Following resection of primary bone tumors of the pelvis, considerations for reconstructive options include patient age, functional status, and remaining native anatomy. Given numerous publications in this area, but with small sample sizes, the objective of this study was to perform a review of the literature and meta-analysis to assess complication rates associated with different reconstructive options. Inclusion criteria were peer-reviewed studies with a minimum of ten patients, which reported on implant(s) used and associated patient outcomes. Thirty-one studies representing 607 patients were included. Effect size was calculated for each of the Henderson failure modes (Type 1 – soft tissue, Type 2 – aseptic loosening, Type 3 – mechanical failure, Type 4 – infection, Type 5 – local recurrence) using the residual maximum likelihood technique and a meta-analysis of proportions was conducted. Additionally, region of resection was included (when available) utilizing the Enneking-Dunham classification. Major reconstruction methods utilized in the literature were: saddle, allograft prosthetic composite, autograft, stem and cup, and custom prostheses. Meta-analysis revealed a statistically lower rate of mechanical failure (p=0.03) in studies that utilized custom prostheses. Modeled rates of mechanical failure in this group were 2.5% (CI 6.23, 0.98) when compared to the overall summary proportion of 7.22% (CI 11.29, 4.54). Meta regression revealed a positive association of aseptic loosening and mechanical failure and percentage of type II+III (periacetabular and ischial) resections in the study (P=0.0002, 0.0045, respectively).

INTRODUCTION: Several benign and malignant bone tumors have aneurysmal content. Primary ABC, secondary ABC, and telangiectatic osteosarcoma are the most common. Confirming diagnosis of biopsy of cystic tumors with aneurysmal content was a dilemma because it was difficult to obtain adequate tissue for pathology and presents risks. Surgeons may choose to remove a lesion without the need for preoperative biopsy. However, the criteria for this are not well defined. The purpose was to develop an algorithm for clinical decision-making using a score based on the lesion’s main characteristics.
METHODS: We conducted a retrospective analysis of bone tumors diagnosed as primary ABC (10 cases), secondary ABC (7), and telangiectatic osteosarcoma (2) between 2008 and 2019. A protocol was devised containing age, diagnosis, and imaging. Through literature review and data collected from the devised protocol criteria a score between 0-8 was generated.
RESULTS: The threshold established to discriminate the need for biopsy was 3.5 (sensitivity 88.9%, specificity 90%, PPV 88.9%, and NPV 90%). Primary ABC (10 cases), scored between 2-4; secondary ABC (7) scored 3-7; and telangiectatic osteosarcoma (2) scored 6.
CONCLUSION: According to our findings it is possible to remove some tumors with aneurysmal content without prior biopsy using the decision algorithm. The algorithm scores from 0-8, separates lesions into lower and higher aggressiveness, indicates cases that require biopsy and can be used only by evaluating the MRI scan. Tumors scoring ≤ 3 can be treated without prior biopsy with curettage and adjuvant therapy. Tumors with other scores should be biopsied.

Background: Limb salvage surgery for tumors of the proximal humerus is challenging. Options of reconstruction include proximal humeral endoprosthesis/cement spacer using a nail. However, to the best of our knowledge, there has been no study in the literature, comparing these two surgical techniques. Objective: To compare the functional outcome and complications of above two reconstruction techniques. Methodology: This is retrospective study which was conducted between April 2013 and April 2020, which had patients who underwent surgical resection for malignant or benign aggressive lesions of the proximal humerus.The functional evaluation was done in terms of MSTS and DASH score. Results: A total of 79(35-endoprosthesis,44-cement spacer)patients were included in the study. Among these 22 patients(10-endoprosthesis,12-cement spacer) died due to disease, leaving with 25 patients(endoprosthesis) and 32 patients(cement spacer) for final follow-up. Average age was 21 ± 7years. Twenty patients were female while 37 patients were male. Diagnosis was GCT in 17 patients, Osteosarcoma in 12, Ewing Sarcoma in 13, Chondrosarcoma in 5, and other diagnosis in ten patients. Average follow up was 27months. The median MSTS score at final follow-up was 22 in nail cement spacer group vs 23 in endoprosthetic group(pvalue>0.05). However, the endoprosthetic group had significantly higher range of forward flexion than the nail cement spacer group. Seven patients had complications in the nail cement spacer group as against four patients in the endoprosthetic group. Conclusion: Tumor resection followed by reconstruction with cement spacer is a cost-effective option. It is technically easy and provides comparable functional outcome to endoprosthetic reconstruction.

Purpose: Wrist reconstruction after distal radial tumor resection poses a challenge to the orthopaedic oncologist. We evaluated the functional outcomes of centralization of ulna along with ulno-carpal fusion as a method of reconstruction following resection of distal radial tumors, using objective measures, with particular emphasis on resulting disability and hand grip strength.Methods: Evaluation of functional outcome was performed using MSTS93 score and DASH questionnaire. We also determined hand grip strength on the affected side, time to radiological union at ulno-carpal junction and reduction in wrist circumference. Any local complications and oncological outcomes were recorded.Results: Of the 28 patients included in the study, 26 had GCTB, 1 had Ewing’s sarcoma and 1 had Chondrosarcoma of the distal radius. Mean follow-up period in study was 32months. The mean resection length was found to be 10.1cm. Mean time to radiological union at the ulno-carpal junction was 4.5month. Mean hand grip strength was found to be 74% of contralateral side while mean reduction in wrist circumference was noted to be 2.5cm. Good functional outcome with a mean MSTS93 score of 26 and less disability with mean DASH score of 10.7 was observed. Fracture of ulna, hardware loosening and RSD were noted in 1 patient each, with an overall complication rate of 10.7% (3/28). None of the patients developed non-union, infection or local recurrence.Conclusion: It is a simple and effective modality of reconstruction after resection of distal radial tumors. It provides good functional outcome and preservation of good hand grip strength, with low complication rates.

Background
Acetabular erosion by head of proximal femur hemiarthroplasty causing pain has been a matter of concern that warrants acetabular resurfacing, especially in young adults. Proximal femoral replacements have a reported dislocation rate of 4-35% when the acetabulum is replaced which is lower with bipolar hemiarthroplasty.

Objectives
To evaluate functional outcomes following hemi-arthroplasty after wide resection of proximal femur tumors.

Study Design
This study included patients with malignant or benign aggressive tumors of proximal femur undergoing wide resection and reconstruction with bipolar proximal femur endoprosthesis without acetabular resurfacing between June 2017 and June 2019. Functional evaluation using MSTS 93 score and complications were recorded.

Results
23 patients undergoing proximal femur endoprosthesis reconstruction were included in this study. Mean age was 28.4 years (16 – 58 years). 17 patients had malignant and 4 had benign aggressive tumours and 2 patients had other histopathological diagnoses. Mean follow up duration was 22.56 months (12 – 42 months). Dislocation was found only in 2 patients, both occurring within one month of index surgery and deep infection in one patient. Three patients developed wound complications which were managed conservatively. Mean MSTS score was 24.91 with 95.6% reporting an excellent or good functional outcome with minimal restriction in walking, minor gait alteration and minimal pain at last follow up.


Conclusions
Larger head size provides more stability. Bipolar head allows motion in 2 planes thereby reducing acetabular wear. Sacrifice of abductor attachment results in trendelenberg gait and reduction in joint reaction forces, hence lessen acetabular wear.

ABSTRACT

 

Introduction: Giant cell tumors (GCT) of distal radius are invasive; yet benign tumors of the bone. They follow a comparatively aggressive behavior with frequent recurrence. Wide excision is the management of choice, but this creates a defect at the distal end of radius. This study was conducted to evaluate clinical and functional outcomes of wide resection and reconstruction by non-vascularized autogenous fibula grafting for GCT of distal radius treatment.

Materials and methods: This is an observational, cross-sectional, hospital-based study of 24 patients with GCT of the distal radius that were recruited over a period of one year in orthopedic departments of 2 major teaching hospitals based in Khartoum, Sudan.

 

Results: The total number of cases involved was 24 patients; females 18(75%) and males 6(25%) and most of them were below 40 years. They have a mean age of 34 years (17-51 years) with Campanacci Grade II /III. Volar surgical approach was done for 17(70.7%) of them and volar with dorsal approach for 7(29.3%), Overall, revised musculoskeletal tumor society (MSTS) score averaged with 17 (70.8%) good, 6(25%) excellent and 1(4.2%) satisfactory results. There were no cases with graft-related complications; but there was one case complicated with superficial infections, two cases with donor side morbidity (peroneal neuropraxia) and one case with nonunion due to fixation failure.

 

Conclusions: En-bloc resection of giant cell tumors of the lower end of the radius is a widely accepted method. Reconstruction with non-vascularized fibular graft, internal fixation with DCP and K-wire gives satisfactory functional results.

 

Giant cell tumors (GCTs) are aggressive benign tumor that typically affect the metaphyseal region of long bones. Surgical treatment of GCT sparing the articular surface typically includes curettage, adjuvant therapy, polymethylmethacrylate (PMMA) cementation, and plate fixation with or without subchondral bone grafting. We asked if the addition of bone graft at the subchondral region of defects decreases risk of non-oncologic complications. Medical records of patients treated for GCT from 1996-2022 at a single institution were retrospectively reviewed. Forty-three patients were analyzed, 20 (47%) treated with subchondral bone grafting. The median age was 34 years. Mean follow-up was 23 months and was comparable between groups. Sixteen (37%) patients had non-oncological complications: 5 pathologic fracture and 11 osteoarthritis. All occurred in the group treated with PMMA alone except for one patient in the bone graft group who developed arthritis. Patients treated with PMMA alone had a 9x greater risk of arthritis and a 6x greater risk of fracture (P= 0.002,0.009 respectively). There were 13 instances of local recurrence. Six (46.2%) recurrences were in the bone graft cohort. The risk of recurrence following intervention was not statistically different between the cohorts (RR = 0.98, 95% CI 0.266 – 3.61). Average time from intervention to recurrence was 32 months and was not statistically comparable. In conclusion, use of bone graft in patients with GCTs resulted in decreased risk of non-oncological complications without an increased likelihood of tumor recurrence.

Introduction: Early diagnosis of bone tumours greatly increases the chances of successful treatment. Although open biopsy is considered to be the diagnostic reference standard, with accuracy upto 98%, it also has an up to 16% risk of complications. Percutaneous core needle biopsy (CNB) is a simple and economical method for the diagnosis of bone tumors. Methods: We performed a prospective cohort study of 50 patients with suspected bone tumour who underwent CNB of the bone lesion followed by definitive surgery over a period of 18 months. Biopsy results were analysed for accuracy of diagnosis against post resection histology as the gold standard. Correlation was studied between clinic-radiological findings, diagnostic CNB findings and post resection histology. Results: Of the total 50 cases enrolled, 23 were females and 27 were males with a mean age of 24±11.8 years (3-64 years). CNB was able to diagnose 47 of 50 cases in the first attempt ( 3 cases were inconclusive) and 2 more cases were diagnosed after second attempt. There is a statistically significant correlation between diagnostic CNB and histopathological diagnosis in benign as well as malignant bone tumors (p value = 0.000).The sensitivity and specificity of the procedure were 92% and 100% respectively for benign lesions and 96% and 100% respectively for malignant lesions. Conclusion : CNB is a simple and economical method for the diagnosis of bone tumors, with high diagnostic accuracy and low complication rates. CNB can be the first line diagnostic technique for bone tumors.

Introduction: Three-dimensional (3D) printing is a new technology. The possibility to realize custom-made 3D-printed prostheses improves its application in surgical field. Aims of the study were to analyze the emerging indications and designs of 3D-printed prostheses for pelvic reconstructions and to analyze treatment outcomes of custom-made implants and complications. Methods: We included every patient in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumor and complex revisions from 2016 to 2021 in one referral Centre. Twenty-one patients (10 males, 11 females) with a mean age of 46 years (range, 10-78 years) were analyzed. Reconstruction included complete articular replacement in 19 cases (90%) whereas a combined spinopelvic implant has been used in six cases. Flaps were used in 10 cases (52%). Results: The mean follow-up was 20 months. At Kaplan-Meier curves, overall survival was 89% at five-years and only three patients died of disease. Overall major and minor complication rate was 22%, mainly wound-related problems. Two patients reported hip dislocation, 3 had deep infections (none required implant removal) and five had local recurrence. Mean MSTS functional outcome score was 73% (range, 23-100%), with a full weight bearing at an average time of 73 days from surgery. Conclusions: Custom-made 3D-printed prostheses represent a good reconstructive technique, maintaining the correct indications for their use in musculoskeletal oncology and challenging revisions. Risk of postoperative complications is high (mainly infection and wound healing problems), even if the rate is acceptable compared to alternative reconstructions.

Background: Spinal tumorectomy can help prolong the survival time of patients with spinal metastasis. However, traditional open surgery (TOS) often brings about severe trauma, which is unbearable to patients with advanced metastatic cancer. Therefore, we propose a new type of surgery called robot-assisted mini-open approach (ICS-RAMA) to reduce trauma and increase the patient’s tolerance.
Methods: A retrospective case-control study was conducted to compare the clinical outcomes between RMICS patients (n=10) and TOS patients (n=50) who received either treatment between September 2018 and June 2021. Data about the patients in both groups were obtained from their medical records upon informed consent. Differences between the two groups were compared using paired analysis.
Results: Comparison of the 10 ICS-RAMA patients and 50 TOS patients showed the following differences: means age (55.70 vs. 57.86 years, p=0.575); surgical indications in terms of SINS score (10.00 vs. 9.10, p=0.055); Frankle classification (D vs. D, p=0.389); life expectancy in terms of Tomita score (6.50 vs. 5.18, p=0.037); modified Tokuhashi score (7.20 vs. 6.80, p=0.653); preoperative status score in terms of ECOG (2.50 vs. 1.62, p=0.005); KPS score (69.00 vs. 74.00, p=0. 318); operation time (4.78h vs. 4.46h, p=0.502); wound length (8.85cm vs. 16.80cm, p=0.001); intraoperative blood loss (780.00ml vs. 1225.00ml, p =0.050); preoperative VAS value (7.20 vs. 5.06, p=0.007); postoperative VAS value (1.80 vs. 2.08, p=0.419); and postoperative VAS change value (5.40 vs. 1.94, p=0.000).
Conclusion: The above results showed that ICS-RAMA is a less invasive and more precise surgery for the treatment of spinal metastatic tumors.