rehabilitation in addition to cancer treatment, seems to be the need of the hour. The fact of the high cost of non-treatment-related expenditure needs to be addressed. A frequent cancer survivor programme will aid these patients to regain their self-confidence.

Applications of artificial intelligence for imaging-driven diagnosis and treatment of bone and soft tissue tumors

Bone and soft tissue tumors occur in the musculoskeletal system, and malignant bone tumors of bone and soft tissue account for 0.2% of all human malignant tumors, and if not diagnosed and treated in a timely manner, patients may be at risk of a poor prognosis. Image interpretation plays an increasingly important role in the diagnosis of bone and soft tissue tumors. Artificial intelligence (AI) can be applied in clinical treatment to integrate large amounts of multidimensional data, derive models, predict outcomes, and improve treatment decisions. Among these methods, deep learning is a widely employed technique in AI that predominantly utilizes convolutional neural networks (CNN). The network is implemented through repeated training of datasets and iterative parameter adjustments. Deep learning-based AI models have successfully been applied to various aspects of bone and soft tissue tumors, encompassing but not limiting in image segmentation, tumor detection, classification, grading and staging, chemotherapy effect evaluation, recurrence and prognosis prediction. This paper provides a comprehensive review of the principles and current state of AI in the medical image diagnosis and treatment of bone and soft tissue tumors. Additionally, it explores the present challenges and future prospects in this field.

Targeting Death Receptor 5 (DR5) for the imaging and treatment of primary bone and soft tissue tumors: an update of the literature.

Death Receptor 5 (DR5) is expressed on the surface of primary bone and soft tissue sarcoma cells, and its activation induces cell death primarily through apoptosis. The combination of DR5 agonists and commonly used chemotherapeutic agents, such as doxorubicin, can promote cell death. Currently, clinical trials are investigating the effectiveness of DR5 activation using new biological agents, such as bi-specific or tetravalent antibodies, in improving the survival of patients with relapsed or refractory cancers. Furthermore, investigations continue into the use of novel combination therapies to enhance DR5 response, for example, with inhibitor of apoptosis protein (IAP) antagonist agents [such as the second mitochondria-derived activator of caspase (SMAC) mimetics] and with immune checkpoint inhibitor anti-programmed death-ligand 1 (anti-PD-L1) or anti-programmed cell death-1 (anti-PD-1) antibodies. Other therapies include nanoparticle-mediated delivery of TRAIL plasmid DNA or TRAIL mRNA and stem cells as a vehicle for the targeted delivery of anti-cancer agents, such as TRAIL, to the tumor. Scoping review of the literature from November 2017 to March 2024, utilizing PubMed and Google Scholar. New agents under investigation include nanoTRAIL, anti-Kv10.1, multimeric IgM, and humanized tetravalent antibodies. Developments have been made to test novel agents, and imaging has been used to detect DR5 in preclinical models and patients. The models include 3D spheroids, genetically modified mouse models, a novel jaw osteosarcoma model, and patient-derived xenograft (PDX) animal models. There are currently two ongoing clinical trials focusing on the activation of DR5, namely, IGM-8444 and INBRX-109, which have progressed to phase 2. Further modifications of TRAIL delivery with fusion to single-chain variable fragments (scFv-TRAIL), directed against tumor-associated antigens (TAAs), and in the use of stem cells focus on targeted TRAIL delivery to cancer cells using bi-functional strategies. In vitro, in vivo, and clinical trials, as well as advances in imaging and theranostics, indicate that targeting DR5 remains a valid strategy in the treatment of some relapsed and refractory cancers.

A Chemotherapy-Photothermal synergistic system in bifunctional bone Scaffold: Tumor therapy and bone repair

Bone defect repair and tumor recurrence are the main challenges in the postoperative treatment of bone tumors. The incorporation of zoledronate (ZOL) into scaffolds presents a promising approach, attributed to its osteogenic and anti-tumor properties. However, there are still some unfavorable factors that make it difficult to eradicate tumor cells at the surgical site, including drug rapid release, the insufficient anti-tumor efficacy of ZOL and the multidrug resistance of chemotherapy. Herein, a novel nano drug delivery platform mesoporous silicon-coated graphene oxide (GO/MSN) and ZOL loaded nanoparticle (GO/MSN-ZOL) were developed. Then PLLA/ GO/MSN-ZOL scaffold that integrates photothermal therapy (PTT) and chemotherapy was fabricated using poly (L-lactic acid) as raw materials by selective laser sintering (SLS) technology. The GO not only imparted scaffold with photothermal properties for localized tumor cell ablation but also significantly enhanced its anti-tumor efficacy through synergistic effects in combination with chemotherapy. The mesoporous structure and large specific surface area of MSN contribute to the sustained release of ZOL. Additionally, GO could promote osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), which in combine with ZOL’s osteoclast inhibition, enhances the bone repair capacity. This study offers a straightforward and promising strategy for treating tumor-related bone defects.

Research trends of bone tumor treatment with 3D printing technology from 2013 to 2022: a bibliometric analysis

ObjectiveBibliometrics was employed in this study to determine the research trends in the worldwide application of 3D printing technology to treat bone tumors over the previous 10 years.MethodsPublished from 2013 to 2022, the papers related to bone tumors treated with 3D printing were located in Web of Science Core Collection (WoSCC), PubMed, and Scopus. The screened articles were included in this bibliometric study. From these papers in WoSCC, information on annual publications, journals, keywords, countries, authors, institutions, and cited references were extracted and visualized with CiteSpace (version 6.1.R6) software to investigate the state of bone tumor treatment using 3D printing as well as research hotspots. The Carrot2 online visualization tool and Vosviewer software (version 1.6.20) were employed to visualize the publications from PubMed and Scopus, respectively, in order to ascertain the most popular research topics from both databases.ResultsA total of 606, 233, and 364 publications were obtained from WoSCC, PubMed, and Scopus, respectively, between the years 2013 and 2022. In WoSCC, the peak number of publications was found in 2021, with 145 publications published. Acta Biomaterialia (11 publications) and World Neurosurgery (10 publications) were the most prolific journals, and Biomaterials was the journal cited the most (244 times). Yong Zhou was the most productive author with 14 publications, while Kwok-Chuen Wong (69 citations) and William F Enneking, (69 citations) possessed the most citations. The country with the largest quantity of publications was China (207). Among all institutions, Shanghai Jiao Tong University produced the most publications (29). Rapid prototyping was the keyword with the strongest citation burst (4.73). ‘Reconstruction’, ‘surgery’, ‘resection’, and ‘design’ caught the significant attention of researchers. 3D-printed materials, pelvic reconstruction, mandibular reconstruction, computer-assisted surgical techniques, photothermal therapy, and in vitro experiments were recognized as hot subjects and trends in current research. The most frequently occurring topics in Scopus are not significantly different from those found in WoSCC. The most prevalent research areas in PubMed encompass implant, patient-specific, bioceramic, models, and pelvic.

Formulation and characterization of a novel anti-human bone cancer supplement from silver nanoparticles green-synthesized using Allium sativum l. Leaf aqueous extract

Several studies have recently uncovered the ability of plants to enhance the therapeutic efficacies of Ag NPs on various carcinoma cells, particularly those associated with human bone tumors. Developing and formulating novel chemotherapy supplements or medications for the management of bone tumors in humans is a top research focus for both developing and developed nations. Our current study involved the development of a contemporary chemotherapeutic medication utilizing silver nanoparticles (AgNPs) combined with an aqueous extract of Allium sativum L. for the purpose of treating bone tumors in humans. AgNPs were characterized using XRD, TEM, UV–Vis, and FE-SEM. The peaks detected at 2θ values of 77.4, 65.1, and 37.8 were associated with the crystal planes 311, 220, and 111, respectively. To examine the antioxidant characteristics of AgNPs, the DPPH assay was employed with BHT serving as the positive control. The MTT assay was employed to examine the anti-human bone tumor and cytotoxicity properties of AgNPs on bone cancer cells, including A-673 and HS-729 (rhabdomyosarcoma), MHH-ES1 and CADO-ES1 (Ewing’s sarcoma), MG-63 and HOS (osteosarcoma), as well as CH-3573 and SW-1353 (chondrosarcoma). The DPPH assay demonstrated comparable antioxidant capacities among AgNPs, and butylated hydroxytoluene. The anti-human bone tumor properties and cell viability of silver nanoparticles exhibited a dose-dependent decrease against CH-3573, SW-1353, MG-63, HOS, MHH-ES1, CADO-ES1, HS-729, and A-673 cells, while showing no cytotoxic effects on the normal cell line. The viability of the cells and their response to the nanoparticles varied based on the dosage administered. The silver nanoparticles exhibited IC50 values of 154, 67, 129, 110, 124, 107, 70, and 81 µg/ml against H-3573, SW-1353, MG-63, HOS, MHH-ES1, CADO-ES1, HS-729, and A-673 cell lines, respectively. The HOS revealed the most effective outcome regarding anti-human bone tumor efficacies when treated with AgNPs, surpassing the results observed in other cell lines. Based on the aforementioned results, it is possible to utilize the silver nanoparticles with A. sativum extract for the management of various human bone tumors, particularly human bone rhabdomyosarcoma, human bone chondrosarcoma, human bone osteosarcoma, and human bone Ewing’s sarcoma.

Treatment of pediatric bone tumors around the knee

Primary bone tumors are rare but more frequently seen during childhood and with predilection for the distal femur and proximal tibia. Therapy of benign tumors-if indicated-includes surgical resection in most cases, whereas malignant bone tumors such as osteo- and Ewing's sarcomas are treated with chemotherapy, wide resection and/or radiation therapy (Ewing's sarcoma). The reconstruction of emerging bone defects is significantly influenced by surgeon-related preferences and tumor-associated factors, respectively. Double-barrel vascularized fibula grafts or extracorporeally irradiated autografts in combination with afree fibula transplant are preferred biological reconstruction techniques around the knee joint. In cases in which the knee joint cannot be preserved, reconstruction is performed using tumor endoprostheses, but potentially emerging leg length discrepancies after resection of apotent physis must be taken into account. In considerably young patients, rotationplasty might represent aviable option with promising functional results.

A targeted and core-shell structured gambogic acid nanomedicine for ameliorating breast cancer-associated osteolysis

The treatment of breast cancer-associated bone tumors is of critical importance and highly challenging, primarily owing to the malignant interplay between tumor proliferation and osteolysis within the bone tumor microenvironment. Although many efforts have been devoted, it is still urgent and desirable to find a robust therapeutic agent that can simultaneously and efficiently inhibit the proliferation of bone tumor and osteoclast differentiation. In this work, we have fabricated a bone-targeting nanoplatform based on bioinspired polydopamine-coated gambogic acid nanoparticles (GA@PDA NPs) integrated with mild temperature photothermal therapy (PTT) and chemotherapy towards the treatment of bone tumors. In particular, GA not only inhibits osteoclast differentiation and proliferation of bone tumor cells, but also downregulates heat shock protein 90 (Hsp90) in the treated tumor cells to sensitize the PTT effect, and the resulting core-shell structured nanomedicine could allow the spatiotemporal control of chemotherapy and mild temperature PTT. Those bioinspired nanomedicine could exhibit excellent tumor suppression and osteolysis inhibition against a xenograft tumor bone metastasis model, and this novel nanoformulation provides a creative paradigm for the treatment of breast cancer-associated osteolysis.

Photothermal switch by gallic acid-calcium grafts synthesized by coordination chemistry for sequential treatment of bone tumor and regeneration

The residual bone tumor and defects which is caused by surgical therapy of bone tumor is a major and important problem in clinicals. And the sequential treatment for irradiating residual tumor and repairing bone defects has wildly prospects. In this study, we developed a general modification strategy by gallic acid (GA)-assisted coordination chemistry to prepare black calcium-based materials, which combines the sequential photothermal therapy of bone tumor and bone defects. The GA modification endows the materials remarkable photothermal properties. Under the near-infrared (NIR) irradiation with different power densities, the black GA-modified bone matrix (GBM) did not merely display an excellent performance in eliminating bone tumor with high temperature, but showed a facile effect of the mild-heat stimulation to accelerate bone regeneration. GBM can efficiently regulate the microenvironments of bone regeneration in a spatial-temporal manner, including inflammation/immune response, vascularization and osteogenic differentiation. Meanwhile, the integrin/PI3K/Akt signaling pathway of bone marrow mesenchymal stem cells (BMSCs) was revealed to be involved in the effect of osteogenesis induced by the mild-heat stimulation. The outcome of this study not only provides a serial of new multifunctional biomaterials, but also demonstrates a general strategy for designing novel blacked calcium-based biomaterials with great potential for clinical use.

Rehabilitation and quality of life of patients after arthroplasty for malignant bone tumors of the upper limb

Arthroplasty is the most widely used surgical technique for bone tumors of the upper limbs. However, it should be noted that the functional outcomes after endoprosthetic reconstruction for malignant bone tumors of the upper limb does not always satisfy patients and often lead to impaired working capacity of patients, and their disability. The need to improve functional outcomes determines the practical and socio-economic significance of the research. The purpose of the study was to evaluate the impact of a complex of rehabilitation measures on the quality of life of patients after surgery with endoprosthetic reconstruction for malignant bone tumors of the upper limb. Material and Methods. The treatment and rehabilitation outcomes in 146 patients were analyzed. There were 88 (60 %) men and 58 (40 %) women with an average age of 47 years (range, 19–75 years). The tumor was localized in the proximal humerus in 98 (67 %) patients, in the diaphysis in 18 (12 %), in bones that make up the elbow joint in 16 (11 %) and in the distal radius in 14 (9.6 %) patients. Results. Our rehabilitation technique improved functional outcomes after endoprosthetic reconstruction for all tumor localizations. The musculoskeletal Tumor Society (MSTS) score was improved by 10 % (75 vs 65 %) for arthroplasty of the shoulder joint, for the wrist joint by 8 (80 vs 72 %). The rehabilitation technique allowed significant improvement of MSTS score for arthroplasty of the humeral diaphysis and bones making up the elbow joint (from 76 to 95 % and from 68 to 82 %, respectively). Conclusion. Rehabilitation measures play an important role in optimizing quality of life of patients after surgical treatment of bone tumors of the upper limb with arthroplasty, helping to improve functional outcomes.

Nanoengineered 3D-printing scaffolds prepared by metal-coordination self-assembly for hyperthermia-catalytic osteosarcoma therapy and bone regeneration

The integration of functional nanomaterials with tissue engineering scaffolds has emerged as a promising solution for simultaneously treating malignant bone tumors and repairing resected bone defects. However, achieving a uniform bioactive interface on 3D-printing polymer scaffolds with minimized microstructural heterogeneity remains a challenge. In this study, we report a facile metal-coordination self-assembly strategy for the surface engineering of 3D-printed polycaprolactone (PCL) scaffolds with nanostructured two-dimensional conjugated metal–organic frameworks (cMOFs) consisting of Cu ions and 2,3,6,7,10,11-hexahydroxytriphenylene (HHTP). A tunable thickness of Cu-HHTP cMOF on PCL scaffolds was achieved via the alternative deposition of metal ions and HHTP. The resulting composite PCL@Cu-HHTP scaffolds not only demonstrated potent photothermal conversion capability for efficient OS ablation but also promoted the bone repair process by virtue of their cell-friendly hydrophilic interfaces. Therefore, the cMOF-engineered dual-functional 3D-printing scaffolds show promising potential for treating bone tumors by offering sequential anti-tumor effects and bone regeneration capabilities. This work also presents a new avenue for the interface engineering of bioactive scaffolds to meet multifaceted demands in osteosarcoma-related bone defects.

A deep learning-based system for accurate diagnosis of pelvic bone tumors

Bone image analysis and categorizing bone cancers have both seen advancements thanks to deep learning (DL), more notably convolution neural networks (CNN). This study suggests a brand-new CNN-based methodology for categorizing pelvic bone tumors specifically. This work aims to create a pelvic bone computed tomography (CT) image categorization system based on deep learning. The proposed technique uses a convolutional neural network (CNN) architecture to automatically extract information from the CT images and classify them into distinct categories of tumors. A total of 178 3D CT pictures was discovered and added retroactively. DenseNet created the image-based model with Adam optimizer and cross entropy loss. The suggested system's accuracy is assessed using a variety of performance indicators, including sensitivity, specificity, and F1-score. As demonstrated by the experiment findings, the suggested deep learning based classification system has a high degree of accuracy (94%), making it useful for the diagnosis and treatment of pelvic bone tumors. Our promising results might hasten the use of DL-assisted CT diagnosis for pelvic bone tumors in the future.

Targeting nanoplatform synergistic glutathione depletion-enhanced chemodynamic, microwave dynamic, and selective-microwave thermal to treat lung cancer bone metastasis

Once bone metastasis occurs in lung cancer, the efficiency of treatment can be greatly reduced. Current mainstream treatments are focused on inhibiting cancer cell growth and preventing bone destruction. Microwave ablation (MWA) has been used to treat bone tumors. However, MWA may damage the surrounding normal tissues. Therefore, it could be beneficial to develop a nanocarrier combined with microwave to treat bone metastasis. Herein, a microwave-responsive nanoplatform (MgFe2O4@ZOL) was constructed. MgFe2O4@ZOL NPs release the cargos of Fe3+, Mg2+ and zoledronic acid (ZOL) in the acidic tumor microenvironment (TME). Fe3+ can deplete intracellular glutathione (GSH) and catalyze H2O2 to generate •OH, resulting in chemodynamic therapy (CDT). In addition, the microwave can significantly enhance the production of reactive oxygen species (ROS), thereby enabling the effective implementation of microwave dynamic therapy (MDT). Moreover, Mg2+ and ZOL promote osteoblast differentiation. In addition, MgFe2O4@ZOL NPs could target and selectively heat tumor tissue and enhance the effect of microwave thermal therapy (MTT). Both in vitro and in vivo experiments revealed that synergistic targeting, GSH depletion-enhanced CDT, MDT, and selective MTT exhibited significant antitumor efficacy and bone repair. This multimodal combination therapy provides a promising strategy for the treatment of bone metastasis in lung cancer patients.

Editorial: New progress in the treatment of bone and soft tissue tumors

Editorial: New progress in the treatment of bone and soft tissue tumors

Clinical Application of Unidirectional Porous Hydroxyapatite to Bone Tumor Surgery and Other Orthopedic Surgery.

Unidirectional porous hydroxyapatite (UDPHAp) was developed as a remarkable scaffold characterized by a distinct structure with unidirectional pores oriented in the horizontal direction and connected through interposes. We evaluated the radiographic changes, clinical outcomes, and complications following UDPHAp implantation for the treatment of bone tumors. Excellent bone formation within and around the implant was observed in all patients treated with intralesional resection and UDPHAp implantation for benign bone tumors. The absorption of UDPHAp and remodeling of the bone marrow space was observed in 45% of the patients at a mean of 17 months postoperatively and was significantly more common in younger patients. Preoperative cortical thinning was completely regenerated in 84% of patients at a mean of 10 months postoperatively. No complications related to the implanted UDPHAp were observed. In a pediatric patient with bone sarcoma, when the defect after fibular resection was filled with UDPHAp implants, radiography showed complete resorption of the implant and clear formation of cortex and marrow in the resected part of the fibula. The patient could walk well without crutches and participate in sports activities. UDPHAp is a useful bone graft substitute for the treatment of benign bone tumors, and the use of this material has a low complication rate. We also review and discuss the potential of UDPHAp as a bone graft substitute in the clinical setting of orthopedic surgery.

Time to full weight-bearing with the use of a calcium sulfate-calcium phosphate bone substitute as a bone void filler following extended curettage in the treatment of primary benign bone tumours.

The primary objective of this study was to determine time to full weight-bearing after the use of a calcium-sulfate-calcium phosphate bone substitute (CaSO4/CaPO4) as a bone void filler in the treatment of primary benign bone tumours following intralesional curettage. The secondary objectives were to determine surgical complications and recurrence rates. Retrospective review of patients identified from a surgeon-specific orthopaedic oncology database, who underwent curettage of benign bone tumours and subsequent bone void filling with CaSO4/CaPO4. A total of 39 patients (20 males, 19 females) met inclusion criteria with an average age of 31years (range: 13 to 62years), a median follow-up of 3.7years, and a maximum follow-up of 11years. The most common tumour diagnosis was giant cell tumour of bone (GCT) (n = 19), and the most common location was the proximal tibia (n = 9). The mean volume of tumour excised was 74.1cm3 including extraosseous bone expansion due to tumour growth, with a mean of volume of 21.4mL of CaSO4/CaPO4 used to fill the intraosseous cavitary defects to restore normal bone anatomy. None of the lesions required additional internal fixation. The primary outcome measure, average time to full weight-bearing/full range of motion, was 11weeks and 6weeks for upper and lower extremity lesions, respectively. Secondary outcomes included tumour recurrence requiring reoperation in five patients and infection requiring reoperation in two patients. This study demonstrates that CaSO4/CaPO4 is a viable option as a bone void filler in the reconstruction of cavitary defects following removal of primary benign bone tumours. CaSO4/CaPO4 provides sufficient bone regeneration early in the post-operative period to allow progression to full weight-bearing within weeks without the need for internal fixation. There were no graft-specific complications noted.

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

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