Aims. Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by
We retrospectively compared the outcome after
the treatment of giant cell tumours of bone either with
Aims. Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs. Methods. A total of 354 consecutive patients with a GCTB underwent joint salvage by
Abstract. Background. Benign osteolytic lesions of bone represent a diverse group of pathological and clinical entities. The aim of this study is to highlight the importance of intraoperative endoscopic assessment of intramedullary osteolytic lesions in view of the rate of complications during the postoperative follow up period. Methods. 69 patients (median age 27 years) with benign osteolytic lesion had been prospectively followed up from December 2017 to December 2018 in a university hospital in Cairo, Egypt and in a level-1 trauma center in United Kingdom. All patients had been treated by
We retrospectively studied local recurrence of giant cell tumour in long bones following treatment with
Background. There is doubt regarding resection compared to
Aim. We investigated low grade intramedullary chondrosarcomas to see if
Aims. The purpose of this retrospective study was to differentiate
between the MRI features of normal post-operative change and those
of residual or recurrent disease after intralesional treatment of
an atypical cartilage tumour (ACT)/grade I chondrosarcoma. Patients and Methods. We reviewed the case notes, radiology and histology of 75 patients,
who had been treated for an ACT/grade I chondrosarcoma by
Introduction and purpose: Benign giant cell tumours (GCT) are locally aggressive and may transform into primary sarcomatous tumours (1–3%) following recurrence (10–15%) and lung metastases (1–6%) even with benign histology. However, survival in these cases is high (96–100% of transformations and 15–50% of metastases). Recurrences after en-block resection are less common (0–5%), but
Aims. Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones. Methods. A systematic review of the published literature was performed to identify all articles relating to the management of primary ABCs. Studies required a minimum 12-month follow-up and case series reporting on under ten participants were not included. Results. A total of 28 articles meeting the eligibility criteria were included in this review, and all but one were retrospective in design. Due to heterogeneity in study design, treatment, and outcome reporting, data synthesis and group comparison was not possible. The most common treatment option reported on was surgical
Introduction. The role of adjuvants in
Aims. The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). Patients and Methods. A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. Results. The initial surgical treatment was
Between 1971 and 1991 we treated 98 patients with giant-cell tumours, 15 of whom presented with a pathological fracture. They were most common around the knee (12). Nine fractures were intra-articular. The tumours were treated by
Due to its indolent clinical behaviour, the treatment paradigm of atypical cartilaginous tumours (ACTs) in the long bones is slowly shifting from intralesional resection (curettage) and local adjuvants, towards active surveillance through wait-and-scan follow-up. In this retrospective cohort study performed in a tertiary referral centre, we studied the natural behaviour of ACT lesions by active surveillance with MRI. Clinical symptoms were not considered in the surveillance programme. The aim of this study was to see whether active surveillance is safe regarding malignant degeneration and local progression. In total, 117 patients were evaluated with MRI assessing growth, cortical destruction, endosteal scalloping, periosteal reaction, relation to the cortex, and perilesional bone marrow oedema. Patients received up to six follow-up scans.Aims
Methods
Introduction: Both enchondromas and chondrosarcomas are mesenchymal neoplasms which originate from cartilage cells, and they occur mainly in the extremities. Both these tumours are resistant to chemotherapy and radiotherapy, and surgery is the only treatment option. In the last few years limb saving procedures have become the treatment of choice. Intra-operative cryosurgery has been introduced as a local adjuvant therapy for skeletal benign and low-grade malignant tumours. It is applied after
Purpose. The traditional management of pediatric aneurysmal bone cysts involves the application of intralesional resection principles that are used to treat benign aggressive tumors in general. Alternatively, some are treated by injections of sclerosing agents. The risks of these approaches include growth arrest, additional bony destruction necessitating the restoration of structural integrity, and soft tissue necrosis. We wished to evaluate the effectiveness of treating aneurysmal bone cysts in children by percutaneous
The August 2023 Knee Roundup. 360. looks at:
Aims. We performed a systematic literature review to define features of patients, treatment, and biological behaviour of multicentric giant cell tumour (GCT) of bone. Methods. The search terms used in combination were “multicentric”, “giant cell tumour”, and “bone”. Exclusion criteria were: reports lacking data, with only an abstract; papers not reporting data on multicentric GCT; and papers on multicentric GCT associated with other diseases. Additionally, we report three patients treated under our care. Results. A total of 52 papers reporting on 104 patients were included in the analysis, with our addition of three patients. Multicentric GCT affected predominantly young people at a mean age of 22 years (10 to 62), manifesting commonly as metachronous tumours. The mean interval between the first and subsequent lesions was seven years (six months to 27 years). Synchronous lesions were observed in one-third of the patients. Surgery was
Aims. The epiphyseal approach to a chondroblastoma of the intercondylar notch of a child’s distal femur does not provide adequate exposure, thereby necessitating the removal of a substantial amount of unaffected bone to expose the lesion. In this study, we compared the functional outcomes, local recurrence, and surgical complications of treating a chondroblastoma of the distal femoral epiphysis by either an intercondylar or an epiphyseal approach. Methods. A total of 30 children with a chondroblastoma of the distal femur who had been treated by intraregional
Introduction: Chondrosarcoma is the second most common malignant solid tumour of bone. The management of extra-axial low grade chondrosarcomas remains a controversial issue. Many groups advocate wide excision, necessitating substantial reconstructive surgery, often requiring massive endoprostheses or allografts. Our unit favours intralesional
Aims. Adjuvant treatment after intralesional
Introduction. An aneurysmatic bone cyst (ABC) is a benign cystic lesion of bone composed of blood-filled spaces separated by connective septa. The most common treatment is
Chondrosarcomas are malignant neoplasms that form an exclusively chondroid matrix. These generally slow-growing cartilage-based tumors most commonly occur in patients between 30 and 60 years old. In this article, we describe our retrospective clinical study, performed on 21 patients (11 males and 10 females) who were affected by conventional chondrosarcoma (Grade 1) and underwent surgery between 1997 and 2008. The patients’ average age was 45,5 (29 to 71 years old) with an average follow-up of 68,4 months. All low grade chondrosarcomas were treated with
The pre-operative differentiation between enchondroma,
low-grade chondrosarcoma and high-grade chondrosarcoma remains a
diagnostic challenge. We reviewed the accuracy and safety of the
radiological grading of cartilaginous tumours through the assessment
of, first, pre-operative radiological and post-operative histological agreement,
and second the rate of recurrence in lesions confirmed as high-grade
on histology. We performed a retrospective review of major long
bone cartilaginous tumours managed by
We treated 26 patients with 27 aneurysmal bone cysts by
Introduction: Surgical removal by means of
Giant cell tumours (GCTs) of the small bones
of the hands and feet are rare. Small case series have been published but
there is no consensus about ideal treatment. We performed a systematic
review, initially screening 775 titles, and included 12 papers comprising
91 patients with GCT of the small bones of the hands and feet. The
rate of recurrence across these publications was found to be 72%
(18 of 25) in those treated with isolated
The purpose of our study was to identify possible risk factors of patients with GCT of the long bones after
Introduction: Good results have been reported with
Purpose: Many surgical techniques have been described for the treatment of pathological fractures due to aggressive unicameral bone cysts in order to varying rates of success and incomplete healing or recurrence. Many Authors suggested
The purpose of this study was to assess whether
the use of a joint-sparing technique such as
A prospective single-cohort study was designed to include 20 patients with enchondromas but was stopped because of poor early results. Four patients with an enchondroma, three in the proximal humerus and one in the distal femur, were treated by
Introduction: Traditional treatment options for unicameral bone cysts (UBCs) include observation, sequential steroid injections, and open
We performed
Aim. To report late development of sarcomas on sites of previously curetted and grafted benign tumours. Rare cases of development of sarcomas in sites of previous benign lesions are documented, and the development is generally considered secondary to progression of benign lesions, even without radiotherapy. Methods and Results. In our files, 12 cases curetted and grafted, without radiotherapy addition developed sarcomas from 6 to 28 years from
We investigated whether the presence of a pathological
fracture increased the risk of local recurrence in patients with
a giant cell tumour (GCT) of bone. We also assessed if curettage
is still an appropriate form of treatment in the presence of a pathological
fracture. We conducted a comprehensive review and meta-analysis
of papers which reported outcomes in patients with a GCT with and
without a pathological fracture at presentation. We computed the
odds ratio (OR) of local recurrence in those with and without a
pathological fracture. . We selected 19 eligible papers for final analysis. This included
3215 patients, of whom 580 (18.0%) had a pathological fracture.
The pooled OR for local recurrence between patients with and without
a pathological fracture was 1.05 (95% confidence interval (CI) 0.66
to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with
curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75
to 2.01, p = 0.417). . A post hoc sample size calculation showed adequate
power for both comparisons. . There is no difference in local recurrence rates between patients
who have a GCT of bone with and without a pathological fracture
at the time of presentation. The presence of a pathological fracture
should not preclude the decision to perform
Aims. The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head. Patients and Methods. A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure,
Patients with high-grade osteosarcoma who have been previously misdiagnosed as benign lesions or infection and accordingly been treated by
This pilot study analysed the outcome of open versus endoscopic
curettage and bone grafting for the treatment of simple calcaneal
bone cysts. A total of 26 patients were evaluated into two equal
groups: group 1 was treated with traditional open
Unicameral bone cyst is a frequent benign lesion of the child’s skeleton of unclear ethopathology and scarce symptoms.Possible complications and limits in the child’s activities necessitate an active approach to management. Intracystic injection of corticosteroid depot,
Aim. Assess the oncological and clinical outcomes associated with intralesional
1. Experience in the treatment of tuberculous disease of the spine, hip and knee by combined constitutional, antibiotic and operative measures is described. 2. In patients with tuberculosis of the spine, especially in the thoracic region and when perispinal abscess formation is a prominent feature, the treatment helps to ensure stable ankylosis in the type of case in which it otherwise might not occur. 3. In children with tuberculosis of the hip and in adults and children with tuberculosis of the knee it is usually possible to save the joint and to restore function, provided the joint has not been destroyed before treatment is begun.
The records of these patients show that restitution of joint function is quite possible even after severe disease. These results have been obtained by a combination of three methods, constitutional, antibiotic and operative. The duration of treatment averaged ten months and the patients were discharged to full activities in a short time without splints. There was one immediate failure in a child who received full, early and adequate treatment. There were two late relapses in patients treated early in the series whose operation was inadequate. The results were more variable in adults. If it is conceded that the triple treatment is valuable for patients with bone necrosis or severe synovial disease with pus in the joint, eight patients in this series remain who might have got better without operation. Two of these had had a synovial biopsy before admission. Whether the remaining six would have done as well without operation is a matter for speculation. It is difficult to assess the condition inside the joint solely by radiographic examination. Cauchoix (1955) allows me to say that, at the Institut Calot, Berck Plage, he has used similar methods to those reported in this paper, and that he endorses my belief that good results can be obtained by them. He does not, however, open the joint when operating upon an iliac focus, and for patients with purely synovial disease he prefers repeated intra-articular injections of streptomycin to operation. For my part, I consider that a simple arthrotomy at the beginning of treatment is less disturbing, and that, even if it is only done for diagnosis, it may be of therapeutic benefit. To me it seems unjustifiable to delay intra-articular operation for a patient whose hip disease is not manifestly resolving: operation is especially indicated for patients who have necrotic bone lesions.
Osteoarthritis of the knee is a common cause of knee pain. The pain from osteoarthritis is due to synovitis, capsular and ligamentous inflammation, and subchondral bone pain because cartilage has no nerves. Degenerative arthritis is usually the end result of mechanical stress inflicted on the articular cartilage, either through a suddenly applied single load or through the cumulative effect of multiple or repetitive loads leads to breakdown of the articular cartilage. The treatment of knee pain due to osteoarthritis of the knee includes conservative treatment such as rest, weight loss, physical therapy, nonsteroidal anti-inflammatory drugs, Cox-II inhibitors, nutritional supplements, steroid injections, Viscosupplementation, and surgical treatment such as arthroscopy, osteotomy or arthroplasty. With failure of conservative treatment, arthroscopic debridement and lavage is the treatment of choice for such patients.
In my group 93.8% (91.2% of the lavage group and 96.4% of the debridement group) were satisfied at 6 months and felt better than before their surgery, at 3 years 45.6% (35.6% of the lavage group and 55.6% of the debridement group) felt better, and at 6 years 30.2% (22.8% of the lavage group and 37.6% of the debridement group) felt better after the arthroscopic procedure.
Aims. The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up. Methods. This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone,
Aims. Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review. Methods. We included 76 patients with distal radius GCTB in three sarcoma centres (1990 to 2019). Median follow-up was 8.8 years (2 to 23). Seven patients underwent
Aims. Local recurrence remains a challenging and common problem following
Aims. The aims of this study were to evaluate the efficacy of preoperative denosumab in achieving prospectively decided intention of therapy in operable giant cell tumour of bone (GCTB) patients, and to document local recurrence-free survival (LRFS). Patients and Methods. A total of 44 patients received preoperative denosumab: 22 to facilitate
The August 2023 Oncology Roundup360 looks at: Giant cell tumour of bone with secondary aneurysmal bone cyst does not have a higher risk of local recurrence; Is bone marrow aspiration and biopsy helpful in initial staging of extraskeletal Ewing’s sarcoma?; Treatment outcomes of extraskeletal Ewing’s sarcoma; Pathological complete response and clinical outcomes in patients with localized soft-tissue sarcoma treated with neoadjuvant chemoradiotherapy or radiotherapy; Long-term follow-up of patients with low-grade chondrosarcoma in the appendicular skeleton treated by extended