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Effect of an Endoprosthetic Reconstruction Tube and Medial Gastrocnemius Flap on Extensor Mechanism Function After Oncologic Prosthesis Reconstruction of the Proximal Tibia. J Arthroplasty 2022; 37:2233-2238. [PMID: 35649465 DOI: 10.1016/j.arth.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Extensor mechanism reconstruction after the proximal tibial resection and implantation of a megaprosthesis is challenging. In this study, we evaluated the effectiveness of the Trevira tube and medial gastrocnemius flap in restoring extensor mechanism following the resection of proximal tibial tumor and implantation of megaprosthesis. METHODS Forty patients who underwent endoprosthetic implantation following the resection of proximal tibial tumor and patellar tendon reconstruction with the Trevira tube and medial gastrocnemius flap were included. The outcome measures were knee range of motion, extensor mechanism function, patellar position, and limb function subjectively evaluated through Toronto Extremity Salvage Score and objectively through Musculoskeletal Tumor Society score. The mean follow-up of the patients was 6.1 years. RESULTS The patellar position was normal in 28 (70%) patients, patella baja in 3 (7.5%) patients, and patella alta in 9 (22.5%) patients. The mean active knee range of motion was 98.9 ± 17° (range: 85°-125°). Extension lag was present in 7 (17.5%) patients (range: 5°-20°). The mean Toronto Extremity Salvage Score of patients was 92.1 ± 6.9% (range: 85-100). The mean Musculoskeletal Tumor Society score of the patients was 87.7 ± 13 (range: 73.3-100). Postoperative complications included aseptic wound dehiscence (2 patients), aseptic loosening of the tibial component (1 patient), periprosthetic fracture in the femur (2 patients), and wound infection (1 patient). CONCLUSION Trevira tube combined with gastrocnemius flap augmentation is a suitable procedure for restoring extensor mechanism after proximal tibial resection and megaprosthesis implantation.
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Mogavero M, Khlopas H, Fallat LM. A Rare Presentation of Ewing's Sarcoma Presenting in the Third Metatarsal. J Foot Ankle Surg 2022; 61:421-425. [PMID: 34728136 DOI: 10.1053/j.jfas.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/13/2021] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Ewing's Sarcoma family of tumors are rare, malignant round cell tumors arising from undifferentiated mesenchymal cells. This aggressive neoplastic disease has a quick metastatic onset often resulting in a poor prognosis. In this case study we present a 21-year-old female diagnosed with Ewing's sarcoma of the third metatarsal bone. She initially presented in the emergency room with a 2-day onset of right foot pain following a minor injury. Radiographs taken in the emergency room revealed a cystic lesion in the third metatarsal. The patient presented to the author's clinic and following evaluation, surgical excision and curettage of the bone cyst was performed supplemented with allogenic bone graft. Due to a high clinical suspicion of malignancy, intraoperative culture and biopsy of the third metatarsal were sent to pathology and microbiology. Following evaluation of the bone biopsy with immunohistochemical staining as well as fluorescent in-situ hybridization studies, a diagnosis was made for Ewing's Sarcoma. This case report serves to display the significance of a timely workup as well as the importance of multiple pathology assessments to obtain a definitive pathologic diagnosis when clinical suspicion of malignancy is high.
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Affiliation(s)
- Marissa Mogavero
- Resident, Submitted During Postgraduate Year 1, Beaumont Hospital, Podiatric Foot and Ankle Surgical Residency, Wayne, MI.
| | - Hannah Khlopas
- Resident Chief Resident, Submitted During Postgraduate Year 3, Beaumont Hospital, Podiatric Foot and Ankle Surgical Residency, Wayne, MI
| | - Lawrence M Fallat
- Director, Beaumont Health Wayne Podiatric Foot and Ankle Surgical Residency, Beaumont Hospital, Wayne, MI
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Jamshidi K, Bagherifard A, Mohaghegh MR, Mirzaei A. Fibular strut allograft or bone cement for reconstruction after curettage of a giant cell tumour of the proximal femur : a retrospective cohort study. Bone Joint J 2022; 104-B:297-301. [PMID: 35094576 DOI: 10.1302/0301-620x.104b2.bjj-2021-1322.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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 curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur. METHODS In a retrospective study, we reviewed 26 patients with a GCT of the proximal femur in whom the bone defect had been filled with either a fibular strut allograft (n = 12) or bone cement (n = 14). Their demographic details and oncological and nononcological complications were retrieved from their medical records. Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) score. RESULTS Mean follow-up was 116 months (SD 59.2; 48 to 240) for the fibular strut allograft group and 113 months (SD 43.7; 60 to 192) for the bone cement group (p = 0.391). The rate of recurrence was not significantly different between the two groups (25% vs 21.4%). The rate of nononcological complications was 16.7% in the strut allograft group and 42.8% in the bone cement group. Degenerative joint disease was the most frequent nononcological complication in the cement group. The mean MSTS score of the patients was 92.4% (SD 11.5%; 73.3% to 100.0%) in the fibular strut allograft group and 74.2% (SD 10.5%; 66.7% to 96.7%) in the bone cement group (p < 0.001). CONCLUSION Given the similar rate of recurrence and a lower rate of nononcological complications, fibular strut grafting could be recommended as a method of reconstructing the bone defect left by curettage of a GCT of the proximal femur. Cite this article: Bone Joint J 2022;104-B(2):297-301.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Jamshidi K, Bahardoust M, Karimi Behnagh A, Bagherifard A, Mirzaei A. How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis. Indian J Orthop 2021; 56:547-558. [PMID: 35342531 PMCID: PMC8921354 DOI: 10.1007/s43465-021-00563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft. MATERIALS AND METHODS We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence. RESULTS In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98-13.49, P < 0.001). The rate of fracture, infection, and local recurrence was not significantly different between the two fixation methods. CONCLUSIONS Intramedullary nail is associated with a significantly higher rate of nonunion. Since the rate of other complications was not significantly different between the two osteosynthesis types, plate fixation could be considered as a better type of fixation. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00563-7.
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Affiliation(s)
- Khodamorad Jamshidi
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Karimi Behnagh
- grid.411746.10000 0004 4911 7066Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Bioinformatics Analysis of ZBTB16 as a Prognostic Marker for Ewing's Sarcoma. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1989917. [PMID: 34660783 PMCID: PMC8514890 DOI: 10.1155/2021/1989917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
Objective The purpose of this study is to identify novel biomarkers for the prognosis of Ewing's sarcoma based on bioinformatics analysis. Methods The GSE63157 and GSE17679 datasets contain patient and healthy control microarray data that were downloaded from the Gene Expression Omnibus (GEO) database and analyzed through R language software to obtain differentially expressed genes (DEGs). Firstly, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment, protein-protein interaction (PPI) networks, and Cytoscape Molecular Complex Detection (MCODE) plug-in were then used to compute the highest scores of the module. After survival analysis, the hub genes were lastly obtained from the two module genes. Results A total of 1181 DEGs were identified from the two GSEs. Through MCODE and survival analysis, we obtain 53 DEGs from the module and 29 overall survival- (OS-) related genes. ZBTB16 was the only downregulated gene after Venn diagrams. Survival analysis indicates that there was a significant correlation between the high expression of ZBTB16 and the OS of Ewing's sarcoma (ES), and the low expression group had an unfavorable OS when compared to the high expression group. Conclusions High expression of ZBTB16 may serve as a predictor biomarker of poor prognosis in ES patients.
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Comparison of preoperative and postoperative radiation therapy for extremity soft-tissue sarcoma: a randomized clinical trial. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang Y, Tian Q, Wu C, Li H, Li J, Feng Y. Management of the Cavity After Removal of Giant Cell Tumor of the Bone. Front Surg 2021; 8:626272. [PMID: 34395504 PMCID: PMC8358324 DOI: 10.3389/fsurg.2021.626272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To find out the most appropriate management scheme through the analysis and comparison of different inactivation methods and filling materials. Method: A systematic literature search was performed using the terms, anhydrous ethanol, phenol, hypertonic saline, cryotherapy, thermal therapy, bone reconstruction, GCTB, and etc., Selected articles were studied and summarized. The mechanism, clinical effects, and influence on bone repair of various methods are presented. Recent developments and perspectives are also demonstrated. Recent Findings: Compared to curettage alone, management of the residual cavity can effectively reduce the recurrence of giant cell tumours of bone. It is a complex and multidisciplinary process that includes three steps: local control, cavity filling, and osteogenic induction. In terms of local control, High-speed burring can enlarge the area of curettage but may cause the spread and planting of tumour tissues. Among the inactivation methods, Anhydrous ethanol, and hyperthermia therapy are relatively safe and efficient. The combination of the two may achieve a better inactivation effect. When inactivating the cavity, we need to adjust the approach according to the invasion of the tumour. Filling materials and bone repair should also be considered in management.
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Affiliation(s)
- Yushan Wang
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiaoqiao Tian
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chenyang Wu
- Department of Computer & Information Technology, Shanxi University, Taiyuan, China
| | - Haoze Li
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Li
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Feng
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
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Jamshidi K, Motaghi P, Bagherifard A, Eigi M, Al-Baseesee HH, Mirzaei A. Comparison of characteristic features and local recurrence in syndromic versus non-syndromic multifocal non-ossifying fibroma. J Orthop Sci 2021; 26:655-659. [PMID: 32819790 DOI: 10.1016/j.jos.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple non-ossifying fibromas (MNOF) could be presented with other extraskeletal anomalies (syndromic) or not (non-syndromic). In this study, we aimed to compare characteristic features and local recurrence between symptomatic syndromic and non-syndromic MNOFs. METHODS Thirty-five patients with symptomatic MNOF were included in this study, comprised of 30 patients without the café-au-lait spot (non-syndromic) and five with café-au-lait spots plus other signs of neurofibromatosis type 1 (syndromic). Characteristic features of the patients and lesions were compared between syndromic and non-syndromic MNOFs. The lesions were treated with curettage and bone graft. The rate of local recurrences was also compared between the two groups of syndromic and non-syndromic MNOF. RESULTS Study population included 19 (54.3%) males and 16 (45.7%) females with the mean age of 7.63 ± 3.1 years (range 4-11). The mean follow-up of the patients was 65.6 ± 38.2 months (range 24-96). The lesion was bilateral in 13.3% of non-syndromic MNOFs and 80% of syndromic MNOFs. This difference was statistically significant (p = 0.01). After curettage and bone grafting, the lesion recurred in 6.7%of non-syndromic MNOFs and 60% of the syndromic MNOF. This difference was statistically significant, as well (p = 0.01). No other significant difference was found between syndromic and non-syndromic MNOFs. CONCLUSIONS The syndromic form of MNOF is much less prevalent and is associated with a higher rate of recurrence after surgical removal. Therefore, a more rigorous removal of the MNOF lesions might be necessary when presented in a syndromic context.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Paniz Motaghi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Misagh Eigi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Jamshidi K, Khadem M, Shooshtarizadeh T, Mirzaei A. Early Diagnosis of Giant Solitary Synovial Chondromatosis of the Hip Using Ultrasound-guided Synovial Biopsy: A Case Report. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:235-239. [PMID: 34026943 DOI: 10.22038/abjs.2020.43730.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The diagnosis of synovial chondromatosis (SCM) is usually delayed, as the arthroscopic-guided synovial biopsy is postponed owing to its invasive nature. We report the timely diagnosis of a giant solitary synovial chondromatosis of the hip in a 32-year-old woman using ultrasound-guided synovial biopsy. This technique revealed to be safe and successful in the diagnosis of SCM, when the imaging studies were obscure. Moreover, it avoided the potential arthroscopy-associated complications. We recommend ultrasound-guided synovium biopsy as a less invasive and less complicated technique for the early diagnosis of SCM in future workouts.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehryar Khadem
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Tina Shooshtarizadeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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An unusual presentation of osteosarcoma in the proximal femur with peculiar diagnostic characteristics: a retrospective series. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jamshidi K, Bagherifard A, Al-Baseesee HH, Mirzaei A. How Can We Differentiate Local Recurrence From Heterotopic Ossification After Resection and Implantation of an Oncologic Knee Prosthesis in Patients with a Bone Sarcoma? Clin Orthop Relat Res 2021; 479:1134-1143. [PMID: 33861216 PMCID: PMC8052004 DOI: 10.1097/corr.0000000000001539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/25/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is common after total joint arthroplasty and usually does not cause diagnostic problems. However, the occurrence of HO after oncologic prostheses implantation can be troublesome as it may mimic a locally recurrent tumor. Because this distinction could have a profound impact on the surgeon and patient, it is important to distinguish the two entities; to our knowledge, no study has evaluated this after oncologic endoprosthetic reconstruction around the knee after tumor resection. QUESTIONS/PURPOSES (1) How common is the occurrence of HO compared with local recurrence (LR) after resection of bone sarcoma and the use of an oncologic knee prosthesis? (2) Are there any factors associated with the development of HO after limb salvage procedures with an endoprosthesis? (3) What features allow the surgeon to differentiate HO from a locally recurrent tumor in this setting? METHODS Between 2002 and 2018, we performed 409 resections of primary bone tumors followed by reconstructions with oncologic endoprostheses. Of these, 17% (71 of 409) died before 2 years and did not have HO at that time, 2% (8 of 409) were lost to follow-up before 2 years, and another 2% (10 of 409) did not have radiographs available at a minimum of 2 years after surgery (and had not developed HO before then), and so could not be analyzed, leaving 320 patients for analysis in this retrospective study. Forty-two patients were excluded; 2% (5 of 320) for a history of failed allograft reconstruction, 3% (8 of 320) for pathologic fracture at presentation, 2% (6 of 320) for inadequate or complicated biopsy, 1% (2 of 320) for stem fractures, 2% (7 of 320) for stem loosening, and 4% (14 of 320) for extracortical bone bridging, leaving 278 patients for final evaluation. Two observers analyzed AP and lateral radiographs for signs of HO at a mean follow-up of 63 ± 33 months after surgery. We defined HO as extraskeletal bone formation in soft tissues. The primary study endpoint was survivorship free from HO, as ascertained by a competing-risks estimator. To identify factors associated with HO appearance, the demographic, radiographic, clinical, pathologic, and surgical characteristics were compared between patients with HO and those who had no lesion. Characteristic features were also compared between patients with HO and those with LR to help their differentiation. Univariate analysis was used for all statistical evaluations. RESULTS HO developed in 8% (21 of 278) of patients in whom oncologic knee prosthesis was implanted. LR developed in 10% (28 of 278) of the patients. According to survivorship estimates, the HO-free survival rate was not different from the LR-free survival rate at 2 years after oncologic knee reconstruction (76 ± 5% [95% CI 63 to 87] versus 74 ± 5% [95% CI 62 to 88]; p = 0.19). History of infection was more common in patients with HO than in patients with no lesion (19% [4 of 21] versus 5% [12 of 229], Odds ratio [OR] 6 [95% CI 2 to 17]; p < 0.001). The male sex was more common in the HO group as well (76% [16 of 21] versus 55% [128 of 229], OR 2 [95% CI 1 to 5]; p = 0.03). The Modular Universal Tumor and Revision System prosthesis was more frequently used in patients with HO (67% [14 of 21]) compared to those with no lesions (40% [92 of 229]; OR 2 [95% CI 1 to 5]; p = 0.02). The lesion border in radiographs was ill-defined in 19% (4 of 21) of patients with HO and 100% (28 of 28) of patients with LR (OR 8 [95% CI 3 to 20]; p < 0.001). The median time to the appearance of HO was shorter than the time to LR (8 months [3 to 13] versus 16 months [11 to 21], [95% CI 10 to 13]; p < 0.001). Pain at presentation was more frequent in patients with LR than in those with HO (86% [24 of 28] versus 14% [3 of 21], OR 36 [95% CI 7 to 181]; p < 0.001). CONCLUSION HO may occur after the use of oncologic knee prostheses for reconstruction after tumor resection. In most patients, HO could be differentiated from local recurrence through identifying a well-defined border on radiographs. Otherwise, factors such as an earlier time of presentation and absence of pain could suggest an HO, rather than an LR. LEVEL OF EVIDENCE Level III, therapeutic study.
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MESH Headings
- Adolescent
- Adult
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/instrumentation
- Bone Neoplasms/diagnostic imaging
- Bone Neoplasms/pathology
- Bone Neoplasms/surgery
- Chondrosarcoma/diagnostic imaging
- Chondrosarcoma/pathology
- Chondrosarcoma/surgery
- Diagnosis, Differential
- Female
- Histiocytoma, Malignant Fibrous/diagnostic imaging
- Histiocytoma, Malignant Fibrous/pathology
- Histiocytoma, Malignant Fibrous/surgery
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/physiopathology
- Knee Joint/surgery
- Knee Prosthesis
- Leiomyosarcoma/diagnostic imaging
- Leiomyosarcoma/pathology
- Leiomyosarcoma/surgery
- Male
- Neoplasm Recurrence, Local
- Ossification, Heterotopic/diagnostic imaging
- Ossification, Heterotopic/etiology
- Osteosarcoma/diagnostic imaging
- Osteosarcoma/pathology
- Osteosarcoma/surgery
- Osteotomy/adverse effects
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Khodamorad Jamshidi
- K. Jamshidi, A. Bagherifard, A. Mirzaei, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- H. H. Al-Baseesee, College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq
| | - Abolfazl Bagherifard
- K. Jamshidi, A. Bagherifard, A. Mirzaei, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- H. H. Al-Baseesee, College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq
| | - Hamadalla Hadi Al-Baseesee
- K. Jamshidi, A. Bagherifard, A. Mirzaei, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- H. H. Al-Baseesee, College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq
| | - Alireza Mirzaei
- K. Jamshidi, A. Bagherifard, A. Mirzaei, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- H. H. Al-Baseesee, College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq
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Jamshidi K, Zandrahimi F, Haji Agha Bozorgi M, Arefpour AM, Bagherifard A, Al-Baseesee HH, Mirzaei A. Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:289-297. [PMID: 33001283 DOI: 10.1007/s00264-020-04836-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE For the treatment of giant cell tumour of the bone (GCTB) around the knee, preserving the native joint confers advantages over scarifying it. But, there is a controversy about the efficacy of intralesional curettage versus en bloc resection for treatment of such lesions. In this study, we compared local recurrence, functional outcomes, and complications of extended curettage and en bloc resection in these lesions. METHODS Patients with grade 3 GCTB of the distal femur or proximal tibia who were presented with a pathologic fracture and treated with either en bloc resection (n = 22) or extended curettage (n = 20) were included. The mean follow-up of the patients was 6.4 ± 1.9 years in the resection group and 5.5 ± 2.4 years in the extended curettage group. The primary outcome was a local recurrence. Secondary outcomes were limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score and rate of complications. RESULTS Local recurrence was seen in four (20%) patients of the curettage group and three (13.7%) patients of the resection group (P = 0.69). The mean MSTS score was 24 ± 1.9 in the resection group and 26.5 ± 1.3 in the curettage group (P < 0.001). The number of complications was not significantly different between the two study groups (P = 0.49). However, the number of complications that required revision surgery was significantly more in the resection group (P = 0.049). CONCLUSION In grade 3 GCTB around the knee with pathologic fracture, extended curettage results in comparable oncologic outcomes to en bloc resection, while providing better function and a lower rate of revision.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Zandrahimi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Haji Agha Bozorgi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Arefpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Jamshidi K, Mirkazemi M, Gharedaghi M, Izanloo A, Mohammadpour M, Pisoudeh K, Bagherifard A, Mirzaei A. Bipolar hemiarthroplasty versus total hip arthroplasty in allograft-prosthesis composite reconstruction of the proximal femur following primary bone tumour resection. Bone Joint J 2020; 102-B:524-529. [PMID: 32228068 DOI: 10.1302/0301-620x.102b4.bjj-2019-0925.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods. METHODS In a retrospective study, 57 patients who underwent APC reconstruction of proximal femur following the primary tumour resection, either using BHA (29) or THA (28), were included. Functional outcome was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and Harris Hip Score (HHS). Postoperative complications of the two techniques were also compared. RESULTS The mean follow-up of the patients was 8.3 years (standard deviation (SD) 5.5) in the BHA and 6.9 years (SD 4.7) in the THA group. The mean HHS was 65 (SD 16.6) in the BHA group and 88 (SD 11.9) in the THA group (p = 0.036). The mean MSTS score of the patients was 73.3% (SD 16.1%) in the BHA and 86.7% (SD 12.2%) in the THA group (p = 0.041). Limping was recorded in 19 patients (65.5%) of the BHA group and five patients (17.8%) of the THA group (p < 0.001). Dislocation occurred in three patients (10.3%) of the BHA group and two patients (7.1%) of the THA group. CONCLUSION While the dislocation rate was not higher in THA than with BHA, the functional outcome was significantly superior. Based on our results, we recommend THA in APC reconstruction of the proximal femur. Cite this article: Bone Joint J 2020;102-B(4):524-529.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirkazemi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Gharedaghi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azra Izanloo
- Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Mehdi Mohammadpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Karim Pisoudeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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