1
|
Jeys LM, Thorkildsen J, Kurisunkal V, Puri A, Ruggieri P, Houdek MT, Boyle RA, Ebeid W, Botello E, Morris GV, Laitinen MK, Abudu A, Ae K, Agarwal M, Ajit Singh V, Akiyama T, Albergo JI, Alexander J, Alpan B, Aoude A, Asavamongkolkul A, Aston W, Baad-Hansen T, Balach T, Benevenia J, Bergh P, Bernthal N, Binitie O, Boffano M, Bramer J, Branford White H, Brennan B, Cabrolier J, Calvo Haro JA, Campanacci DA, Cardoso R, Carey Smith R, Casales Fresnga N, Casanova JM, Ceballos O, Chan CM, Chung YG, Clara-Altamirano MA, Cribb G, Dadia S, Dammerer D, de Vaal M, Delgado Obando J, Deo S, Di Bella C, Donati DM, Endo M, Eralp L, Erol B, Evans S, Eward W, Fiorenza F, Freitas J, Funovics PT, Galli Serra M, Ghert M, Ghosh K, Gomez Mier LC, Gomez Vallejo J, Griffin A, Gulia A, Guzman M, Hardes J, Healey J, Hernandez A, Hesla A, Hongsaprabhas C, Hornicek F, Hosking K, Iwata S, Jagiello J, Johnson L, Johnston A, Joo MW, Jutte P, Kapanci B, Khan Z, Kobayashi H, Kollender Y, Koob S, Kotrych D, Le Nail LR, Legosz P, Lehner B, Leithner A, Lewis V, Lin P, Linares F, Lozano Calderon S, Mahendra A, Mahyudin F, Mascard E, Mattei JC, McCullough L, Medellin Rincon MR, Morgan-Jones R, Moriel Garcesco DJ, Mottard S, Nakayama R, Narhari P, O'Toole G, Vania O, Olivier A, Omar M, Ortiz-Cruz E, Ozger H, Ozkan K, Palmerini E, Papagelopoulos P, Parry M, Patton S, Petersen MM, Powell G, Puhaindran M, Raja A, Rajasekaran RB, Repsa L, Ropars M, Sambri A, Schubert T, Shehadeh A, Siegel G, Sommerville S, Spiguel A, Stevenson J, Sys G, Temple T, Traub F, Tsuchiya H, Valencia J, Van de Sande M, Vaz G, Velez Villa R, Vyrva O, Wafa H, Wan Faisham Numan WI, Wang E, Warnock D, Werier J, Wong KC, Norio Y, Zhaoming Y, Zainul Abidin S, Zamora T, Zumarraga JP, Abou-Nouar G, Gebert C, Randall RL. Controversies in orthopaedic oncology. Bone Joint J 2024; 106-B:425-429. [PMID: 38689572 DOI: 10.1302/0301-620x.106b5.bjj-2023-1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
Collapse
Affiliation(s)
- Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | | | - Ajay Puri
- Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Walid Ebeid
- Orthopedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Keisuke Ae
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Toru Akiyama
- Saitama Medical Center, JIchi Medical University, Saitama, Japan
| | - Jose I Albergo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | - Peter Bergh
- Sahlgren University Hospital, Gothenburg, Sweden
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Michele Boffano
- Orthopaedic Oncology Unit, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Jos Bramer
- Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | | | | | - Rodrigo Cardoso
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
| | | | - Nicolas Casales Fresnga
- National Orthopaedic and Trauma Institute Republic University Montevideo Montevideo, Montevideo, Uruguay
| | - Jose M Casanova
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Chung M Chan
- National University Hospital, Singapore, Singapore
| | - Yang-Guk Chung
- Seoul St. Mary's Hospital/The Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | - Levent Eralp
- Complex Extremity Reconstruction Unit, Acibadem Hospital Group, Istanbul, Turkey
| | - Bulent Erol
- Marmara University Orthopedics and Traumatology, Istanbul, Turkey
| | | | - Will Eward
- Duke University, Durham, North Carolina, USA
| | | | - Joao Freitas
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Marcos Galli Serra
- Hospital Universitario Austral / Orthopedic Oncology Unit Buenos, Aires, Argentina
| | | | | | | | | | | | - Ashish Gulia
- Homi Bhabha Cancer Hospital & Research Centre, Vishakhapatnam, India
| | | | | | - John Healey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Asle Hesla
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Keith Hosking
- Life Orthopaedic Hospital / Groote Schuur, Cape Town, South Africa
| | | | | | - Luke Johnson
- South Australian Bone & Soft Tissue Tumour Unit, Flinders Medical Centre, Adelaine, Australia
| | | | - Min Wook Joo
- The Catholic University of Korea, Seoul, South Korea
| | - Paul Jutte
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Zeeshan Khan
- Rehman Medical Institute and Medical College, Peshawar, Pakistan
| | | | | | | | - Daniel Kotrych
- Pomeranian Medical University of Szczecin, Szczecin, Poland
| | | | | | - Burkhard Lehner
- Orthopedic University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Peng Lin
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | | | | | | | | | | | | | | | | | | | - Sophie Mottard
- Maisonneuve Rosemont Hospital, Université de Montréal, Montreal, Canada
| | | | | | - Gary O'Toole
- St. Vincent's University Hospital Dublin, Dublin, Ireland
| | - Oliveira Vania
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | | | | | | | - Harzem Ozger
- Istanbul University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | - Sam Patton
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michael M Petersen
- Rigshospitalet/University of Copenhagen/Department of Orthopedics, Copenhagen, Denmark
| | | | | | | | | | | | | | - Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | - Ahmad Shehadeh
- Orthopaedic Unit, King Hussein Cancer Center, Amman, Jordan
| | - Geoffrey Siegel
- Michigan Medicine / University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Gwen Sys
- Ghent University Hospital, Ghent, Belgium
| | | | - Frank Traub
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | | | - Oleg Vyrva
- Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Hazem Wafa
- Leuven University Hospitals, Leuven, Belgium
| | | | - Edward Wang
- University of the Philippines Musculoskeletal Tumor Unit, Manila, Phillipines
| | | | | | - Kwok-Chuen Wong
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ye Zhaoming
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | - Tomas Zamora
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Zumarraga
- Hospital Metropolitano / Departamento de Ortopedia y Traumatología, Quito, Ecuador
| | | | | | - R L Randall
- University of California, Sacramento, California, USA
| |
Collapse
|
2
|
Laitinen MK, Parry MC, Morris GV, Grimer RJ, Sumathi V, Stevenson JD, Jeys LM. Chondrosarcoma of the Femur: Is Local Recurrence Influenced by the Presence of an Extraosseous Component? Cancers (Basel) 2024; 16:363. [PMID: 38254852 PMCID: PMC10814051 DOI: 10.3390/cancers16020363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Chondrosarcoma (CS) is the second most common surgically treated primary malignancy of the bone. The current study explored the effect of the margin and extraosseous tumor component in CS in the femur on local recurrence (LR), LR-free survival (LRFS), and disease-specific survival (DSS). METHODS Among 202 patients, 115 were in the proximal extremity of the femur, 4 in the corpus of the femur, and 83 in the distal extremity of femur; 105 patients had an extraosseous tumor component. RESULTS In the Kaplan-Meier analysis, factors significant for decreased LRFS were the extraosseous tumor component (p < 0.001), extraosseous tumor component arising from the superior aspect (p < 0.001), histological grade (p = 0.031), and narrow surgical margin < 3 mm (p < 0.001). Factors significantly affecting DSS were the histological grade (p < 0.001), extraosseous component (p < 0.001), LR (p < 0.001), metastases (p < 0.001), and surgical margin (p < 0.001). CONCLUSIONS In CS of the femur, the presence of an extraosseous tumor component has a predictive role in LRFS, and extraosseous tumor component arising from the superior aspect was significant for decreased LRFS. Wide margins were more commonly achieved when the tumor had only an intraosseous component, and the rate of LR was significantly higher in cases with an extraosseous tumor component. When the extraosseous component arose from the superior aspect of the femur, LR occurred more frequently despite achieving adequate margins.
Collapse
Affiliation(s)
- Minna K. Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland
| | - Michael C. Parry
- Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK; (M.C.P.); (G.V.M.); (J.D.S.)
| | - Guy V. Morris
- Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK; (M.C.P.); (G.V.M.); (J.D.S.)
| | - Robert J. Grimer
- Royal Orthopaedic Hospital, Birmingham B31 2AP, UK; (R.J.G.); (V.S.)
| | - Vaiyapuri Sumathi
- Royal Orthopaedic Hospital, Birmingham B31 2AP, UK; (R.J.G.); (V.S.)
| | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK; (M.C.P.); (G.V.M.); (J.D.S.)
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, Faculty of Health Sciences, Aston University, Birmingham B4 7ET, UK;
| |
Collapse
|
3
|
Laitinen MK, Thorkildsen J, Morris G, Kurisunkal V, Stevenson JD, Parry MC, Jeys LM. Intraosseous conventional central chondrosarcoma does not metastasise irrespective of grade in pelvis, scapula and in long bone locations. J Bone Oncol 2023; 43:100514. [PMID: 38033413 PMCID: PMC10682821 DOI: 10.1016/j.jbo.2023.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
Background Histological grade has been regarded as the most important prognostic factor in conventional central chondrosarcoma. To evaluate whether the presence of an extraosseous tumour component is associated with a decreased metastasis-free survival or disease-specific survival and alternatively to develop a simple prognostic and clinical decision-making tool. Material and methods We searched two prospectively maintained international sarcoma centre databases for primary non metastatic central conventional chondrosarcomas of all grades in pelvis, scapula or long bone location, undergoing curative treatment, diagnosed between 2000 and 2020. Pre-treatment MRI scans were reviewed for the presence of an extraosseous mass. The metastasis-free survival (MFS) and disease-specific survival (DSS) were estimated by the Kaplan-Meier method from surgery to event, death or last follow-up. Results 336 patients were identified between 2000 and 2020, undergoing surgical treatment for conventional central chondrosarcoma. 111 patients (33 %) had grade 1 tumours, 149 patients (44 %) had grade 2, and 76 patient (23 %) had grade 3 chondrosarcomas determined as the highest grade in the final resected specimen. An extraosseous soft tissue component was more frequent in higher grade tumours (p < 0.001) and present in 200 cases (60 %). None of the patients with an intraosseous tumour developed metastases or died of the disease. For patients with extraosseous tumour component, MFS was 92 % (95 % CI, 96-100) at 2-years and 74 % (95 % CI, 67-81) at 10-years and DSS was 91 % (95 % CI, 87-95) at 2-years and 75 % (95 % CI, 68-82) at 10-years. The MFS and DSS was significantly different (p < 0.001) for those patients with or without an extraosseous tumour component, irrespective of grade or anatomical location. Discussion The results of this study has shown that the metastatic potential of intraosseous conventional central chondrosarcoma is negligible. The presence of an extraosseous soft tissue component may be used for prognostication and to guide treatment pathways for patients with central cartilage tumours.
Collapse
Affiliation(s)
- Minna K. Laitinen
- Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | - Guy Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK
- Aston University Medical School. Aston University, Birmingham, UK
| | - Michael C. Parry
- Royal Orthopaedic Hospital, Birmingham, UK
- Aston University Medical School. Aston University, Birmingham, UK
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
- Faculty of Health Sciences, Aston University, Birmingham, UK
| |
Collapse
|
4
|
Laitinen MK, Parry MC, Morris GV, Jeys LM. Pelvic bone sarcomas, prognostic factors, and treatment: A narrative review of the literature. Scand J Surg 2023; 112:206-215. [PMID: 37438963 DOI: 10.1177/14574969231181504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing's sarcoma and chemotherapy for both Ewing's sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors' experiences.
Collapse
Affiliation(s)
- Minna K Laitinen
- Helsinki University Hospital and University of Helsinki Helsinki Finland Bridge Hospital Haartmaninkatu 4 PL 370 00029 HUS
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Guy V Morris
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
5
|
Ray GS, Werth P, Alexander JH, Eward WC, Bernthal NM, Jeys LM, Funovics P, Windhager R, Temple HT, Lozano-Calderon S, Avedian RS, Jutte PC, Ghert M, Ruggieri P, Henderson ER. Surgical Site Infection in Patients Managed with an Endoprosthesis for the Treatment of Cancer: Evaluation of Patient, Disease, and Index Surgical Factors. J Bone Joint Surg Am 2023; 105:87-96. [PMID: 37466585 DOI: 10.2106/jbjs.22.01376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Surgical site infection (SSI) after segmental endoprosthetic reconstruction in patients treated for oncologic conditions remains both a devastating and a common complication. The goal of the present study was to identify variables associated with the success or failure of treatment of early SSI following the treatment of a primary bone tumor with use of a segmental endoprosthesis. METHODS The present study used the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) data set to identify patients who had been diagnosed with an SSI after undergoing endoprosthetic reconstruction of a lower extremity primary bone tumor. The primary outcome of interest in the present study was a dichotomous variable: the success or failure of infection treatment. We defined failure as the inability to eradicate the infection, which we considered as an outcome of amputation or limb retention with chronic antibiotic suppression (>90 days or ongoing therapy at the conclusion of the study). Multivariable models were created with covariates of interest for each of the following: surgery characteristics, cancer treatment-related characteristics, and tumor characteristics. Multivariable testing included variables selected on the basis of known associations with infection or results of the univariable tests. RESULTS Of the 96 patients who were diagnosed with an SSI, 27 (28%) had successful eradication of the infection and 69 had treatment failure. Baseline and index procedure variables showing significant association with SSI treatment outcome were moderate/large amounts of fascial excision ≥1 cm2) (OR, 10.21 [95% CI, 2.65 to 46.21]; p = 0.001), use of local muscle/skin graft (OR,11.88 [95% CI, 1.83 to 245.83]; p = 0.031), and use of a deep Hemovac (OR, 0.24 [95% CI, 0.05 to 0.85]; p = 0.041). In the final multivariable model, excision of fascia during primary tumor resection was the only variable with a significant association with treatment outcome (OR, 10.21 [95% CI, 2.65 to 46.21]; p = 0.018). CONCLUSIONS The results of this secondary analysis of the PARITY trial data provide further insight into the patient-, disease-, and treatment-specific associations with SSI treatment outcomes, which may help to inform decision-making and management of SSI in patients who have undergone segmental bone reconstruction of the femur or tibia for oncologic indications. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- G S Ray
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - P Werth
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - J H Alexander
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - W C Eward
- Duke Health Department of Orthopaedic Surgery, Duke Cancer Center, Duke, North Carolina
| | - N M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - L M Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - P Funovics
- Department of Orthopaedics, Medical University of Vienna, Austria
| | - R Windhager
- Department of Orthopaedics, Medical University of Vienna, Austria
| | - H T Temple
- Miller School of Medicine, University of Miami, Miami, Florida
| | - S Lozano-Calderon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - R S Avedian
- Department of Orthopaedic Surgery, Stanford Health Care, Redwood City, California
| | - P C Jutte
- Department of Orthopaedics, University of Groningen, Groningen, The Netherlands
| | - M Ghert
- Department of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - P Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, Padova University, Padova, Italy
| | - E R Henderson
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| |
Collapse
|
6
|
Hanusrichter Y, Gebert C, Dudda M, Hardes J, Streitbuerger A, Frieler S, Jeys LM, Wessling M. Custom-Made Metaphyseal Sleeves in "Beyond" AORI III Defects for Revision Knee Arthroplasty-Proof of Concept and Short-Term Results of a New Technique. J Pers Med 2023; 13:1043. [PMID: 37511656 PMCID: PMC10381695 DOI: 10.3390/jpm13071043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND While off-the-shelf cones and sleeves yield good results in AORI type 2 and 3 defects in revision knee surgery, massive longitudinal defects may require a proximal tibia replacement. To achieve the best anatomical as well as biomechanical reconstruction and preserve the tibial tuberosity, we developed custom-made metaphyseal sleeves (CMSs) to reconstruct massive defects with a hinge knee replacement. METHODS Between 2019 and 2022, 10 patients were treated in a single-center study. The indication for revision was aseptic loosening in five cases and periprosthetic joint infection in five cases. The mean number of previous revisions after the index operations was 7 (SD: 2; 4-12). A postoperative analysis was conducted to evaluate the functional outcome as well as the osteointegrative potential. RESULTS Implantation of the CMS in rTKA was carried out in all cases, with a mean operation time of 155 ± 48 (108-256) min. During the follow-up of 23 ± 7 (7-31) months, no CMS was revised and revisions due to other causes were conducted in five cases. Early radiographic evidence of osseointegration was recorded using a validated method. The postoperative OKS showed a significant increase (p < 0.001), with a mean score of 24 (SD: 4; range: 14-31). CONCLUSION Custom-made metaphyseal sleeves show acceptable results in extreme cases. As custom-made components become more and more common, this treatment algorithm presents a viable alternative in complex rTKA.
Collapse
Affiliation(s)
- Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, Germany
| | - Marcel Dudda
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
- Department of Trauma Surgery, University Hospital Essen, 45147 Essen, Germany
- Department of Orthopedics and Trauma Surgery, BG-Klinikum Duisburg, University Duisburg-Essen, 47249 Duisburg, Germany
| | - Jendrik Hardes
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Arne Streitbuerger
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
- Faculty of Health Sciences, Aston University, Birmingham B4 7ET, UK
| | - Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
| |
Collapse
|
7
|
Kask G, Laitinen MK, Parry MC, Albergo JI, Stevenson JD, Farfalli G, Aponte-Tinao L, Grimer R, Sumathi V, Jeys LM. Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival? Cancers (Basel) 2023; 15:cancers15082337. [PMID: 37190265 DOI: 10.3390/cancers15082337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst resection margin contributes to local recurrence free survival (LRFS). The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional central CSs arising from the proximal humerus. A multi-centre, retrospective study from three international collaborative sarcoma centres identified 110 patients between 1995 and 2020 undergoing treatment for a conventional central CS of the proximal humerus; 58 patients (53%) had a grade 1 tumour, 36 (33%) had a grade 2 tumour, and 16 patients (13%) had a grade 3 CS. The mean age of patients was 50 years (range 10-85). The incidence of local recurrence (LR) was 9/110 (8.2%), and the disease specific mortality was 6/110 (5.5%). The grade was a statistically significant factor for LRFS (p < 0.001). None of the grade 1 tumours developed LR. The DSS was affected by the grade (p < 0.001) but not by the LR (p = 0.4). Only one patient with a grade 2 tumour died from the disease. The proximal humeral grade 1 CS behaved as a benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus behaved in a more indolent way when compared with comparable grade tumours elsewhere in the appendicular skeleton, being locally aggressive with a higher LR rate than grade 1 CSs but still having very low mortality and a high rate of DSS. The LR in grade 2 CSs did not affect the DSS; therefore, surgical management in proximal humeral grade 2 CSs should have a greater emphasis on preserving function whilst maintaining an adequate margin for resection. The proximal humeral grade 3 CS was, as elsewhere in the skeleton, an aggressive, high-grade tumour. Therefore, surgical management should include en bloc resection with clear margins to avoid LR.
Collapse
Affiliation(s)
- Gilber Kask
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland
| | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland
| | - Michael C Parry
- Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK
| | - Jose I Albergo
- Department of Orthopaedics, Hospital de Italiano, Buenos Aires C1199, Argentina
| | - Jonathan D Stevenson
- Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK
| | - German Farfalli
- Department of Orthopaedics, Hospital de Italiano, Buenos Aires C1199, Argentina
| | - Luis Aponte-Tinao
- Department of Orthopaedics, Hospital de Italiano, Buenos Aires C1199, Argentina
| | - Robert Grimer
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Vaiyapuri Sumathi
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Lee M Jeys
- Royal Orthopaedic Hospital, Faculty of Health Sciences, Aston University, Birmingham B4 7ET, UK
| |
Collapse
|
8
|
Maes DJ, Alaqeel M, Parry M, Botchu R, Sumathi V, Jeys LM, Stevenson JD. Haemorrhagic soft-tissue sarcoma: Oncological outcomes and prognostic factors for survival. Eur J Surg Oncol 2023; 49:345-352. [PMID: 36031468 DOI: 10.1016/j.ejso.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Haemorrhagic soft-tissue sarcomas (HSTS) are characterised by aggressive local growth and highly metastatic behaviour. We aimed to describe oncological outcomes and prognostic factors. MATERIALS AND METHODS Retrospective review including 64 patients treated with palliation (n = 7), with limb salvage surgery (LSS) (n = 9), with neoadjuvant radiotherapy (RT) + LSS (n = 12), with LSS + adjuvant RT (n = 30) or amputation (n = 6). Kaplan-Meier survival analysis estimated overall survival (OS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). After uni- and multivariate analysis, prognostic factors affecting OS, MFS and LRFS were identified. RESULTS Median age was 67 years (IQR 23 years) with median follow-up of 11 months (IQR 28 months). All cases were high grade. Eight (13%) had pulmonary metastases at presentation and another 40 (63%) developed metastases after median 9 months (IQR 19 months). Median OS was 12 months (IQR 38 months), and estimated OS after two-years was 15.9% and 52.9% for patients with and without metastatic disease at presentation, respectively. Improved OS was associated with negative resection margins (p = 0.031), RT (p = 0.045), neoadjuvant RT (versus adjuvant RT, p = 0.044) and amputation (versus LSS, p < 0.001). MFS was 35.1% after two-years. LR occurred in 18 of 51 (35.3%) patients with surgically treated localised disease. LRFS was 63.4% after two-years and significantly affected by a negative margin (p = 0.042) and RT (p = 0.001). CONCLUSION Haemorrhagic soft-tissue sarcomas should be excised, either with amputation or LSS with a clear resection margin. If LSS is attempted, neoadjuvant RT reduces the risk of tumour spillage and early LR, enhances the feasibility of achieving clear resection margins, and offers superior overall survival compared to adjuvant RT.
Collapse
Affiliation(s)
- Danielle J Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Motaz Alaqeel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Michael Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Vaiyapuri Sumathi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Lee M Jeys
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
| |
Collapse
|
9
|
Lozano-Calderón SA, Albergo JI, Groot OQ, Merchan NA, El Abiad JM, Salinas V, Gomez Mier LC, Montoya CS, Ferrone ML, Ready JE, Linares FJ, Levin AS, Peleteiro Pensado M, Pozo Kreilinger JJ, Ruiz IB, Ortiz-Cruz EJ, Gebhardt MC, Cote GM, Choy E, Spentzos D, Hung YP, Deshpande V, Chebib IA, McCulloch RA, Farfalli G, Aponte Tinao L, Morris CD, Petur Nielsen G, Anderson ME, Jeys LM. Complete tumor necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing sarcoma. Cancer 2023; 129:60-70. [PMID: 36305090 DOI: 10.1002/cncr.34506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Survival in patients who have Ewing sarcoma is correlated with postchemotherapy response (tumor necrosis). This treatment response has been categorized as the response rate, similar to what has been used in osteosarcoma. There is controversy regarding whether this is appropriate or whether it should be a dichotomy of complete versus incomplete response, given how important a complete response is for in overall survival of patients with Ewing sarcoma. The purpose of this study was to evaluate the impact that the amount of chemotherapy-induced necrosis has on (1) overall survival, (2) local recurrence-free survival, (3) metastasis-free survival, and (4) event-free survival in patients with Ewing sarcoma. METHODS In total, 427 patients who had Ewing sarcoma or tumors in the Ewing sarcoma family and received treatment with preoperative chemotherapy and surgery at 10 international institutions were included. Multivariate Cox proportional-hazards analyses were used to assess the associations between tumor necrosis and all four outcomes while controlling for clinical factors identified in bivariate analysis, including age, tumor volume, location, surgical margins, metastatic disease at presentation, and preoperative radiotherapy. RESULTS Patients who had a complete (100%) tumor response to chemotherapy had increased overall survival (hazard ratio [HR], 0.26; 95% CI, 0.14-0.48; p < .01), recurrence-free survival (HR, 0.40; 95% CI, 0.20-0.82; p = .01), metastasis-free survival (HR, 0.27; 95% CI, 0.15-0.46; p ≤ .01), and event-free survival (HR, 0.26; 95% CI, 0.16-0.41; p ≤ .01) compared with patients who had a partial (0%-99%) response. CONCLUSIONS Complete tumor necrosis should be the index parameter to grade response to treatment as satisfactory in patients with Ewing sarcoma. Any viable tumor in these patients after neoadjuvant treatment should be of oncologic concern. These findings can affect the design of new clinical trials and the risk-stratified application of conventional or novel treatments.
Collapse
Affiliation(s)
- Santiago A Lozano-Calderón
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose Ignacio Albergo
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Olivier Q Groot
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nelson A Merchan
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jad M El Abiad
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Salinas
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Luis Carlos Gomez Mier
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Camilo Soto Montoya
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marco L Ferrone
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John E Ready
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Francisco J Linares
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adam S Levin
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuel Peleteiro Pensado
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - José Juan Pozo Kreilinger
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Irene Barrientos Ruiz
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo J Ortiz-Cruz
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Mark C Gebhardt
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory M Cote
- Division of Sarcoma and Connective Tissue Oncology, Department of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Edwin Choy
- Division of Sarcoma and Connective Tissue Oncology, Department of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dimitrios Spentzos
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Vikram Deshpande
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivan A Chebib
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Allan McCulloch
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Royal Orthopedic Hospital National Health Service Trust, Aston University, Birmingham, UK
| | - Germán Farfalli
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Luis Aponte Tinao
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Carol D Morris
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gunnlaugur Petur Nielsen
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan E Anderson
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee M Jeys
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Royal Orthopedic Hospital National Health Service Trust, Aston University, Birmingham, UK
| |
Collapse
|
10
|
Mahoney R, Khan Z, Abudu A, Kurisunkal V, Evans S, Jeys LM. Outcomes of distal radial endoprostheses for tumour reconstruction: a single centre experience over 15 years. J Hand Surg Eur Vol 2022; 47:1147-1154. [PMID: 35950216 DOI: 10.1177/17531934221116469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a retrospective study over a 15-year period, between 2005 and 2020, evaluating clinical and functional outcomes in patients who underwent reconstruction of the distal radius with an endoprosthetic replacement following excision of both malignant and aggressive benign bone tumours. Data was collected retrospectively from a prospectively maintained electronic database, and prospectively via telephone patient consultation. Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were assessed at a minimum of 1 year postoperatively. Of nine implants, five were arthrodeses and four were arthroplasties. One patient required amputation within 6 months for proximal metastatic disease. At last follow-up, eight patients subjectively reported good function. Five patients returned to high functionally demanding jobs. Mean Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were 72% and 50/100, respectively. We conclude that distal radius endoprosthetic replacements offer acceptable functional outcomes and remain a viable option when biological reconstruction is not possible.Level of evidence: IV.
Collapse
Affiliation(s)
- Rachel Mahoney
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Health and Life Sciences, Aston University, Birmingham, UK
| | - Zeeshan Khan
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Adesegun Abudu
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Scott Evans
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Health and Life Sciences, Aston University, Birmingham, UK
| |
Collapse
|
11
|
Wessling M, Gebert C, Hakenes T, Dudda M, Hardes J, Frieler S, Jeys LM, Hanusrichter Y. Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position? : short-term radiological results. Bone Joint J 2022; 104-B:1110-1117. [PMID: 36177641 DOI: 10.1302/0301-620x.104b10.bjj-2022-0508.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. METHODS A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. RESULTS Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. CONCLUSION At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation.Cite this article: Bone Joint J 2022;104-B(10):1110-1117.
Collapse
Affiliation(s)
- Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tilmann Hakenes
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany
| | - Marcel Dudda
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Jendrik Hardes
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Seattle Science Foundation, Seattle, Washington, USA.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
12
|
Kurisunkal V, Laitinen MK, Kaneuchi Y, Kapanci B, Stevenson J, Parry MC, Reito A, Fujiwara T, Jeys LM. Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis? Bone Joint J 2021; 103-B:1150-1154. [PMID: 34058869 DOI: 10.1302/0301-620x.103b6.bjj-2020-1869.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis. METHODS We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm. RESULTS The disease--specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001). CONCLUSION Obtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis. Cite this article: Bone Joint J 2021;103-B(6):1150-1154.
Collapse
Affiliation(s)
| | - Minna K Laitinen
- Dept of Orthopaedic and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Bilal Kapanci
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Aleksi Reito
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | | | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Dept of Health and Life Sciences, Aston University, Birmingham, UK
| |
Collapse
|
13
|
Lex JR, Kurisunkal V, Kaneuchi Y, Fujiwara T, Sherriff J, Wigley C, Stevenson JD, Parry MC, Jeys LM. Pelvic Ewing sarcoma: Should all patients receive pre-operative radiotherapy, or should it be delivered selectively? Eur J Surg Oncol 2021; 47:2618-2626. [PMID: 34030919 DOI: 10.1016/j.ejso.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Locally recurrent disease following surgical resection of Ewing sarcoma (ES) confers a poor prognosis. Limited evidence is available evaluating non-selective use of pre-operative radiotherapy (RT) for patients with pelvic ES and its effect on local control and survival. PATIENTS AND METHODS 49 consecutive patients with pelvic ES were identified retrospectively from a prospectively collated database. Patients either received non-selective pre-operative RT and surgery (n = 27), or selective post-operative RT (n = 22) (surgery alone (n = 11) or surgery and post-operative RT (n = 11)). RESULTS Patients who had non-selective pre-operative radiotherapy appeared to have a higher LRFS, 88.0% compared to 66.5% in the selective RT group (p = 0.096, Kaplan Meier; p = 0.028, Chi-squared). Administration of non-selective, pre-operative RT to all patients with pelvic ES elevates the LFRS to that of the good responder group (≥90% tumour necrosis and margins, p = 0.880). There was no difference in metastasis-free survival, 60.0% and 54.5% (p = 0.728) and overall survival (OS), 57.7% and 63.6% (p = 0.893). The majority of pre-operative RT patients had both good necrosis (≥90%) (p = 0.003) and widely excised tumours, 81.5% vs 59.1% (p = 0.080). Tumour volume ≥250 ml was associated with worse LRFS (p = 0.045) and post-operative complications (p = 0.017). There may be improved LRFS (p = 0.057) with pre-operative proton-beam RT compared to surgery and selective post-operative RT. CONCLUSION Pre-operative photon or proton-beam RT to all pelvic ES may improve LRFS compared to the selective delivery of post-operative RT. Radiotherapy delivered to all patients results in a greater percentage of highly necrotic tumours at surgical excision, enabling a greater proportion of patients with wide resection margins.
Collapse
Affiliation(s)
- Johnathan R Lex
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
| | - Vineet Kurisunkal
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Tomohiro Fujiwara
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Jenny Sherriff
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Catrin Wigley
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Jonathan D Stevenson
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK.
| | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK.
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Faculty of Health Sciences, Aston University, Birmingham, UK.
| |
Collapse
|
14
|
Abstract
AIMS Chondrosarcoma is the second most common primary sarcoma of bone: conventional chondrosarcoma accounts for 85% of all cases. Conventional chondrosarcoma may be central or peripheral. Most studies group central and peripheral chondrosarcomas together, although there is growing evidence that their clinical behaviour and prognosis differ. The aims of this study were to analyze any differences in characteristics between central and peripheral chondrosarcomas and to investigate the incidence and role of different syndromes. METHODS Data from two international tertiary referral sarcoma centres between January 1995 and December 2018 were retrospectively reviewed. The study population consisted of 714 patients with surgically treated conventional chondrosarcoma of the pelvis and limbs. RESULTS In patients with Ollier's disease and Mafucci's syndrome, 12/20 (60%) and 2/5 (60%) of malignancies, respectively, were in the limbs, most frequently in the proximal humerus, proximal tibia, and in the hands and feet. In patients with hereditary multiple exostosis (HME), 20/29 (69.0%) of chondrosarcomas were in the pelvis and scapula, specifically in the ilium in 13/29 (44.8%) and the scapula in 3/29 (10.3%). In central chondrosarcoma, survival of patients with Ollier's disease and non-syndromic patients was the same (p = 0.805). In peripheral chondrosarcoma, survival among HME patients was similar (p = 0.676) in patients with tumours of the pelvis and limbs. CONCLUSION Both central and peripheral chondrosarcoma have specific characteristics. HME is frequently seen in patients with a peripheral chondrosarcoma, in whom tumours are commonly located in the ilium and scapula. The incidence of Ollier's disease is uncommon in patients with a central chondrosarcoma. Disease-specific survival is equal in different subtypes after adjustment for histological grade. The local recurrence-free survival is the same for different locations and subtypes after adjustment for surgical margin. Cite this article: Bone Joint J 2021;103-B(5):984-990.
Collapse
Affiliation(s)
- Minna K Laitinen
- Department of Orthopaedics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Scott Evans
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Stevenson
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| | - Vaiyapuri Sumathi
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Gilber Kask
- Department of Orthopaedics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lee M Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Michael C Parry
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| |
Collapse
|
15
|
Abstract
METHODS A multicentre retrospective study was carried out at two tertiary sarcoma centres. A database search identified all patients with a CS treated between January 1995 and January 2018. There were 810 CSs of which 76 (9.4%) were located in the fingers, toes, metacarpals, and metatarsal bones. RESULTS The median age of the study population was 55 years (36 to 68) with a median follow-up of 52 months (22 to 87) months. Overall, 70% of the tumours were in the hand (n = 54) and 30% in the foot (n = 22). Predictors for LR were margin (p = 0.011), anatomical location (p = 0.017), and method of surgical management (p = 0.003). Anatomical location (p = 0.026), histological grade between 1 and 3 (p = 0.004) or 2 and 3 (p = 0.016), and surgical management (p = 0.001) were significant factors for LR-free survival. Disease-specific survival was affected by histological grade (p < 0.001), but not by LR (p = 0.397). CONCLUSION Intralesional curettage of a low-grade CS is associated with an increased risk of LR, but LR does not affect disease-specific survival. Therefore, for low-grade CSs of the hands and feet, surgical management should aim to preserve function. In grade 2 CS, our study did not show any decreased disease-specific survival after recurrence; however, we suggest a more aggressive surgical approach to these tumours to prevent local recurrence, especially in the metacarpal and metatarsal bones. In high-grade tumours, the incidence of progressive disease is high and, therefore, the treatment of the primary tumour should be aggressive where possible, and patients observed closely for the development of metastatic disease. Cite this article: Bone Joint J 2021;103-B(3):562-568.
Collapse
Affiliation(s)
- Gilber Kask
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Helsinki, Finland
| | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonathan Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| | | | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Science, Aston University, Birmingham, UK
| | - Michael C Parry
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| |
Collapse
|
16
|
Tsoi KM, Lowe M, Tsuda Y, Lex JR, Fujiwara T, Almeer G, Gregory J, Stevenson J, Evans SE, Botchu R, Jeys LM. How Are Indeterminate Pulmonary Nodules at Diagnosis Associated with Survival in Patients with High-Grade Osteosarcoma? Clin Orthop Relat Res 2021; 479:298-308. [PMID: 32956141 PMCID: PMC7899536 DOI: 10.1097/corr.0000000000001491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pulmonary metastases are a poor prognostic factor in patients with osteosarcoma; however, the clinical significance of subcentimeter lung nodules and whether they represent a tumor is not fully known. Because the clinician is faced with decisions regarding biopsy, resection, or observation of lung nodules and the potential impact they have on decisions about resection of the primary tumor, this remains an area of uncertainty in patient treatment. Surgical management of the primary tumor is tailored to prognosis, and it is unclear how aggressively patients with indeterminate pulmonary nodules (IPNs), defined as nodules smaller than 1 cm at presentation, should be treated. There is a clear need to better understand the clinical importance of these nodules. QUESTIONS/PURPOSES (1) What percentage of patients with high-grade osteosarcoma and spindle cell sarcoma of bone have IPNs at diagnosis? (2) Are IPNs at diagnosis associated with worse metastasis-free and overall survival? (3) Are there any clinical or radiologic factors associated with worse overall survival in patients with IPN? METHODS Between 2008 and 2016, 484 patients with a first presentation of osteosarcoma or spindle cell sarcoma of bone were retrospectively identified from an institutional database. Patients with the following were excluded: treatment at another institution (6%, 27 of 484), death related to complications of neoadjuvant chemotherapy (1%, 3 of 484), Grade 1 or 2 on final pathology (4%, 21 of 484) and lack of staging chest CT available for review (0.4%, 2 of 484). All patients with abnormalities on their staging chest CT underwent imaging re-review by a senior radiology consultant and were divided into three groups for comparison: no metastases (70%, 302 of 431), IPN (16%, 68 of 431), and metastases (14%, 61 of 431) at the time of diagnosis. A random subset of CT scans was reviewed by a senior radiology registrar and there was very good agreement between the two reviewers (κ = 0.88). Demographic and oncologic variables as well as treatment details and clinical course were gleaned from a longitudinally maintained institutional database. The three groups did not differ with regard to age, gender, subtype, presence of pathological fracture, tumor site, or chemotherapy-induced necrosis. They differed according to local control strategy and tumor size, with a larger proportion of patients in the metastases group presenting with larger tumor size and undergoing nonoperative treatment. There was no differential loss to follow-up among the three groups. Two percent (6 of 302) of patients with no metastases, no patients with IPN, and 2% (1 of 61) of patients with metastases were lost to follow-up at 1 year postdiagnosis but were not known to have died. Individual treatment decisions were determined as part of a multidisciplinary conference, but in general, patients without obvious metastases received (neo)adjuvant chemotherapy and surgical resection for local control. Patients in the no metastases and IPN groups did not differ in local control strategy. For patients in the IPN group, staging CT images were inspected for IPN characteristics including number, distribution, size, location, presence of mineralization, and shape. Subsequent chest CT images were examined by the same radiologist to reevaluate known nodules for interval change in size and to identify the presence of new nodules. A random subset of chest CT scans were re-reviewed by a senior radiology resident (κ = 0.62). The association of demographic and oncologic variables with metastasis-free and overall survival was first explored using the Kaplan-Meier method (log-rank test) in univariable analyses. All variables that were statistically significant (p < 0.05) in univariable analyses were entered into Cox regression multivariable analyses. RESULTS Following re-review of staging chest CTs, IPNs were found in 16% (68 of 431) of patients, while an additional 14% (61 of 431) of patients had lung metastases (parenchymal nodules 10 mm or larger). After controlling for potential confounding variables like local control strategy, tumor size, and chemotherapy-induced necrosis, we found that the presence of an IPN was associated with worse overall survival and a higher incidence of metastases (hazard ratio 1.9 [95% CI 1.3 to 2.8]; p = 0.001 and HR 3.6 [95% CI 2.5 to 5.2]; p < 0.001, respectively). Two-year overall survival for patients with no metastases, IPN, or metastases was 83% [95% CI 78 to 87], 65% [95% CI 52 to 75] and 45% [95% CI 32 to 57], respectively (p = 0.001). In 74% (50 of 68) of patients with IPNs, it became apparent that they were true metastatic lesions at a median of 5.3 months. Eighty-six percent (43 of 50) of these patients had disease progression by 2 years after diagnosis. In multivariable analysis, local control strategy and tumor subtype correlated with overall survival for patients with IPNs. Patients who were treated nonoperatively and who had a secondary sarcoma had worse outcomes (HR 3.6 [95% CI 1.5 to 8.3]; p = 0.003 and HR 3.4 [95% CI 1.1 to 10.0]; p = 0.03). The presence of nodule mineralization was associated with improved overall survival in the univariable analysis (87% [95% CI 39 to 98] versus 57% [95% CI 43 to 69]; p = 0.008), however, because we could not control for other factors in a multivariable analysis, the relationship between mineralization and survival could not be determined. We were unable to detect an association between any other nodule radiologic features and survival. CONCLUSION The findings show that the presence of IPNs at diagnosis is associated with poorer survival of affected patients compared with those with normal staging chest CTs. IPNs noted at presentation in patients with high-grade osteosarcoma and spindle cell sarcoma of bone should be discussed with the patient and be considered when making treatment decisions. Further work is required to elucidate how the nodules should be managed. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
Affiliation(s)
- Kim M Tsoi
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Martin Lowe
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Yusuke Tsuda
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Johnathan R Lex
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Tomohiro Fujiwara
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Ghassan Almeer
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Gregory
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Stevenson
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Scott E Evans
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Rajesh Botchu
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Lee M Jeys
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| |
Collapse
|
17
|
Tsuda Y, Tsoi K, Stevenson JD, Laitinen M, Ferguson PC, Wunder JS, Griffin AM, van de Sande MAJ, van Praag V, Leithner A, Fujiwara T, Yasunaga H, Matsui H, Parry MC, Jeys LM. Development and external validation of nomograms to predict sarcoma-specific death and disease progression after surgical resection of localized high-grade conventional primary central chondrosarcoma and dedifferentiated chondrosarcoma. Bone Joint J 2020; 102-B:1752-1759. [PMID: 33249892 DOI: 10.1302/0301-620x.102b12.bjj-2020-0810.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS Our aim was to develop and validate nomograms that would predict the cumulative incidence of sarcoma-specific death (CISSD) and disease progression (CIDP) in patients with localized high-grade primary central and dedifferentiated chondrosarcoma. METHODS The study population consisted of 391 patients from two international sarcoma centres (development cohort) who had undergone definitive surgery for a localized high-grade (histological grade II or III) conventional primary central chondrosarcoma or dedifferentiated chondrosarcoma. Disease progression captured the first event of either metastasis or local recurrence. An independent cohort of 221 patients from three additional hospitals was used for external validation. Two nomograms were internally and externally validated for discrimination (c-index) and calibration plot. RESULTS In the development cohort, the CISSD at ten years was 32.9% (95% confidence interval (CI) 19.8% to 38.4%). Age at diagnosis, grade, and surgical margin were found to have significant effects on CISSD and CIDP in multivariate analyses. Maximum tumour diameter was also significantly associated with CISSD. In the development cohort, the c-indices for CISSD and CIDP at five years were 0.743 (95% CI 0.700 to 0.819) and 0.761 (95% CI 0.713 to 0.800), respectively. When applied to the validation cohort, the c-indices for CISSD and CIDP at five years were 0.839 (95% CI 0.763 to 0.916) and 0.749 (95% CI 0.672 to 0.825), respectively. The calibration plots for these two nomograms demonstrated good fit. CONCLUSION Our nomograms performed well on internal and external validation and can be used to predict CISSD and CIDP after resection of localized high-grade conventional primary central and dedifferentiated chondrosarcomas. They provide a new tool with which clinicians can assess and advise individual patients about their prognosis. Cite this article: Bone Joint J 2020;102-B(12):1752-1759.
Collapse
Affiliation(s)
- Yusuke Tsuda
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan
| | - Kim Tsoi
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan D Stevenson
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | - Minna Laitinen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | | | - Veroniek van Praag
- Department of Orthopedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, University of Tokyo, Tokyo, Japan
| | - Michael C Parry
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
18
|
Kiiski J, Laitinen MK, Nail LRL, Kuokkanen HO, Peart F, Rosset P, Bourdais-Sallot A, Jeys LM, Parry MC. Soft tissue reconstruction after pelvic amputation: The efficacy and reliability of free fillet flap reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:987-994. [PMID: 33431341 DOI: 10.1016/j.bjps.2020.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap ischaemia time was 420 (249-650) and 89 (64-210) min, respectively. Median hospital and ICU stay was 18 (10-42) and 3 (1-8) days, respectively. Median blood loss was 2400 (950-10000) ml. There were three returns to theatre due to vascular compromise, with one total flap loss due to arterial thrombosis. Overall survival was 58% (95%CI 28-91%) both at 1-year and at 3-years. DISCUSSION Carefully selected patients requiring hindquarter amputation with extensive soft tissue defect necessitating free flap reconstruction can be reconstructed with a lower extremity free fillet flap with low rate of local wound complications. Survival of these patients is similar to that in patients requiring less extensive resection.
Collapse
Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences Tampere, Finland.
| | - Minna K Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Finland; University of Helsinki, Helsinki, Finland
| | - Louis-Romée Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Hannu O Kuokkanen
- University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Department of Plastic Surgery, Finland
| | | | - Philippe Rosset
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Aurélie Bourdais-Sallot
- Plastic and Reconstructive Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | | |
Collapse
|
19
|
Tsuda Y, Tsoi K, Parry MC, Stevenson JD, Fujiwara T, Sumathi V, Jeys LM. Impact of chemotherapy-induced necrosis on event-free and overall survival after preoperative MAP chemotherapy in patients with primary high-grade localized osteosarcoma. Bone Joint J 2020; 102-B:795-803. [PMID: 32475245 DOI: 10.1302/0301-620x.102b6.bjj-2019-1307.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To assess the correlation between the histological response to preoperative chemotherapy and event-free survival (EFS) or overall survival (OS) in patients with high-grade localized osteosarcoma. METHODS Out of 625 patients aged ≤ 40 years treated for primary high-grade osteosarcoma between 1997 and 2016, 232 patients without clinically detectable metastases at the time of diagnosis and treated with preoperative high-dose methotrexate, adriamycin and cisplatin (MAP) chemotherapy and surgery were included. Associations of chemotherapy-induced necrosis in the resected specimen and EFS or OS were assessed using Cox model and the Pearson's correlation coefficients (r). Time-dependent receiver operating characteristic analysis was applied to determine the optimal cut-off value of chemotherapy-induced necrosis for EFS and OS. RESULTS OS was 74% (95% confidence interval (CI) 67 to 79) at five years. Median chemotherapy-induced necrosis was 85% (interquartile range (IQR) 50% to 97%). In multivariate Cox model, chemotherapy-induced necrosis was significantly associated with EFS and OS (hazard ratio (HR) = 0.99 (95% CI 0.98 to 0.99); p < 0.001 and HR = 0.98 (95% CI 0.97 to 0.99); p < 0.001, respectively). Positive correlation was observed between chemotherapy-induced necrosis and five-year EFS and five-year OS (r = 0.91; p < 0.001, and r = 0.85; p < 0.001, respectively). The optimal cut-off value of chemotherapy-induced necrosis for five-year EFS and five-year OS was 85% and 72%, respectively. CONCLUSION Chemotherapy-induced necrosis in the resected specimen showed positive correlation with EFS and OS in patients with high-grade localized osteosarcoma after MAP chemotherapy. In our analysis, optimal cut-off values of MAP chemotherapy-induced necrosis in EFS and OS were lower than the commonly used 90%, suggesting the need for re-evaluation of the optimal cut-off value through larger, international collaborative research. Cite this article: Bone Joint J 2020;102-B(6):795-803.
Collapse
Affiliation(s)
- Yusuke Tsuda
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Kim Tsoi
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | - Jonathan D Stevenson
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | | | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Life & Health Sciences at University of Aston, Birmingham, UK
| |
Collapse
|
20
|
Kiiski J, Parry MC, Le Nail LR, Sumathi V, Stevenson JD, Kaartinen IS, Jeys LM, Laitinen MK. Surgical and oncological outcomes after hindquarter amputation for pelvic sarcoma. Bone Joint J 2020; 102-B:788-794. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1317.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Survival rates and local control after resection of a sarcoma of the pelvis compare poorly to those of the limbs and have a high incidence of complications. The outcome for patients who need a hindquarter amputation (HQA) to treat a pelvic sarcoma is poor. Our aim was to evaluate the patient, tumour, and reconstructive factors that affect the survival of the patients who undergo HQA for primary or recurrent pelvic sarcoma. Methods We carried out a retrospective review of all sarcoma patients who had undergone a HQA in a supraregional sarcoma unit between 1996 and 2018. Outcomes included oncological, surgical, and survival characteristics. Results A total of 136 patients, with a mean age of 51 (12 to 83) underwent HQA, 91 for a bone sarcoma and 45 for a soft tissue sarcoma. The overall survival (OS) after primary HQA for a bone sarcoma was 90.7 months (95% confidence interval (CI) 64.1 to 117.2). In patients undergoing a secondary salvage HQA it was 90.3 months (95% CI 58.1 to 122.5) (p = 0.727). For those treated for a soft tissue sarcoma (STS), the mean OS was 59.3 months (95% CI 31.1 to 88.6) for patients with a primary HQA, and 12.5 months (95% CI 9.4 to 15.5) for those undergoing a secondary salvage HQA (p = 0.038). On multivariate analysis, high histological grade (hazard ratio (HR) 2.033, 95% CI 1.127 to 3.676; p = 0.018) and a diagnosis of STS (HR 1.653, 95% CI 1.027 to 2.660; p = 0.039) were associated with a poor prognosis. The 30-day mortality for patients with curative intent was 0.8% (1/128). For those in whom surgery was carried out with palliative intent it was 33.3% (2/6) (p = 0.001). In total, 53.7% (n = 73) of patients had at least one complication with 23.5% (n = 32) requiring at least one further operation. Direct closure was inferior to flap reconstruction in terms of complete primary wound healing (60.0% (3/5) vs 82.0% (82/100); p = 0.023). Conclusion In carefully selected patients HQA is associated with satisfactory overall survival, with a low risk of perioperative mortality, but considerable morbidity. However, caution must be exercised when considering the procedure for palliation due to the high incidence of early postoperative mortality. Cite this article: Bone Joint J 2020;102-B(6):788–794.
Collapse
Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Michael C. Parry
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luis-Romee Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, Tours, France
| | - Vaiyapuri Sumathi
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Ilkka S. Kaartinen
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Minna K. Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| |
Collapse
|
21
|
Laitinen MK, Albergo JI, Stevenson JD, Farfalli GL, Aponte-Tinao LA, Grimer RJ, Jeys LM, Parry MC. Female gender in the hormonally active age group plays a major role in high-grade chondrosarcoma survival. Acta Oncol 2020; 59:242-246. [PMID: 31769322 DOI: 10.1080/0284186x.2019.1695064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Minna K. Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics, University of Helsinki, Helsinki, Finland
| | | | | | | | | | - Robert J. Grimer
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M. Jeys
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C. Parry
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
22
|
Tsuda Y, Lowe M, Evans S, Parry MC, Stevenson JD, Fujiwara T, Kaneuchi Y, Le Nail LR, Jeys LM. Surgical outcomes and prognostic factors of non-metastatic radiation-induced sarcoma of bone. Eur J Surg Oncol 2019; 46:293-298. [PMID: 31703834 DOI: 10.1016/j.ejso.2019.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/13/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The survival and prognostic factors in non-metastatic, radiation-induced bone sarcomas of bone have not been described. Moreover, the quantitative data about surgical outcomes and complications after limb-salvage surgery versus amputation are quite limited. METHODS Twenty-five patients with non-metastatic, radiation-induced sarcoma of bone who underwent definitive surgery were analysed. Histological diagnosis was osteosarcoma in 19 and undifferentiated pleomorphic sarcoma in six. The definitive surgery was limb-salvage surgery in 15 patients and an amputation in 10. RESULTS The 5-year overall survival rate (OS) and the 5-year event-free survival rate (EFS) were 53% (95% CI 31%-70%) and 40% (21%-59%), respectively. Patients with wide or radical surgical margins (n = 13) showed significantly better OS compared with those with marginal (n = 8) or intralesional (n = 2) margins (5-year OS, radical or wide = 74%, marginal = 17%, intralesional = 0%, p = 0.044). The risk of local recurrence was significantly higher in the limb-salvage group compared to the amputation group (49% vs 0%, p = 0.011). OS and EFS were not significantly different between limb-salvage group and an amputation group (p = 0.188 and 0.912, respectively). CONCLUSIONS We believe non-metastatic, radiation-induced sarcoma of bone should be resected with the aim of achieving wide or radical margins. Although limb-salvage surgery was related to higher rates of local recurrence compared with those of the amputation group, OS and EFS were not different among two groups. Surgeons need to discuss the higher risk of local recurrence in limb-salvage surgery.
Collapse
Affiliation(s)
- Yusuke Tsuda
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK.
| | - Martin Lowe
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Scott Evans
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - Michael C Parry
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK; Aston University Medical School, Aston Express Way, Birmingham, B4 7ET, UK
| | - Jonathan D Stevenson
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK; Aston University Medical School, Aston Express Way, Birmingham, B4 7ET, UK
| | - Tomohiro Fujiwara
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - Yoichi Kaneuchi
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - Louis-Romee Le Nail
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK; Orthopaedic Department University Hospital of Tours, 37044, Cedex 9 Tours, France
| | - Lee M Jeys
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK; Life & Health Sciences at University of Aston, Aston Expressway, Birmingham, B4 7ET, UK
| |
Collapse
|
23
|
Parratte S, Price AJ, Jeys LM, Jackson WF, Clarke HD. Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric Study. J Arthroplasty 2019; 34:2799-2803. [PMID: 31301912 DOI: 10.1016/j.arth.2019.06.040] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although the utility of robotic surgery has already been proven in cadaveric studies, it is our hypothesis that this newly designed robotically assisted system will achieve a high level of accuracy for bone resection. Therefore, we aimed to analyze in a cadaveric study the accuracy to achieve targeted angles and resection thickness. METHODS For this study, 15 frozen cadaveric specimens (30 knees) were used. In this study, Zimmer Biomet (Warsaw, IN) knees, navigation system, and robot (ROSA Knee System; Zimmer Biomet) were used. Eight trained, board-certified orthopedic surgeons performed robotically assisted total knee arthroplasty implantation using the same robotic protocol with 3 different implant designs. The target angles obtained from the intraoperative planning were then compared to the angles of the bone cuts performed using the robotic system and measured with the computer-assisted system considered to be the gold standard. For each bone cut the resection thickness was measured 3 times by 2 different observers and compared to the values for the planned resections. RESULTS All angle mean differences were below 1° and standard deviations below 1°. For all 6 angles, the mean differences between the target angle and the measured values were not significantly different from 0 except for the femoral flexion angle which had a mean difference of 0.95°. The mean hip-knee-ankle axis difference was -0.03° ± 0.87°. All resection mean differences were below 0.7 mm and standard deviations below 1.1mm. CONCLUSION Despite the fact that this study was funded by Zimmer Biomet and only used Zimmer Biomet implants, robot, and navigation tools, the results of our in vitro study demonstrated that surgeons using this new surgical robot in total knee arthroplasty can perform highly accurate bone cuts to achieve the planned angles and resection thickness as measured using conventional navigation.
Collapse
Affiliation(s)
- Sébastien Parratte
- Adult Reconstructive Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates; Adult Reconstructive Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Andrew J Price
- Adult Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Lee M Jeys
- Adult Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - William F Jackson
- Adult Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | | |
Collapse
|
24
|
Fujiwara T, Lex JR, Stevenson JD, Tsuda Y, Clark R, Parry MC, Grimer RJ, Jeys LM. Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments? J Surg Oncol 2019; 120:985-993. [PMID: 31381161 DOI: 10.1002/jso.25660] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to clarify which local treatment is oncologically and functionally effective in pelvic Ewing sarcoma (ES). METHODS A consecutive series of patients who underwent pelvic resections and acetabular reconstructions after chemotherapy between 1986 and 2016 at a supra-regional center were evaluated. RESULTS The cohort consisted of 35 patients. The 5-year overall survival (OS) and local recurrence-free survival (LRFS) was 61% and 72%, respectively. Preoperative radiotherapy (RT) and surgery provided an excellent/good histological response in 92% and achieved significantly better OS (5 years, 64%) and LRFS (5 years, 100%) than surgery alone or surgery with postoperative RT. The Musculoskeletal Tumor Society functional scores were significantly better in patients with hip transposition than those with structural reconstructions (74% vs 57%; P = .031) using custom-made prostheses, irradiated autografts, and ice-cream cone prostheses. These scores were significantly lower if patients had deep infection (P = .035), which was the most common complication (28%) in structural reconstructions but did not occur in hip transposition even when performed after preoperative RT. CONCLUSION Acetabular reconstruction with hip transposition resulted in no deep infection and superior function in patients with pelvic ES even when combined with preoperative RT, which improved tumor necrosis and rate of local control and survival.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Johnathan R Lex
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rhys Clark
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Robert J Grimer
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
25
|
Laitinen MK, Stevenson JD, Evans S, Abudu A, Sumathi V, Jeys LM, Parry MC. Chondroblastoma in pelvis and extremities- a signle centre study of 177 cases. J Bone Oncol 2019; 17:100248. [PMID: 31428555 PMCID: PMC6695276 DOI: 10.1016/j.jbo.2019.100248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Chondroblastoma is a rare benign bone tumour that usually occurs in children and young adults. They are cartilaginous tumours arising in the epiphysis or apophysis of a long bone. The tumour is classified as benign, although rare cases of pulmonary metastases have been reported. The aims of this study were to describe clinical, radiographic characteristics of chondroblastoma; to analyse the local recurrence rate and complications associated with surgery. Material and methods This retrospective study included 177 patients, who had been diagnosed with a chondroblastoma in extremity between 1990 and 2015. Results The most common site was proximal tibia 20%, followed by proximal humerus 19%, proximal femur 18%, distal femur 16% and foot 15%. One patient has died of the disease and one patient is alive after being operated for lung metastases. There was local recurrence in 25/177 (14%) patients. The median time to local recurrence was 10 months (range 3–158 months). The most common site for local recurrence was proximal tibia (22.2%). The proximal femur was the location in 32/178 (18%) of the cases. 18/32 (56%) were in the greater trochanter and 14/32 (44%) in the femoral head. The mean age was lower in tumours located in femoral head when compared to the greater trochanter; 19.5 years and 13.9 years respectively (p = =0.004). Tumours located in greater trochanter were all curetted without further complications. Local recurrence was seen more often in femoral head tumours, though without statistical significance; 3/14 (21%) and none, respectively (p = =0.073). Conclusions Chondroblastoma is a rare benign to intermediate grade bone tumour with a potential to metastasise. Femoral head chondroblastoma is rare, presenting 4.5% of all chondroblastoma cases. Around 50% of the chondroblastoma in femoral head. occur in patients with open growth plates.
Collapse
Affiliation(s)
- M K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - J D Stevenson
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK.,Aston University Medical School, Aston Expressway, Birmingham B4 7ET, UK
| | - S Evans
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK
| | - A Abudu
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK
| | - V Sumathi
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK
| | - L M Jeys
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK.,Aston University Medical School, Aston Expressway, Birmingham B4 7ET, UK
| | - M C Parry
- Oncology Department, Royal Orthopaedic Hospital, Bristol Road, Birmingham B31 2AP, UK.,Aston University Medical School, Aston Expressway, Birmingham B4 7ET, UK
| |
Collapse
|
26
|
Abstract
AIMS The aim of this study was to identify factors that determine outcomes of treatment for patients with chondroblastic osteosarcomas (COS) of the limbs and pelvis. PATIENTS AND METHODS The authors carried out a retrospective review of prospectively collected data from 256 patients diagnosed between 1979 and 2015. Of the 256 patients diagnosed with COS of the pelvis and the limbs, 147 patients (57%) were male and 109 patients (43%) were female. The mean age at presentation was 20 years (0 to 90). RESULTS In all, 82% of the patients had a poor response to chemotherapy, which was associated with the presence of a predominantly chondroblastic component (more than 50% of tumour volume). The incidence of local recurrence was 15%. Synchronous or metachronous metastasis was diagnosed in 60% of patients. Overall survival was 51% and 42% after five and ten years, respectively. Limb localization and wide surgical margins were associated with a lower risk of local recurrence after multivariable analysis, while the response to chemotherapy was not. Local recurrence, advanced patient age, pelvic tumours, and large volume negatively influenced survival. Resection of pulmonary metastases was associated with a survival benefit in the limited number of patients in whom this was undertaken. CONCLUSION COS demonstrates a poor response to chemotherapy and a high incidence of metastases. Wide resection is associated with improved local control and overall survival, while excision of pulmonary metastases is associated with improved survival in selected patients. Cite this article: Bone Joint J 2019;101-B:739-744.
Collapse
Affiliation(s)
- P Tsagozis
- Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institutet, Stockholm, Sweden.,The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - M K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.,The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - J D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L M Jeys
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - M C Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
27
|
Lex JR, Evans S, Stevenson JD, Parry M, Jeys LM, Grimer RJ. Dedifferentiated chondrosarcoma of the pelvis: clinical outcomes and current treatment. Clin Sarcoma Res 2018; 8:23. [PMID: 30559960 PMCID: PMC6293503 DOI: 10.1186/s13569-018-0110-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
Background Dedifferentiated chondrosarcomas (CS) are a high-grade variant of CS that confers a 5-year survival of around 10–24%. Dedifferentiated CS arising from the pelvis confers an even worse prognosis. Questions (1) What is the prognosis of patients with dedifferentiated CS of the pelvis? (2) Do wide margins or type of surgical intervention influence outcome? (3) Does the use of adjuvant therapy affect outcome? Methods Patients were retrospectively reviewed from a prospectively collated musculoskeletal oncology database from 1995 to 2016. Thirty-one cases of dedifferentiated CS arising from the pelvis were included. Wide margins were defined as greater than 4 mm. The mean age was 55.6 years (range 33 to 76 years) and there were 19 males (61.3%) and 12 females (38.7%). Results The disease presented at a locally or systemically advanced stage in 13 patients (41.9%). Eighteen patients (58.1%) underwent surgery with curative intent. Overall survival at 12 months was 15.4% for patients treated with palliative intent and 50% for those treated with surgery. In the surgical group, there were higher rates of disease-free survival in patients who underwent hindquarter amputation and those who received wide surgical margins (p = 0.047 and p = 0.019, respectively). Those who underwent hindquarter amputation were more likely to achieve wide margins (p = 0.05). Time to recurrent disease (local or systemic) was always less than 24 months. No hindquarter amputation for recurrent disease resulted in disease-free survival. No patient who received adjuvant therapy for palliative or recurrent disease had disease control. Conclusions Pelvic dedifferentiated CS often presents at an advanced local or systemic stage and confers a poor prognosis. Achieving wide surgical margins (> 4 mm) provided the highest rate of long-term disease-free survival. Failing to achieve wide margins results in rapid disease recurrence, conferring deleterious consequences.
Collapse
Affiliation(s)
| | - Scott Evans
- 1Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
| | | | | | - Lee M Jeys
- 1Royal Orthopaedic Hospital, Birmingham, B31 2AP UK.,2Aston University, Birmingham, UK
| | | |
Collapse
|
28
|
Parry MC, Laitinen MK, Albergo JI, Gaston CL, Stevenson JD, Grimer RJ, Jeys LM. Silver-coated (Agluna®) tumour prostheses can be a protective factor against infection in high risk failure patients. Eur J Surg Oncol 2018; 45:704-710. [PMID: 30591310 DOI: 10.1016/j.ejso.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/21/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Endoprostheses in the treatment of extremity sarcomas are associated with late complications including periprosthetic infection. This study analysed the incidence of infection in patients undergoing endoprosthetic replacement (EPR) with a silver-coated prosthesis. MATERIALS AND METHODS The study comprised a retrospective single centre study of 394 consecutive patients treated with resection and EPR for primary extremity bone tumours. RESULTS 89 patients at risk for infection were treated with a silver-coated (Agluna®) EPR (22.6%), compared to 305 patients treated with a non-silver EPR (77.4%). The incidence of periprosthetic infection, requiring revision as the primary endpoint was 34/394 (8.6%); 11 patients (12.4%) in the silver group and 23 patients (7.5%) in the non-silver group (p = 0.154). Overall implant survival was 90.9% and 95.3% at 1-year and 86.8% and 91.8% at 5-years in the silver-coated and non-silver coated group, respectively (p = 0.193). Infection was treated in the silver group by washout of the prosthesis in 2/11, debridement and implant retention (DAIR) in 1/11 and single-stage revision in 1/11, and in the non-silver group by washout in 1/23 or DAIR in 2/23. Two-stage revision was successful in 2/11in the silver group, and in 11/23 in the non-silver group. Amputation was required in 4/11 in the silver group and 9/23 in the non-silver group. One patient in the silver group died due to disease with an infected EPR. CONCLUSIONS Silver-coated prostheses in high risk patients show similar infection free survival as non-silver coated prosthesis in standard sites in primary bone tumours of the extremities.
Collapse
Affiliation(s)
- Michael C Parry
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK.
| | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University General Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Jose I Albergo
- Hospital Italiano Buenos Aires, 4190, Buenos Aires, Argentina
| | - Czar L Gaston
- Department of Orthopaedics, Musculoskeletal Tumor Unit, Philippine General Hospital, Manila, 1000, Philippines
| | - Jonathan D Stevenson
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK
| | - Robert J Grimer
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK
| | - Lee M Jeys
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK
| |
Collapse
|
29
|
Medellin MR, Fujiwara T, Tillman RM, Jeys LM, Gregory J, Stevenson JD, Parry M, Abudu A. Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture. Bone Joint J 2018; 100-B:1626-1632. [PMID: 30499317 DOI: 10.1302/0301-620x.100b12.bjj-2018-0189.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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 curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. CONCLUSION In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.
Collapse
Affiliation(s)
| | - T Fujiwara
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - L M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J D Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - A Abudu
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
30
|
Stevenson JD, Laitinen MK, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of surgical margins in chondrosarcoma. European Journal of Surgical Oncology 2018; 44:1412-1418. [DOI: 10.1016/j.ejso.2018.05.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
|
31
|
Abstract
Aims The purpose of this study was to describe the effect of histological grade on disease-specific survival in patients with chondrosarcoma. Patients and Methods A total of 343 patients with a chondrosarcoma were included. The histological grade was assessed on the initial biopsy and on the resection specimen. Where the histology showed a mixed grade, the highest grade was taken as the definitive grade. When only small focal areas showed higher grade, the final grade was considered as both. Results The concordance between the highest preoperative biopsy grading and the highest final grading of the resection specimen in total was only 43% (146/343). In 102 specimens (30%), a small number of cells or focal areas of higher grade were observed in contrast to the main histology. The disease-specific survival, stratified according to the predominant histological grade, showed greater variation than when stratified according to the highest grade seen in the resection specimen. Conclusion The diagnostic biopsy in chondrosarcoma is unreliable in assessing the definitive grade and the malignant potential of the tumour. When categorizing the grade of the resection specimen, the prognosis for local recurrence and disease-specific survival should be based on the highest grade seen, even when seen in only a few cells. Cite this article: Bone Joint J 2018;100-B:662-6.
Collapse
Affiliation(s)
- M K Laitinen
- Department Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - J D Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - M C Parry
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - V Sumathi
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R J Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L M Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
32
|
Bus MPA, Campanacci DA, Albergo JI, Leithner A, van de Sande MAJ, Gaston CL, Caff G, Mettelsiefen J, Capanna R, Tunn PU, Jeys LM, Dijkstra PDS. Conventional Primary Central Chondrosarcoma of the Pelvis: Prognostic Factors and Outcome of Surgical Treatment in 162 Patients. J Bone Joint Surg Am 2018; 100:316-325. [PMID: 29462035 DOI: 10.2106/jbjs.17.00105] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies focusing on the oncological outcome after treatment of conventional primary central chondrosarcoma of pelvic bone are lacking. We conducted this retrospective study at 5 referral centers to gain insight in the outcome of treatment for this tumor type and to identify risk factors for impaired oncological outcome. METHODS One hundred and sixty-two consecutive patients (118 male patients [73%]) who underwent resection of a conventional primary central chondrosarcoma of pelvic bone from 1985 to 2013 were evaluated. The median age was 51 years (range, 15 to 78 years). The median follow-up was 12.6 years (95% confidence interval [CI], 8.4 to 16.9 years). There were 30 grade-I lesions (19%), 93 grade-II lesions (57%), and 39 grade-III lesions (24%). RESULTS Sixty-two patients (38%) experienced local recurrence: 9 grade-I lesions (30%), 31 grade-II lesions (33%), and 22 grade-III lesions (56%). Forty-eight patients (30%) developed metastases. The risk of disease-related death was 3% for grade-I tumors (1 of 30; this patient had a grade-II recurrence and died of metastases), 33% (31 of 93) for grade-II tumors, and 54% (21 of 39) for grade-III tumors. Identified risk factors for impaired disease-specific survival were tumor grade (grade II: hazard ratio [HR], 20.18; p = 0.003; and grade III: HR, 58.94; p < 0.001), resection margins (marginal: HR, 3.21; p = 0.001; and intralesional: HR, 3.56; p < 0.001), and maximal tumor size (HR, 1.08 per cm; p = 0.026). Deep infection (19% [n = 31]) was the predominant complication. CONCLUSIONS This study offers a standard for survival rates for conventional primary central chondrosarcoma of the pelvis. The survival for grade-I tumors was excellent. Wide resection margins were associated with a significant survival advantage for higher-grade tumors. Because of the inability to reliably distinguish low-grade and high-grade tumors preoperatively, we conclude that any central pelvic chondrosarcoma should be treated with aggressive primary resection with the aim of obtaining wide resection margins. There may be aggressive biologic features in some tumors for which a surgical procedure alone may not be adequate to improve outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michaël P A Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Domenico A Campanacci
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Jose I Albergo
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | | | - Czar Louie Gaston
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - Giuseppe Caff
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Jan Mettelsiefen
- Helios Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | - Rodolfo Capanna
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Per-Ulf Tunn
- Helios Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | - Lee M Jeys
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - P D Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
33
|
van Praag VM, Rueten-Budde AJ, Jeys LM, Laitinen MK, Pollock R, Aston W, van der Hage JA, Dijkstra PS, Ferguson PC, Griffin AM, Willeumier JJ, Wunder JS, van de Sande MA, Fiocco M. A prediction model for treatment decisions in high-grade extremity soft-tissue sarcomas: Personalised sarcoma care (PERSARC). Eur J Cancer 2017; 83:313-323. [DOI: 10.1016/j.ejca.2017.06.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022]
|
34
|
Laitinen MK, Parry MC, Albergo JI, Umathi VS, Jeys LM, Grimer RJ. Resection of the ilium in patients with a sarcoma: should the pelvic ring be reconstructed? Bone Joint J 2017; 99-B:538-543. [PMID: 28385945 DOI: 10.1302/0301-620x.99b4.bjj-2016-0147.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/18/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the study was to investigate the controversial issue of whether the pelvic ring should be reconstructed following resection of the sarcomas of the ilium. PATIENTS AND METHODS From our database, we identified 64 patients who underwent excision of a tumour involving the ilium between 1976 and 2015. A total of 35 underwent complete resection, of whom 24 were reconstructed with a non-vascularised fibula graft, and four with extracorporeal irradiation and reimplantation. A total of 29 patients had a partial resection. The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes were assessed using the Toronto Extremity Salvation Score (TESS) at final follow-up. In all, 32 patients (50%) had a chondrosarcoma. RESULTS The mean TESS for all patients was 71.6% (17% to 100%). The mean TESS for those who underwent total resection with reconstruction was 72.0% (17% to 100%) and without reconstruction it was 53.3% (20% to 90%) and for those who underwent partial resection it was 76.3% (31.3% to 100%). The rate of local recurrence was 42.2% and this was more common in those treated by partial resection (p = 0.048). The risk of local recurrence was related to the margin achieved at resection. CONCLUSIONS Given the high rate of local recurrence following excision of a tumour from the ilium, obtaining wide surgical margins should be a priority even if this requires more aggressive surgery. In young patients, where late recurrence may occur, more radical complete resection should be considered. When total resection of the ilium is considered, reconstruction should also be considered as it confers a higher functional outcome than total resection without reconstruction. Cite this article: Bone Joint J 2017;99-B:538-43.
Collapse
Affiliation(s)
- M K Laitinen
- Tampere University Hospital, Unit of Musculoskeletal Surgery, 33521 Tampere, Finland
| | - M C Parry
- Royal Orthopaedic Hospital NHS Foundation, Birmingham, B31 2AP, UK
| | - J I Albergo
- Hospital Italiano Buenos Aires, 4190 Buenos Aires, Argentina
| | - V S Umathi
- Royal Orthopaedic Hospital NHS Foundation, Birmingham, B31 2AP, UK
| | - L M Jeys
- Royal Orthopaedic Hospital NHS Foundation, Birmingham, B31 2AP, UK
| | - R J Grimer
- Royal Orthopaedic Hospital NHS Foundation, Birmingham, B31 2AP, UK
| |
Collapse
|
35
|
Albergo JI, Gaston CL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL, Jeys LM, Carter SR, Tillman RM, Abudu AT, Grimer RJ. Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar? Clin Orthop Relat Res 2017; 475:676-682. [PMID: 27103142 PMCID: PMC5289179 DOI: 10.1007/s11999-016-4843-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The proximal tibia is one of the most challenging anatomic sites for extremity reconstructions after bone tumor resection. Because bone tumors are rare and large case series of reconstructions of the proximal tibia are lacking, we undertook this study to compare two major reconstructive approaches at two large sarcoma centers. QUESTIONS/PURPOSES The purpose of this study was to compare groups of patients treated with endoprosthetic replacement or osteoarticular allograft reconstruction for proximal tibia bone tumors in terms of (1) limb salvage reconstruction failures and risk of amputation of the limb; (2) causes of failure; and (3) functional results. METHODS Between 1990 and 2012, two oncologic centers treated 385 patients with proximal tibial resections and reconstruction. During that time, the general indications for those types of reconstruction were proximal tibia malignant tumors or bone destruction with articular surface damage or collapse. Patients who matched the inclusion criteria (age between 15 and 60 years old, diagnosis of a primary bone tumor of the proximal tibia treated with limb salvage surgery and reconstructed with endoprosthetic replacement or osteoarticular allograft) were included for analysis (n = 149). In those groups (endoprosthetic or allograft), of the patients not known to have reached an endpoint (death, reconstructive failure, or limb loss) before 2 years, 85% (88 of 104) and 100% (45 of 45) were available for followup at a minimum of 2 years. A total of 88 patients were included in the endoprosthetic group and 45 patients in the osteoarticular allograft group. Followup was at a mean of 9.5 (SD 6.72) years (range, 2-24 years) for patients with endoprosthetic reconstructions, and 7.4 (SD 5.94) years for patients treated with allografts (range, 2-21 years). The following variables were compared: limb salvage reconstruction failure rates, risk of limb amputation, type of failures according to the Henderson et al. classification, and functional results assessed by the Musculoskeletal Tumor Society system. RESULTS With the numbers available, after competitive risk analysis, the probability of failure for endoprosthetic replacement of the proximal tibia was 18% (95% confidence interval [CI], 10.75-27.46) at 5 years and 44% (95% CI, 31.67-55.62) at 10 years and for osteoarticular allograft reconstruction was 27% (95% CI, 14.73-40.16) at 5 years and 32% (95% CI, 18.65-46.18) at 10 years. There were no differences in terms of risk of failures at 5 years (p = 0.26) or 10 years (p = 0.20) between the two groups. Fifty-one of 88 patients (58%) with proximal tibia endoprostheses developed a reconstruction failure with mechanical causes being the most prevalent (32 of 51 patients [63%]). A total of 19 of 45 osteoarticular allograft reconstructions failed (42%) and nine of 19 (47%) of them were caused by early infection. Ten-year risk of amputation after failure for endoprosthetic reconstruction was 10% (95% CI, 5.13-18.12) and 11% (95% CI, 4.01-22.28) for osteoarticular allograft with no difference between the groups (p = 0.91). With the numbers available, there were no differences between the groups in terms of the mean Musculoskeletal Tumor Society score (26.58, SD 2.99, range, 19-30 versus 27.52, SD 1.91, range, 22-30; p = 0.13; 95% CI, -2,3 to 0.32). Mean extension lag was more severe in the endoprosthetic group than the osteoarticular allograft group: 13.56° (SD 18.73; range, 0°-80°) versus 2.41° (SD 5.76; range, 0°-30°; p < 0.001; 95% CI, 5.8-16.4). CONCLUSIONS Reconstruction of the proximal tibia with either endoprosthetic replacement or osteoarticular allograft appears to offer similar reconstruction failures rates. The primary cause of failure for allograft was infection and for endoprosthesis was mechanical complications. We believe that the treating surgeon should have both options available for treatment of patients with malignant or aggressive tumors of the proximal tibia. (S)he might consider an allograft in a younger patient to achieve better extensor mechanism function, whereas in an older patient or one with a poorer prognosis where return to function and ambulation quickly is desired, an endoprosthesis may be advantageous. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Jose I. Albergo
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina
| | - Czar L. Gaston
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luis A. Aponte-Tinao
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina
| | - Miguel A. Ayerza
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina
| | - D. Luis Muscolo
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina
| | - Germán L. Farfalli
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina
| | - Lee M. Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Simon R. Carter
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | | |
Collapse
|
36
|
Willeumier JJ, Rueten-Budde AJ, Jeys LM, Laitinen M, Pollock R, Aston W, Dijkstra PDS, Ferguson PC, Griffin AM, Wunder JS, Fiocco M, van de Sande MAJ. Individualised risk assessment for local recurrence and distant metastases in a retrospective transatlantic cohort of 687 patients with high-grade soft tissue sarcomas of the extremities: a multistate model. BMJ Open 2017; 7:e012930. [PMID: 28196946 PMCID: PMC5318556 DOI: 10.1136/bmjopen-2016-012930] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study investigates the effect of surgical margins and radiotherapy, in the presence of individual baseline characteristics, on survival in a large population of high-grade soft tissue sarcoma of the extremities using a multistate model. DESIGN A retrospective multicentre cohort study. SETTING 4 tertiary referral centres for orthopaedic oncology. PARTICIPANTS 687 patients with primary, non-disseminated, high-grade sarcoma only, receiving surgical treatment with curative intent between 2000 and 2010 were included. MAIN OUTCOME MEASURES The risk to progress from 'alive without disease' (ANED) after surgery to 'local recurrence' (LR) or 'distant metastasis (DM)/death'. The effect of surgical margins and (neo)adjuvant radiotherapy on LR and overall survival was evaluated taking patients' and tumour characteristics into account. RESULTS The multistate model underlined that wide surgical margins and the use of neoadjuvant radiotherapy decreased the risk of LR but have little effect on survival. The main prognostic risk factors for transition ANED to LR are tumour size (HR 1.06; 95% CI 1.01 to 1.11 (size in cm)) and (neo)adjuvant radiotherapy. The HRs for patients treated with adjuvant or no radiotherapy compared with neoadjuvant radiotherapy are equal to 4.36 (95% CI 1.34 to 14.24) and 14.20 (95% CI 4.14 to 48.75), respectively. Surgical resection margins had a protective effect for the occurrence of LR with HRs equal to 0.61 (95% CI 0.33 to 1.12), and 0.16 (95% CI 0.07 to 0.41) for margins between 0 and 2 mm and wider than 2 mm, respectively. For transition ANED to distant metastases/Death, age (HR 1.64 (95% CI 0.95 to 2.85) and 1.90 (95% CI 1.09 to 3.29) for 25-50 years and >50 years, respectively) and tumour size (1.06 (95% CI 1.04 to 1.08)) were prognostic factors. CONCLUSIONS This paper underlined the alternating effect of surgical margins and the use of neoadjuvant radiotherapy on oncological outcomes between patients with different baseline characteristics. The multistate model incorporates this essential information of a specific patient's history, tumour characteristics and adjuvant treatment modalities and allows a more comprehensive prediction of future events.
Collapse
Affiliation(s)
- Julie J Willeumier
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lee M Jeys
- Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Minna Laitinen
- Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rob Pollock
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Aston
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - P D Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Anthony M Griffin
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Marta Fiocco
- Mathematical Institute, Leiden University, Leiden, The Netherlands
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
37
|
Albergo JI, Gaston CL, Jeys LM, Khajuria A, Carter SR, Tillman RM, Abudu AT, Grimer RJ. Management and prognostic significance of pathological fractures through chondrosarcoma of the femur. Int Orthop 2015; 39:943-6. [PMID: 25711397 DOI: 10.1007/s00264-015-2706-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the study was to report overall survival, local recurrence and development of metastasis in a group of patients with femur chondrosarcoma that presented with or without a pathological fracture. METHODS A retrospective review was performed, and 182 patients (39 pathological fractures) that had been treated by oncologic surgery for femoral chondrosarcoma were included. The mean age of the series was 50 years (range, eight to 90) and 114 patients were male (63%). Mean follow-up was 113 months (range, three to 216). Cancer-specific overall survival, development of metastasis and local recurrence were analysed, grouping patients by grade (grade I / grade 2-3 / dedifferentiated). RESULTS Disease-specific survival in the entire group of chondrosarcoma of the femur was 69% (CI95% 63-76) at 5 years. Five-year disease-specific survival in the fracture group was 49% lower than in the control group 75% (p = 0.0001). Survival of patients with grade 1 chondrosarcoma with fracture was significantly less than those without fracture (p = 0.02) but there was no difference in those with grade 2-3 (p = 0.49) and dedifferentiated tumours (p = 0.09). The local recurrence rate of the entire series was 27%. Only dedifferentiated chondrosarcomas with an associated pathological fracture had a significantly higher rate of local recurrence. There was no relationship between development of metastases and fracture. CONCLUSION A pathological fracture of the femur has a negative prognostic influence in grade 1 chondrosarcoma and increases the risk of local recurrence in dedifferentiated femur chondrosarcomas.
Collapse
Affiliation(s)
- Jose I Albergo
- Hospital Italiano de Buenos Aires, Peron 1190 (c1199abd), Buenos Aires, Argentina,
| | | | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Hwang N, Nandra R, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Massive endoprosthetic replacement for bone metastases resulting from renal cell carcinoma: factors influencing patient survival. Eur J Surg Oncol 2013; 40:429-34. [PMID: 24063967 DOI: 10.1016/j.ejso.2013.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/23/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgery remains the main treatment of bone metastases due to renal cell carcinoma (RCC). We reviewed 135 patients treated with resection and endoprosthetic replacement (EPR) and examined clinico-pathological factors predicting survival. METHODS Surgical and oncological outcomes were examined using a prospectively maintained database between 1976 and 2012. Survival rates were calculated by Kaplan-Meier method. Multivariate analyses were performed to investigate factors predictive of increased survival. RESULTS At diagnosis, 81 patients had synchronous RCC and bone metastases and the remaining developed metachronous metastases after primary treatment for RCC. The majority were solitary tumours (75%) and 77% had ≥ one concurrent visceral metastases. The median age at surgery was 61 years old (IQR 53-69). The median follow-up was 20 months (IQR 10-43) and the overall survival was 72% at one-year. This declined to 45% and 28% at three and five-years, respectively. After adjustments for prognostic factors, there was an increased risk of death in patients with multiple skeletal metastases (HR = 2), ≥one visceral metastases (HR = 3) and local recurrence (HR = 3) (all p ≤ 0.01). Ten patients required revision (7%) and the risk of revision was 4% at one-year and remained low at 8% from two years postoperatively. CONCLUSION Patients with solitary bone lesions and no visceral metastases should be considered for bone resection and EPR. As survival beyond one-year can be expected in a majority of patients and the risk of further surgery after EPR is low, patients with multiple skeletal metastases and visceral metastases should also be considered.
Collapse
Affiliation(s)
- N Hwang
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
| | - R Nandra
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - R J Grimer
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - S R Carter
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - R M Tillman
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - A Abudu
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - L M Jeys
- Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| |
Collapse
|
40
|
Albergo JI, Gaston CLL, Davies M, Abudu AT, Carter SR, Jeys LM, Tillman RM, Grimer RJ. Hoffa's fat pad tumours: what do we know about them? Int Orthop 2013; 37:2225-9. [PMID: 24000088 DOI: 10.1007/s00264-013-2041-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We report on a group of patients with tumours in the Hoffa's fat pad (HFP), their clinical presentation, histological type and treatment, including two synovial sarcomas with their clinical follow-up, which have not been described previously in the literature. METHODS We performed a retrospective review of our prospectively collected database of 25 cases of HFP tumours with at least six months follow-up. RESULTS The gender, age at presentation (over and under 16 years of age), clinical features, history of trauma, treatment chosen, and complications were recorded. The mean age of the patients was 32 years (three to 47). Six patients were under 16 years old. Pain was the most common symptom, present in 92% (n = 23/25). The final diagnoses included 23 (92%) benign tumours and two (8%) malignant tumours. The most common benign tumour was pigmented villonodular synovitis (PVNS) (48% n = 12). The two malignant tumours were synovial sarcomas and both presented in patients under 16 years old. CONCLUSIONS Hoffa's fat pad tumours are an uncommon and rarely diagnosed group of lesions that can be misinterpreted as any knee pathology. Although the majority of HFP tumours are benign, malignant tumours should be considered in the differential diagnosis for the paediatric population.
Collapse
Affiliation(s)
- Jose I Albergo
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, B31 2AP, UK
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Hwang N, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Early results of a non-invasive extendible prosthesis for limb-salvage surgery in children with bone tumours. ACTA ACUST UNITED AC 2012; 94:265-9. [PMID: 22323698 DOI: 10.1302/0301-620x.94b2.27536] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We reviewed our initial seven-year experience with a non-invasive extendible prosthesis in 34 children with primary bone tumours. The distal femur was replaced in 25 cases, total femur in five, proximal femur in one and proximal tibia in three. The mean follow-up was 44 months (15 to 86) and 27 patients (79%) remain alive. The prostheses were lengthened by an electromagnetic induction mechanism in an outpatient setting and a mean extension of 32 mm (4 to 80) was achieved without anaesthesia. There were lengthening complications in two children: failed lengthening in one and the formation of scar tissue in the other. Deep infection developed in six patients (18%) and local recurrence in three. A total of 11 patients required further surgery to the leg. Amputation was necessary in five patients (20%) and a two-stage revision in another. There were no cases of loosening, but two patients had implant breakage and required revision. The mean Musculoskeletal Tumor Society functional score was 85% (60% to 100%) at last known follow-up. These early results demonstrate that the non-invasive extendible prosthesis allows successful lengthening without surgical intervention, but the high incidence of infection is a cause for concern.
Collapse
Affiliation(s)
- N Hwang
- University Hospital Coventry Warwickshire, Clifford Bridge Road, Coventry, Warwickshire CV2 2DX, UK.
| | | | | | | | | | | |
Collapse
|
42
|
Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM, Cheung WGH, Sharma R. Pathological fracture of the proximal femur in osteosarcoma: need for early radical surgery? ISRN Oncol 2012; 2012:512389. [PMID: 22523706 PMCID: PMC3317026 DOI: 10.5402/2012/512389] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/11/2012] [Indexed: 11/23/2022]
Abstract
Seventeen patients underwent treatment for a pathological fracture of the proximal femur due to osteosarcoma. Their age range was from 9 to 84 (mean age 42) with nine patients under the age of 40 and eight above the age of 40. Twelve patients had a fracture at diagnosis and five developed a fracture after the diagnosis. Seven patients had metastatic disease at diagnosis. Five patients were referred after internal fixation of the fracture prior to diagnosis. Chemotherapy was used when appropriate and eight patients then underwent limb salvage surgery, six had an amputation, and three had palliative treatment. The estimated five-year survival was 14%. These results are significantly worse than expected, and it proved impossible to identify any group who fared well. The high incidence of metastases both at diagnosis and subsequently suggests this group of patients are at very high risk. Review of multicentre data may suggest an optimum treatment for this patient group.
Collapse
Affiliation(s)
- C R Chandrasekar
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Prescot Street, Liverpool L7 8XP, UK
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Pakos EE, Nearchou AD, Grimer RJ, Koumoullis HD, Abudu A, Bramer JAM, Jeys LM, Franchi A, Scoccianti G, Campanacci D, Capanna R, Aparicio J, Tabone MD, Holzer G, Abdolvahab F, Funovics P, Dominkus M, Ilhan I, Berrak SG, Patino-Garcia A, Sierrasesumaga L, San-Julian M, Garraus M, Petrilli AS, Filho RJG, Macedo CRPD, Alves MTDS, Seiwerth S, Nagarajan R, Cripe TP, Ioannidis JPA. Prognostic factors and outcomes for osteosarcoma: an international collaboration. Eur J Cancer 2009; 45:2367-75. [PMID: 19349163 DOI: 10.1016/j.ejca.2009.03.005] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/09/2009] [Indexed: 11/30/2022]
Abstract
We aimed to evaluate the prognostic significance of traditional clinical predictors in osteosarcoma through an international collaboration of 10 teams of investigators (2680 patients) who participated. In multivariate models the mortality risk increased with older age, presence of metastatic disease at diagnosis, development of local recurrence when the patient was first seen, use of amputation instead of limb salvage/wide resection, employment of unusual treatments, use of chemotherapeutic regimens other than anthracycline and platinum and use of methotrexate. It was also influenced by the site of the tumour. The risk of metastasis increased when metastatic disease was present at the time the patient was first seen and also increased with use of amputation or unusual treatment combinations or chemotherapy regimens not including anthracycline and platinum. Local recurrence risk was higher in older patients, in those who had local recurrence when first seen and when no anthracycline and platinum were used in chemotherapy. Results were similar when limited to patients seen after 1990 and treated with surgery plus combination chemotherapy. This large-scale international collaboration identifies strong predictors of major clinical outcomes in osteosarcoma.
Collapse
Affiliation(s)
- Emilios E Pakos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am 2008; 90:1265-71. [PMID: 18519320 DOI: 10.2106/jbjs.f.01324] [Citation(s) in RCA: 186] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Excision of a bone tumor requires reconstruction if limb salvage is a priority. Reconstruction with an endoprosthetic implant is preferred in our unit, as the patient typically can return rapidly to full weight-bearing and functional activities. Long-term complications, such as deep infection, aseptic loosening, and mechanical failure of the implants, have led to concerns about the efficacy of reconstruction and the ability to revise failed implants while maintaining limb salvage in the longer term. The purpose of this study was to investigate the survival of endoprosthetic reconstructions in the medium to long term in order to determine the factors associated with their failure. METHODS A consecutive series of 776 patients underwent endoprosthetic reconstruction following resection of a bone tumor at a minimum of ten years prior to this investigation. One hundred and nine children with a so-called growing endoprosthesis were excluded as they often require revision to an adult prosthesis near skeletal maturity. Six patients were excluded because of a lack of adequate follow-up data, leaving 661 patients for analysis. Kaplan-Meier survival analysis of the implant was performed, with implant revision for any cause (infection, local recurrence, and mechanical failure), mechanical failure alone, and amputation used as the end points. RESULTS The mean duration of follow-up was fifteen years for patients who survived the original disease. Two hundred and twenty-seven patients (34%) had revision surgery because of mechanical failure (116 patients), infection (seventy-five patients), and locally recurrent disease (thirty-six patients). Implant survival at ten years was 75% with mechanical failure as the end point and 58% with failure from any cause as the end point. The limb salvage rate was 84% at twenty years. CONCLUSIONS We believe these medium to long-term results with first-generation endoprostheses are encouraging and justify the continued use of endoprostheses for reconstruction following the excision of a bone tumor.
Collapse
Affiliation(s)
- L M Jeys
- Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP, United Kingdom.
| | | | | | | | | | | |
Collapse
|
45
|
Jeys LM, Grimer RJ, Carter SR, Tillman RM, Abudu A. Post Operative Infection and Increased Survival in Osteosarcoma Patients: Are They Associated? Ann Surg Oncol 2007; 14:2887-95. [PMID: 17653803 DOI: 10.1245/s10434-007-9483-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 05/11/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite neo-adjuvant chemotherapy osteosarcomas having significant mortality, recent studies have shown survival advantages following infections for some tumour types. This study investigates the effect of post-operative infection in patients treated for osteosarcoma using endoprosthetic replacement and neo-adjuvant chemotherapy. MATERIAL AND METHODS A consecutive series of 547 patients underwent surgery between 1981 and 2001 for osteosarcoma. Patients were excluded from the study if over 60 years old at diagnosis (n = 14) as they would not routinely receive chemotherapy. Studies showed that 70% of deep infections occur within one year from reconstruction. Therefore landmark analysis was performed; all patients infected after 12 months of reconstruction were excluded (15 patients, 2.7%) and those who died within 12 months from diagnosis due to metastases were excluded (105 patients, 19.2%), leaving 412 patients. Any survival advantage of early infection was analysed by Kaplan-Meier survival analysis from this landmark point. RESULTS Overall population survival was 65% at 10 years after landmarking. There were 41 patients (10%) who developed an infection within one year of implantation. These patients had significantly better survival (p = 0.017). The 10-year survival for patients with osteosarcoma with infection was 84.5% compared to 62.3% in the non-infected group after landmarking. There was no significant difference in the percentage post-chemotherapy specimen necrosis between the two groups (p = 0.36). Infection was an independent prognostic factor on cox regression analysis. CONCLUSIONS There was evidence for increased survival after deep post-operative infection in osteosarcoma patients, in keeping with other research. The authors feel this warrants further investigation.
Collapse
Affiliation(s)
- L M Jeys
- Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP, United Kingdom.
| | | | | | | | | |
Collapse
|
46
|
Jeys LM, Suneja R, Chami G, Grimer RJ, Carter SR, Tillman RM. Impending fractures in giant cell tumours of the distal femur: incidence and outcome. Int Orthop 2006; 30:135-8. [PMID: 16474936 PMCID: PMC2532068 DOI: 10.1007/s00264-005-0061-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 11/18/2005] [Indexed: 10/25/2022]
Abstract
Giant cell tumours are rare bone tumours that are characteristically benign but locally aggressive, most frequently occurring in the distal femur with pathological fractures being common. This paper investigates relationships between tumour size and cortical breach on initial X-rays and subsequent treatment. The X-rays of 54 patients with distal femoral giant cell tumours were reviewed. The volumes of the tumour, distal femur and a ratio between the two parameters were estimated. The presence of a cortical breach, discrete fracture and Campanacci grade was recorded. X-rays revealed intact cortical rim in 20 patients (37%), cortical breach in 22 patients (41%) and discrete fracture in 12 patients (22%). There was a significant difference in the ratio of tumour volume to distal femoral volume between the discrete fracture group and the cortical breach group. No significant differences in rates of local recurrence were demonstrated. Extended curettage was effective for intact and cortical breach groups; however, patients in the fracture group often required radical treatment.
Collapse
Affiliation(s)
- L M Jeys
- Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Prosthetic replacement following excision of a bone tumor can be complicated by infection because patients who undergo surgery for a neoplastic condition often are subjected to extensive soft-tissue dissection and long operating times and are immunosuppressed. The aim of this study was to investigate the rate of periprosthetic infection, identify possible predisposing factors, and assess treatment efficacy in such patients. METHODS Prosthetic reconstruction was performed in 1264 patients over a thirty-seven-year period in a single hospital by four surgeons. Twenty-four patients were excluded because of incomplete follow-up, leaving 1240 patients who had been followed for a mean of 5.8 years. Infection was identified in 136 patients (11.0%). The management and outcome of the infections in all of these patients were analyzed. RESULTS Coagulase-negative Staphylococcus was the most common organism isolated. Two-stage revision successfully treated the infection in 72% (forty-two) of the fifty-eight patients in whom it was performed. Local surgical debridement with or without antibiotic implants was successful in only 6% (four) of sixty-eight patients. Amputation to treat the infection was performed in fifty (37%) of the 136 patients. The factors that were associated with a significant risk of infection (p <or= 0.05) included tibial and pelvic prosthetic replacements, radiation therapy, and the use of a pediatric expandable prosthesis. CONCLUSIONS Patients treated with an orthopaedic procedure for an oncological condition have high infection rates. The treatment of infection in these patients is arduous and lengthy, with a substantial risk of amputation.
Collapse
Affiliation(s)
- L M Jeys
- Waterstones House, 31a Green Abbey, Hade Edge, Holmfirth, West Yorkshire HD9 2SH, United Kingdom.
| | | | | | | |
Collapse
|
48
|
Jeys LM, Grimer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 2003; 27:160-3. [PMID: 12799759 PMCID: PMC3458454 DOI: 10.1007/s00264-003-0429-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2003] [Indexed: 10/25/2022]
Abstract
Endoprosthetic replacements are commonly used for limb salvage following surgical excision of bone tumours. Advantages include initial reliability, rapid restoration of function and their ready availability. Potential long-term problems include loosening, infection and mechanical failure. Increasing problems may lead to the necessity for amputation; this paper assesses that risk. A total of 1,261 patients have undergone endoprosthetic replacements in our centre in the past 34 years, with a total of 6,507 patient years of follow up. A total of 112 patients have had subsequent amputation. The reasons for amputation were local recurrence in 71, infection in 38, mechanical failure in two and chronic pain in one. The proximal tibia had the greatest risk of amputation (n=38/245). The time to amputation varied from 2 days to 16 years, with a mean of 31 months. The risk of amputation decreased with time, although 10% took place after more than 5 years.
Collapse
Affiliation(s)
- L M Jeys
- Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP United Kingdom.
| | | | | | | |
Collapse
|
49
|
|
50
|
Abstract
BACKGROUND Off road mountain biking is now an extremely popular recreation and a potent cause of serious injury. AIM To establish the morbidity associated with this sport. METHODS Data were collected prospectively over one year on all patients presenting with an injury caused by either recreational or competitive off road mountain biking. RESULTS Eighty four patients were identified, 70 males and 14 females, with a mean age of 22.5 years (range 8-71). Most accidents occurred during the summer months, most commonly in August. Each patient had an average of 1.6 injuries (n = 133) and these were divided into 15 categories, ranging from minor soft tissue to potentially life threatening. Operative intervention was indicated for 19 patients (23%) and several required multiple procedures. The commonest injuries were clavicle fractures (13%), shoulder injuries (12%), and distal radial fractures (11%). However, of a more sinister nature, one patient had a C2/3 dislocation requiring urgent stabilisation, one required a chest drain for a haemopneumothorax, and another required an emergency and life saving nephrectomy. CONCLUSION This sport has recently experienced an explosion in popularity, and, as it carries a significant risk of potentially life threatening injury across all levels of participation, the use of protective equipment to reduce this significant morbidity may be advisable.
Collapse
Affiliation(s)
- L M Jeys
- Trauma Unit, Orthopaedic Surgery Department, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, UK.
| | | | | | | |
Collapse
|