Frequent imaging after a completed multimodal therapy of osteosarcoma is recommended by therapy optimization studies to detect local or systemic tumor recurrence. Considering the low rates of local recurrence, regular local imaging has to be questioned. 150 patients with osteosarcoma were treated in our department between 1991 and 2005. The median age of patients with osteosarcoma was 17 years with a range of 4 – 79 years and a female:male ratio of 1:1.1. The primary tumors of 147 patients were treated surgically, while 3 patients refused to be operated. After a wide resection, a tumor endoprosthesis was implanted in 103 (70.1%) of the 147 patients, 16 (10.9%) patients underwent a Borggreve rotationplasty, a resection and biological reconstruction was implemented in 10 (6.8%) patients, while further 18 (12.2%) patients were amputated. The median follow up was 95 months. Local recurrences appeared in 2 (1.4%) patients which had been treated with a hemipelvectomy. After implantation of a tumor endoprosthesis, local recurrences were not observed. Postoperative complications observed after the implantation of a tumor endoprosthesis included infections (n=14; 13.6%), loosening, fractures and wearing of endoprotheses (n=7; 4.8%), luxation (n=1; 0.7%) as well as traumatic shaft fractures of involved bones (n=5; 3.4%). All complications included specific symptoms and were diagnosed outside the routine follow up. In conclusion, local radiological imaging after resection of an osteosarcoma and reconstruction with a tumor endoprosthesis as a routine examination should be questioned, however it is definitely indicated in patients with specific symptoms

Introduction: Little data are available about the incidence and the management of hip dislocation following the implantation of megaprosthesis of the proximal femur, which is one of the main complications following this procedure. Material and Methods: 190 patients, who received a proximal femur KMFTR/GMRS at our institution between 1982 and 2007, were retrospectively reviewed with regard to the incidence of hip dislocation as well as the success rate of the subsequent surgical/non-surgical treatment. A proximal femur tumor endoprosthesis was used in 148 patients following the resection of a malignant tumor and in 43 patients in severe revision cases following total hip arthroplasty. The average age at the time of surgery was 48 [6a to 83a] in the tumor group and 57.3 [45a to 78a] in the revision group. All of the revision cases and 12 patients from the tumor group had additional revision cups, such as the Schoellner pedestal cup. Results: 12.3 % (18/147) of the tumor patients and 13.9% (6/43) of the revision cases dislocated at least once. 66.7% (12/18) of the first dislocations from the tumor and 50 % (3/6) of the revision group were treated with closed reduction, the rest required surgery. All patients received an abduction cast for at least 8 weeks. 38% (7/18) of the dislocated hips of tumor group (4.8% [7/147] total) and 67% (4/6) of the revision group (9.3% [4/43] total) experienced a second dislocation. 57% (4/7) of the dislocations from the tumor and 100 % (4/4) of the revision group were treated with closed reduction. Three patients from the tumor group (2% [3/147] total) experienced a total of three dislocations and one patient four dislocations (< 1% [1/147] total). The first dislocation occurred in 88% of the cases within 5 months following surgery during activities of daily living. 82% of the second dislocations and all third dislocations occurred within 4 months of the previous dislocation. Interestingly, no significant difference was found in the rate of re-dislocation between surgical and non-surgical treatment in either group. Discussion: Dislocation of a proximal femur tumor endoprosthesis is an early complication following surgery and continues to be a challenging condition to treat, especially in cases with extensive soft-tissue defects. Since 2000, a polyester ligament is successfully used in our institution as a reinforcement to reduce the risk of hip dislocation in proximal femur tumor endoprosthesis. Surgical and non-surgical methods to reduce the risk of hip dislocation are discussed

Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The “SMILES spacer” was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24–70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation

The use of megaprostheses is accompanied with periprosthetic infection in up to 15% of cases. Among metals with antimicrobial activity, silver has raised the interest of investigators because of its good antimicrobial activity. The aim of this study was to determine the infection rate of silver-coated megaprostheses in comparision to uncoated titanium prostheses. We prospectively identified 40 patients who were treated with a silver-coated proximal femur (n=17) or proximal tibia (n=23) replacement (Mutars. ®. , Implantcast, Germany). Patients with a silver-coated tumor endoprosthesis were compared with 74 (proximal femur replacement n=33, proximal tibia n=41) retrospectively assessed patients with a titanium endoprosthesis regarding the number of infections. In the titanium group a proximal femur replacement was associated with the highest infection rate (18.2%; time of infection in mean 15 months postoperatively). In the silver-group infection could be reduced to 5.9% (time of infection 12 months postoperatively). In patients with a proximal tibia replacement the infection rate could be reduced from 17.1% (time of infection in mean 28 months postoperatively) to 4.3% (time of infection 4 months postoperatively) in the silver group. Regarding the final, successful treatment of infection it can be stated that in the silver group the patients could be treated either by intravenous antibiotics only or by a one-stage exchange of the prosthetic body. In the titanium group seven patients (53%) were treated by a two-stage reimplantation of the prosthesis, in 4 patients (31%) an amputation and in one patient rotationplasty was performed. We conclude that silver-coated megaendoprostheses can reduce the risk of infection on a short-term followup. Importantly, minor revisions in the case of infection in patients with a silver-coated prostheses were more often successful. Further studies with more patients and a longer followup are necessary in order to evaluate the possible benefit of silver exactly

We describe a new method of reconstruction of the extensor apparatus after extensive resection of malignant tumours around the knee joint with a polyester ligament. Twenty- two patients after a mean follow up of eighteen months (six to thirty-six months) were treated. Six patients had excellent knee function with a lag of extension less than five degrees, four of less than twenty, three had less than forty degrees and six patients could not lift their limb extended against gravity, although no patient required any kind of walking aid. The mean Enneking Score was 81.5 the mean TESS Score was eighty-three. Limb salvage surgery in primary malignant bone tumours is widely accepted as the surgical treatment of choice around the knee joint. Extraarticular resection for oncological radicality usually results in additional resection of at least part of the extensor mechanism. Since January 2000 we used a Polyester Band (LARS®) for either augmentation of a transposed muscle or as a complete soft tissue bridging after tumour resection in twenty-two patients (fourteen men, eight women) with a mean age of thirty-two (8–75). The HMRS tumour endoprosthesis was used for the reconstruction of the knee joint. The location of the tumour was in the distal femur in ten cases and the proximal tibia in eleven. One synovial sarcoma arose at the lateral meniscus. The mean follow up was eighteen months (6–36) after implantation of the Lars® ligament. Patient’s functional outcome and satisfaction was eighty-three (65–92) at the TESS Score and 81,5 (43–92) at the Enneking Score, respectively. Six patients had excellent knee function with an extension deficit of less than five degrees. In four cases the extension deficit was less than twenty, in three cases it was less than forty. In six patients the active extension lag was more than forty degrees. However, their remaining quadriceps strength was sufficient for stabilisation of the knee joint during gait without any aids. At last follow up all implants were in situ without any signs of loosening. No patient had to be amputated because of septic complication

AIM. To present our experience in patients treated under primary diagnosis giant cell tumor of bone at Department Orthopaedic Surgery Zagreb University School of Medicine in a 15-year period from 1995 to 2009. METHODS. We performed a retrospective study of all patients treated in our Department because of giant cell tumor of bone (GCT) from 1995 to 2009. The mean age of our patients was 29,9 years (range: 14 to 70 years). Sex distribution showed prevalence in female (F:M=23:12=66%:34%). All together, 39 patients were operated under primary diagnosis of GCT. Four patients were lost in follow-up. In total, 35 patients were included in study. Diagnosis of GCT was made according to clinical, imaging and histological findings, and distributed by Campanacci's classification. RESULTS. Not including diagnostic biopsy, 84 operations were performed on 35 patients. Fourteen patients (40%) had GCT grade 1, fourteen (40%) had GCT grade 2, and seven (20%) had GCT grade 3. From the first symptoms to diagnosis there was an average duration of 7 months (range: 0 to 24 months), where the main symptoms were pain and swelling of affected bone and/or joint. GCT was localized in distal femur (n=12, 34%), proximal tibia (n=10, 29%), distal tibia (n=4, 11%), distal radius (n=3, 9%), and other locations (n=6, 17%). Patients with less aggressive GCT (grades 1 and 2) were treated with marginal excision: excochleation and reconstruction with bone transplant (n=12, 34%). In patients with locally more aggressive tumor (grades 2 and 3), “en bloc” resection and reconstruction with tumor endoprosthesis or bone transplant was performed (n=22, 63%). Due to localization of tumor, one patient was treated with radiation (3%). Complications were recorded in 12 patients (34%), and are shown as total number and percentage of all complications. Complications were the most common in knee region, proximal tibia (n=4, 33%) and distal femur (n=3, 25%). Also, the complications occured more frequently after “en bloc” resection (n=7, 58%). GCT classified as gradus 2 had most complications (n=5, 42%) till GCT classified as gradus 3 had least (n=3, 25% of complications, 9% of all). We recorded and treated local recurrence of tumor (n=6, 50%), infection (n=2, 17%), and mehanical complications of endoprosthesis (n=2, 17%). Due to local recurrences, in 2 patients underlying osteosarcoma was revealed, and they were treated with amputation. CONCLUSION. Each patient with GCT should be treated individually. Regardless non-malignant attribute, local behaviour of tumor determines treatment approach according to treatment principles of malignant tumor of bone. Number of complications in our patients is relatively high, recorded in one third of our patients, which matches the literature in announced studies

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Aims

Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction.

Objectives

Preclinical data showed poly(methyl methacrylate) (PMMA) loaded with microsilver to be effective against a variety of bacteria. The purpose of this study was to assess patient safety of PMMA spacers with microsilver in prosthetic hip infections in a prospective cohort study.

The December 2013 Oncology Roundup³⁶⁰ looks at: Peri-articular resection fraught with complications; Navigated margins; Skeletal tumours and thromboembolism; Conditional survival in Ewing’s sarcoma; Reverse shoulders and tumour; For how long should we follow up sarcoma patients?; and already metastasised?

The August 2015 Oncology Roundup³⁶⁰ looks at: Glasgow prognostic score in soft-tissue sarcoma; Denosumab in giant cell tumour; Timing, complications and radiotherapy; Pigmented villonodular synovitis and arthroscopy; PATHFx: estimating survival in pathological cancer; Prosthetic lengthening of short stumps; Chondrosarcoma and pathological fracture