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Levanon E, Merose O, Segal O, Dadia S, Sternheim A, Levin D, Sher O, Gortzak Y. Does cryotherapy decrease the local recurrence rate in the treatment of an aneurysmal bone cyst? A comparative assessment. J Orthop Res 2024; 42:1369-1375. [PMID: 38146068 DOI: 10.1002/jor.25775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
Curettage with or without the use of adjuvants is the standard of care in the treatment of an aneurysmal bone cyst (ABC). Historically, our approach combined curettage, high-speed burr drilling, and cryoablation. However, treatments varied based on age, tumor location, and surgeon preference. We asked: (1) Does cryoablation in addition to curettage and burr drilling decrease the local recurrence rates? (2) Are there any risk factors for the local recurrence rate? (3) Does cryoablation improve postsurgical functional outcomes in these patients? Patients treated for an ABC, between January 2006 and December 2019 were included in this retrospective analysis. Patient and surgical characteristics, such as age, gender, tumor location, type of treatment, time of follow-up, recurrence rate, and functional outcome measured by the Musculoskeletal Tumor Society Score 1993 (MSTS93) score were compared between those treated with and without cryoablation. Both groups, without cryoablation (n = 88) and with cryoablation (n = 42), showed no significant difference in local recurrence rates (9.1% vs. 7.1%, p = 0.553) and functional outcomes as measured by the MSTS93 score (28.9 vs. 27.8, p = 0.262). Risk factors analyzed did not significantly affect local recurrence risk, except for secondary ABC diagnosis (p = 0.017). The cryoablation group had a more extended follow-up (45.6 vs. 73.2 months, p < 0.001), reflecting a shift in practice over time. We found no significant difference in local recurrence rate or functional outcome in patients treated with or without cryoablation. Formal curettage with additional high-speed burr drilling provides effective tumor control and favorable functional outcomes, negating the need for adjuvant cryoablation.
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Affiliation(s)
- Eran Levanon
- Faculty of Health Sciences, Goldman School of Medicine, Ben Gurion University, Beer Sheva, Israel
| | - Omri Merose
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Sternheim
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Levin
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Osnat Sher
- Bone and Soft Tissue Pathology, Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Pediatric Orthopedic Oncology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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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.
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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
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Merose O, Factor S, Gortzak Y, Dadia S, Segal O, Vituri A, Bussiba A, Sternheim A. Mechanical failure of distal femur mega prosthesis due to polyaryl-ether-ether-ketone (PEEK) hinge component. Arch Orthop Trauma Surg 2024; 144:2067-2076. [PMID: 38642161 PMCID: PMC11093828 DOI: 10.1007/s00402-024-05306-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Polyaryl-ether-ether-ketone (PEEK) has gained popularity as a substrate for orthopaedic hardware due to its desirable properties such as heat and deformation resistance, low weight, and ease of manufacturing. However, we observed a relatively high failure rate of PEEK-based hinges in a distal femur reconstruction system. In this study, we aimed to evaluate the proportion of patients who experienced implant failure, analyse the mechanism of failure, and document the associated clinical findings. METHODS We conducted a retrospective cohort study, reviewing the medical charts of 56 patients who underwent distal femur resection and reconstruction with a PEEK Optima hinge-based prosthesis between 2004 and 2018. Concurrently, we performed a clinical and biomechanical failure analysis. RESULTS PEEK component failure occurred in 21 out of 56 patients (37.5%), with a mean time to failure of 63.2 months (range: 13-144 months, SD: 37.9). The survival distributions of PEEK hinges for males and females were significantly different (chi-square test, p-value = 0.005). Patient weight was also significantly associated with the hazard of failure (Wald's test statistic, p-value = 0.031). DISCUSSION Our findings suggest that PEEK hinge failure in a distal femur reconstruction system is correlated with patient weight and male gender. Retrieval analysis revealed that failure was related to fretting and microscopic fractures due to cyclic loading, leading to instability and mechanical failure of the PEEK component in full extension. Further assessment of PEEK-based weight bearing articulating components against metal is warranted.
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Affiliation(s)
- Omri Merose
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yair Gortzak
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Vituri
- Tel Aviv University Center for AI and Data Science (TAD), Tel Aviv, Israel
| | - Arie Bussiba
- Department of Materials Engineering, Ben Gurion of the Negev, P.O.Box 653, Beer Sheva, Israel
| | - Amir Sternheim
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Segal O, Benady A, Pickholz E, Ovadia JE, Druckmann I, Dadia S, Rath E, Albagli A, Efrima B. MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases. BMC Musculoskelet Disord 2023; 24:969. [PMID: 38102608 PMCID: PMC10722811 DOI: 10.1186/s12891-023-07074-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. METHODS In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. RESULTS All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. CONCLUSION These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
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Affiliation(s)
- Ortal Segal
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliana Pickholz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Shaylor R, Golden E, Verenkin V, Kolodii M, Peer M, Dadia S, Matot I, Cohen B. Virtual reality and 3D printing in clinical anesthesia: a case series of two years' experience in a single tertiary medical centre. Can J Anaesth 2023; 70:1433-1440. [PMID: 37498441 DOI: 10.1007/s12630-023-02530-2] [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: 10/19/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE Anatomically correct patient-specific models made from medical imaging can be printed on a three-dimensional (3D) printer or turned into a virtual reality (VR) program. Until recently, use in anesthesia has been limited. In 2019, the anesthesia department at Tel Aviv Medical Center launched a 3D program with the aim of using 3D modelling to assist in preoperative anesthesia planning. METHODS A retrospective review of all relevant patients between July 2019 and June 2021 referred for preoperative airway planning with 3D modelling. Patient files were reviewed for correlation between the model-based airway plan and the actual airway plan, the type of model used, and any anesthetic complications related to airway management. RESULTS Twenty patients were referred for 3D modelling. Of these, 15 models were printed, including 12 children requiring one lung ventilation. Five patients had VR reconstructions, including three with mediastinal masses. One patient had both a 3D-printed model and a VR reconstruction. There were two cases (10%) where the model plan did not correlate with the final airway plan and one case where a model could not be created because of poor underlying imaging. For the remaining 17 cases, the plan devised on the model matched the final airway plan. There were no anesthetic complications. CONCLUSIONS Three-dimensional modelling and subsequent printing or VR reconstruction are feasible in clinical anesthesia. Its routine use for patients with challenging airway anatomy correlated well with the final clinical outcome in most cases. High-quality imaging is essential.
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Affiliation(s)
- Ruth Shaylor
- Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
| | - Eran Golden
- Levin Center for Surgical Innovation and 3D Printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Vladimir Verenkin
- Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Marina Kolodii
- Department of Thoracic Surgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Michael Peer
- Department of Thoracic Surgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Levin Center for Surgical Innovation and 3D Printing, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Idit Matot
- Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Barak Cohen
- Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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Gurel R, Shehadeh K, Elbaz E, Benady A, Factor S, Ashkenazi I, Gortzak Y, Sternheim A, Dadia S, Segal O. Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the upper extremity: A series of 19 cases. J Orthop Surg (Hong Kong) 2023; 31:10225536231217123. [PMID: 37976541 DOI: 10.1177/10225536231217123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The surgical treatment for osteoid osteoma (OO) in the upper extremity is challenging due to the difficulty in locating the lesion and the crowding of sensitive structures within the anatomy. This study aimed to describe the outcomes of navigated minimally invasive radiofrequency ablation and those of navigated mini open-intralesional curettage in treating these lesions. Nineteen consecutive patients with OO in the upper limb who underwent navigated surgery were included. The average QuickDASH and Numeric Pain Rating Scale improved from 62.2 ± 23.7 to 11.7 ± 16.9 and from 8.1 ± 1.6 to 0.5 ± 1.8, respectively (p < .01 each) following the procedure. Two complications were recorded: one patient had persistent radial nerve palsy, and one patient had transient partial radial nerve weakness. In conclusion, navigation is an important tool in the surgical treatment of OO in the upper limb. A mini open approach to identify and protect neurovascular structures is recommended.
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Affiliation(s)
- Ron Gurel
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Kathrine Shehadeh
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Itay Ashkenazi
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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7
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Efrima B, Benady A, E Ovadia J, Albagli A, Rath E, Dadia S, Gortzak Y, Sternheim A, Merose O, Segal O. Favorable outcomes of navigated percutaneous ablation and cementoplasty of bone metastasis in the extremities and pelvis-a case series of 13 cases. J Orthop Surg (Hong Kong) 2023; 31:10225536231171046. [PMID: 37222680 DOI: 10.1177/10225536231171046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES Palliative treatment options for bone metastasis are limited, especially in cases where standard protocols have already failed. The purpose of this study was to evaluate the efficacy and safety of percutaneous ablation, either by cryoablation or radiofrequency, combined with percutaneous cementoplasty using cone-beam guided navigation. The objective was to relieve symptoms and improve functionality in patients suffering from pain secondary to bone metastases, as well as evaluate local disease progression post ablation. METHODS We conducted a retrospective study of 13 patients (average age 63.6 ± 9.8, nine females) with symptomatic skeletal metastases treated using 3D imaging with navigation and followed for at least 12 months. The treatment protocol was implemented either after failure of first line treatment, or as first line when mechanical instability was present. Percutaneous lesion ablation was performed along with percutaneous cementation. RESULTS In this study, we observed a statistically significant decrease in pain. The mean Visual Analog Scale pain score decreased from 7.1 ± 0.4 prior to CRA/RFA to 2.2 ± 0.3 after the procedure (p < 0.001). At the 12-months follow-up, all patients were able to ambulate with no assistance (Eastern Cooperative Oncology Group <2). One minor adverse event (paresthesia) and one major adverse event (drop foot) were resolved at 1 year of follow-up. CONCLUSIONS Treatment of bone metastasis with RFA and CRA in conjunction with cementoplasty using Cone-beam computed tomography navigation provides patients with significant palliative outcomes and in most cases, local tumor control.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Omri Merose
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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8
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Portnoy Y, Koren J, Khoury A, Factor S, Dadia S, Ran Y, Benady A. Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives. Int J Surg 2023; 109:3-10. [PMID: 36799780 PMCID: PMC10389328 DOI: 10.1097/js9.0000000000000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/14/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. METHODS The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. RESULTS Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. CONCLUSIONS Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.
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Affiliation(s)
- Yotam Portnoy
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Jonathan Koren
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Amal Khoury
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Shai Factor
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Solomon Dadia
- Sackler School of Medicine, Tel Aviv University
- Levin Center of 3D Printing and Surgical Innovation
- National Unit of Orthopedic Oncology
| | - Yuval Ran
- Sackler School of Medicine, Tel Aviv University
- Office of the Deputy Medical Manager, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amit Benady
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
- Levin Center of 3D Printing and Surgical Innovation
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9
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Gurel R, Amzallag N, Benady A, Efrima B, Barriga J, Gortzak Y, Sternheim A, Dadia S, Hasbani N, Segal O. Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle - A series of 14 cases. Foot Ankle Surg 2022; 28:1468-1472. [PMID: 36117006 DOI: 10.1016/j.fas.2022.09.001] [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] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions. METHODS All patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures. RESULTS Fourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients' symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss. CONCLUSION Navigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.
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Affiliation(s)
- Ron Gurel
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
| | - Nisan Amzallag
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juan Barriga
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Hasbani
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Morgan S, Barriga J, Dadia S, Merose O, Sternheim A, Snir N. Three dimensional printing as an aid for pre-operative planning in complex cases of total joint arthroplasty: A case series. J Orthop 2022; 34:142-146. [PMID: 36072761 PMCID: PMC9441292 DOI: 10.1016/j.jor.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Digital templating is an essential aspect of pre-operative planning for total joint arthroplasty procedures. For complex cases of joint reconstruction, the standard templating software is insufficient to achieve the desired accuracy. 3D printing significantly aids the pre-operative planning in complicated cases of joint reconstruction and offers immense potential towards improving outcomes in these cases. The purpose of the present study is to present the various ways in which 3D printing has aided our department in facilitating complex cases of lower extremity reconstruction. Methods Data was retrospectively retrieved for all patients that underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) with the aid of 3D printing technology at our institution between January 2016-February 2021. Patient pain was determined before and after surgery using the visual analogue scale (VAS). Patient reported outcome measures (PROMs) were additionally analyzed using the hip disability and osteoarthritis outcome score (HOOS) and knee injury and osteoarthritis outcome score (KOOS). Results The final study population consisted of 39 patients that underwent TKA or THA procedures with the use of 3D printing. Twenty-four (61.5%) of the surgeries in the study were THA procedures, whereas 15 (38.5%) were TKA procedures. The average VAS for patients reduced from 8.4% before surgery to 5.4% after surgery (p < 0.001). The mean KOOS of patients that underwent TKA was 17.33 ± 9.33 (43%) and the mean HOOS of patients that underwent THA was 13.79 ± 6.6 (42%). Conclusions The following series demonstrates the ability by which 3D printing facilitates complex cases of hip and knee reconstruction. 3D printing offers an improvement in understanding of patient specific anatomy, enhancing patient outcomes. Departments should consider the use of 3D printing technology as an adjunct when performing complex cases of lower extremity reconstruction.
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Affiliation(s)
- Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Juan Barriga
- Department of Orthopaedics, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Solomon Dadia
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Omri Merose
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Nimrod Snir
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Division of Adult Joint Reconstruction, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
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11
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Kollender R, Merimsky O, Sternheim A, Gortzak Y, Dadia S, Doron A, Novikov I, Kollender Y, Soyfer V. Radiation Therapy Before the Repeat Wide Resection for Unplanned Surgery of Soft Tissue Sarcoma (“Oops” Operation) Results in Improved Disease-Free Survival. Adv Radiat Oncol 2022; 7:101007. [DOI: 10.1016/j.adro.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022] Open
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12
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Factor S, Atlan F, Pritsch T, Rumack N, Golden E, Dadia S. In-hospital production of 3D-printed casts for non-displaced wrist and hand fractures. SICOT J 2022; 8:20. [PMID: 35608413 PMCID: PMC9128606 DOI: 10.1051/sicotj/2022021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: To examine the clinical feasibility and results of a multidisciplinary workflow, employing rapid three-dimensional (3D) scanning and modeling software along with a high-speed printer, for in-hospital production of patient-specific 3D-printed casts, for the treatment of non-displaced wrist and hand fractures. Methods: Consenting adult patients admitted to the emergency department (ED) due to wrist or hand fractures between January and February 2021 were prospectively enrolled. The study participants underwent conversion of the standard plaster of Paris cast to a 3D-printed cast one week after the ED visit, and follow-up examinations were performed around two, six, and twelve weeks later. The primary objective was to examine the clinical feasibility in terms of complexity and length of the overall procedure. Secondary outcomes were patient-reported impressions and radiological results. Results: Twenty patients (16 males, mean age 37 ± 13.1 years) were included. The entire printing workflow took a mean of 161 ± 8 min. All patients demonstrated clinical improvement and fracture union at final follow-up, with no pressure sores or loss of reduction. Patient-reported comfort and satisfaction rates were excellent. The mean Visual Analog Scale was 0.9 ± 1.1 and 0.6 ± 1, and the mean Disabilities of the Arm, Shoulder, and Hand score was 18.7 ± 9.5 and 7.6 ± 7.6 at 2 and 6 weeks after application of the 3D-printed cast, respectively. Conclusion: The in-hospital workflow was feasible and efficient, with excellent clinical and radiographic results and high patient satisfaction and comfort rates. Our medical center now routinely provides this cast option for non-displaced wrist and hand fractures. Level of evidence: IV, Therapeutic Study
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netta Rumack
- Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - Eran Golden
- Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - Solomon Dadia
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel - Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
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13
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Gigi R, Gortzak Y, Barriga Moreno J, Golden E, Gabay R, Rumack N, Yaniv M, Dadia S, Segev E. 3D-printed Cutting Guides for Lower Limb Deformity Correction in the Young Population. J Pediatr Orthop 2022; 42:e427-e434. [PMID: 35200209 DOI: 10.1097/bpo.0000000000002104] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional (3D) virtual surgical planning technology has advanced applications in the correction of deformities of long bones by enabling the production of 3D stereolithographic models, patient-specific instruments and surgical-guiding templates. Herein, we describe the implementation of this technology in young patients who required a corrective osteotomy for a complex 3-plane (oblique plane) lower-limb deformity. PATIENTS AND METHODS A total of 17 patients (9 males, average age 14.7 y) participated in this retrospective study. As part of preoperative planning, the patients' computerized tomographic images were imported into a post-processing software, and virtual 3D models were created by a segmentation process. Femoral and tibial models and cutting guides with locking points were designed according to the deformity correction plan. They were used for both planning and as intraoperative guides. Clinical parameters, such as blood loss and operative time were compared with a traditional surgical approach group. RESULTS All osteotomies in the 3D group were executed with the use intraoperative customized cutting guides which matched the preoperative planning simulation and allowed easy fixation with prechosen plates. Surgical time was 101±6.2 minutes for the 3D group and 126.4±16.1 minutes for the control group. The respective intraoperative hemoglobin blood loss was 2.1±0.2 and 2.5+0.3 g/dL.Clinical and radiographic follow-up findings showed highly satisfactory alignment of the treated extremities in all 3D intervention cases, with an average time-to-bone union (excluding 2 neurofibromatosis 1 patients) of 10.3 weeks (range 6 to 20 wk). CONCLUSION The use of 3D-printed models and patient-specific cutting guides with locking points improves the clinical outcomes of osteotomies in young patients with complex bone deformities of the lower limbs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roy Gigi
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
| | | | - Juan Barriga Moreno
- Orthopedics Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University
| | - Eran Golden
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ronnie Gabay
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Netta Rumack
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Yaniv
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
| | - Solomon Dadia
- National Unit of Orthopedic Oncology
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eitan Segev
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
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14
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Soyfer V, Kollender R, Sternheim A, Gortzak Y, Dadia S, Doron A, Novikov I, Kollender Y, Merimsky O. PO-1427 Salvage Irradiation and Repeat Wide Resection for Unplanned Surgery of Soft Tissue Sarcoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Elias A, Benady A, Golden E, Segal O, Dadia S. In situ cryoablation of sacral Giant Cell Tumor using three-dimensional (3D) model: A case report. J Orthop 2022; 30:46-50. [PMID: 35241887 PMCID: PMC8857548 DOI: 10.1016/j.jor.2022.02.007] [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] [Received: 12/24/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022] Open
Abstract
Three-dimensional planning of in-situ (trans-sacral) image guided cryoablation provides a method to treat sacral GCTs that accommodates the intricacies of the pelvis offering a safer, more efficacious alternative. Here we report on IM a 23-year-old female with a sacral GCT. She presented to Tel Aviv Medical Center with ongoing pain as well as neurological symptoms. For six years, the patient was in-and-out of the hospital for Denosumab treatment and recurrent infections. Eventually, further treatment became necessary, and she was treated with image guided cryoablation. By six months follow-up, the patient was mobile and pain-free.
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Affiliation(s)
- Avital Elias
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Levin Center for 3D Printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,Corresponding author. Weitzman 14, Tel Aviv, Israel.
| | - Eran Golden
- Levin Center for 3D Printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Levin Center for 3D Printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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16
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Wasserzug O, Fishman G, Carmel-Neiderman N, Oestreicher-Kedem Y, Saada M, Dadia S, Golden E, Berman P, Handzel O, DeRowe A. Three dimensional printed models of the airway for preoperative planning of open Laryngotracheal surgery in children: Surgeon's perception of utility. J Otolaryngol Head Neck Surg 2021; 50:47. [PMID: 34256870 PMCID: PMC8278656 DOI: 10.1186/s40463-021-00524-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/13/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preoperative planning of open laryngotracheal surgery is important for achieving good results. This study examines the surgeon's perception of the importance of using life size 3D printed models of the pediatric airway on surgical decision making. METHODS Life-size three-dimensional models of the upper airway were created based on CT images of children scheduled for laryngotracheal-reconstruction and cricotracheal resection with anastomosis. Five pediatric airway surgeons evaluated the three-dimensional models for determining the surgical approach, incision location and length, graft length, and need for single or double-stage surgery of seven children (median age 4.4 years, M:F ratio 4:3). They rated the importance of the three-dimensional model findings compared to the direct laryngoscopy videos and CT findings for each domain on a validated Likert scale of 1-5. RESULTS The mean rating for all domains was 3.6 ± 0.63 ("moderately important" to "very important"), and the median rating was 4 ("very important"). There was full agreement between raters for length of incision and length of graft. The between-rater agreement was 0.608 ("good") for surgical approach, 0.585 ("moderate") for incision location, and 0.429 ("moderate") for need for single- or two-stage surgery. CONCLUSION Patient-specific three-dimensional printed models of children's upper airways were scored by pediatric airway surgeons as being moderately to very important for preoperative planning of open laryngotracheal surgery. Large-scale, objective outcome studies are warranted to establish the reliability and efficiency of these models.
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Affiliation(s)
- Oshri Wasserzug
- Pediatric Otolaryngology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Fishman
- Pediatric Otolaryngology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin Carmel-Neiderman
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Oestreicher-Kedem
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maher Saada
- Pediatric Otolaryngology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Solomon Dadia
- The Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Golden
- The Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Philip Berman
- The Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari DeRowe
- Pediatric Otolaryngology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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17
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Efrima B, Ovadia J, Drukman I, Khoury A, Rath E, Dadia S, Gortzak Y, Albagli A, Sternheim A, Segal O. Cryo-surgery for symptomatic extra-abdominal desmoids. A proof of concept study. J Surg Oncol 2021; 124:627-634. [PMID: 34043245 DOI: 10.1002/jso.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Extra abdominal desmoid tumors are rare, highly aggressive, and invasive benign soft tissue tumors. Current treatment modalities show high levels of recurrence and comorbidities. Cryo-surgery as an alternative was subsequently investigated. METHODS In this retrospective, single center study 11 patients showing symptomatic tumors were treated with individualized cryo-surgery. Treatment protocol included preoperative planning using computer rendered 3D models, intraoperative navigation and execution using cone beam guidance, and postoperative magnetic resonance imaging image analysis using a gaussian mixture model software. Subjective outcomes were reported using Short Form Health Survey (SF-36) questionnaires. RESULTS Sixteen ablations were performed, each demonstrating a complete match with the determined preoperative plan and model. A total of 9/11 (82%) of patients showed improvements in symptoms and a reduction in tumor volume while 2/11 (18%) did not. Average reduction in tumor volume and viable segments were 36.7% (p = 0.0397) and 63.3% (p = 0.0477), respectively. Mild complications according to the SIR Adverse Event Classification Guidelines were experienced in 3/16 (19%) ablations. SF-36 scores showed a statistically significant improvement (p = 0.0194) in the mental health category and a nonsignificant (p = 0.8071) improvement in the physical health category. CONCLUSION Cryo-surgery using the three-phase protocol as described may improve the overall outcome of future ablation procedures.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Drukman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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Shaylor R, Francis M, Shaylor E, Dadia S, Cohen B. Development and validation of a 3D printed antiviral ventilator filter - a comparative study. BMC Anesthesiol 2021; 21:115. [PMID: 33853526 PMCID: PMC8044501 DOI: 10.1186/s12871-021-01310-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/01/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current coronavirus infectious disease 2019 (COVID-19) pandemic has caused unexpected pressure on medical supplies, interrupting supply chains and increasing prices. The supply of antiviral filters which form an essential part of the ventilator circuit have been affected by these issues. Three-dimensional (3D) printing may provide a solution to some of these issues. METHODS We designed and tested 3D printed heat and moisture exchange (HME) and antiviral casing. For each casing we tested two different filter materials derived from a sediment water filter cartridge or 1.5-μm glass fiber filter paper. A polyurethane sponge was used for the HME. Each design was tested for circuit leak, circuit compliance, peak inspiratory pressure and casing integrity using methylene blue dye. RESULTS We designed, produced, and tested two different types of antiviral filters with six different internal configurations. Overall, we tested 10 modified filter designs and compared them with the original commercial filter. Except for the combination of 1.5-μm filter paper and 5 mm sponge peak inspiratory pressure and circuit compliance of the filters produced were within the operating limits of the ventilator. All In addition, all filters passed the dye test. CONCLUSIONS Our filter may be of particular importance to those working in low middle-income countries unable to compete with stronger economies. Our design relies on products available outside the healthcare supply chain, much of which can be purchased in grocery stores, hardware stores, or industrial and academic institutions. We hope that these HMEs and viral filters may be beneficial to clinicians who face critical supply chain issues during the COVID-19 pandemic.
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Affiliation(s)
- Ruth Shaylor
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center; Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Mathew Francis
- Department of Food Science, University of Leeds, Leeds, UK
| | - Esther Shaylor
- Supply Division, United Nations Children's Fund, Copenhagen, Denmark
| | - Solomon Dadia
- Surgical 3D printing Laboratory, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Department of Orthopedic Oncology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Cohen
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center; Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel. .,Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
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19
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Abstract
AIMS Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur. METHODS Data were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves). RESULTS The sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008). CONCLUSION All the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638-645.
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Affiliation(s)
- A Sternheim
- National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - F Traub
- Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany
| | - N Trabelsi
- Department of Mechanical Engineering, Shamoon College of Engineering, Beer-Sheva, Israel.,PerSimiO, Personalized Simulation in Orthopedics, Inc, Beer-Sheva, Israel
| | - S Dadia
- National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Gortzak
- National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Snir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Orthopaedic Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - M Gorfine
- Department of Statistics and Operations Research, Tel Aviv University, Ramat-Aviv, Israel
| | - Z Yosibash
- PerSimiO, Personalized Simulation in Orthopedics, Inc, Beer-Sheva, Israel.,School of Mechanical Engineering, Tel Aviv University, Ramat-Aviv, Israel
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20
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Ungar OJ, Handzel O, Haviv L, Dadia S, Cavel O, Fliss DM, Oron Y. Optimal Head Position Following Intratympanic Injections of Steroids, As Determined by Virtual Reality. Otolaryngol Head Neck Surg 2019; 161:1012-1017. [PMID: 31547770 DOI: 10.1177/0194599819878699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study optimal head position after intratympanic steroid injections to enhance drug bioavailability. STUDY DESIGN Application of virtual and in vitro models of the intratympanic anatomy. SETTING The surgical 3-dimensional printing laboratory of a tertiary academic medical center. SUBJECTS AND METHODS A high-resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3-dimensional model. The tympanic membrane was perforated in the posterior-inferior quadrant. Methylene blue-stained 10-mg/mL dexamethasone was administered to the middle ear cleft, after which a 3-dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice. RESULTS The virtual model yielded the following position of the head as optimal: 53º rotation away from the injected ear in the vertical axis (yaw), 27º rotation toward the noninjected ear in the longitudinal axis (roll), and 10º neck extension in the transverse axis (pitch). CONCLUSIONS Virtual imaging determined that 53º and 27º yaw and roll, respectively, away and 10º pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear.
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Affiliation(s)
- Omer J Ungar
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Haviv
- Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Cavel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Ungar OJ, Dadia S, Yahav O, Handzel O, Fliss DM, Cavel O. Tri-dimensional model for ventilation tube permeability. Eur Arch Otorhinolaryngol 2018; 275:2627-2632. [PMID: 30178418 DOI: 10.1007/s00405-018-5117-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/22/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Ventilation tubes (VT) in the tympanic membrane expose the middle ear (ME) to the external auditory canal and its content. It carries the risk of penetration of contaminated material and could provide a pathway for the delivery of drugs into the ME. The aim of this study was to use a printed 3D-model of the external auditory canal (EAC) and ME to assess the permeability of various VTs to different fluids. METHODS CT scan of the external and ME was 3D-reconstructed and printed. Five different types of VT were inserted in the model's tympanic membrane and the minimal pressure for penetration to the ME was measured. Liquids with different viscosities, including commonly used ear drops, were tested. RESULTS Water passed through the standard 1.14 mm diameter VTs after filling the EAC with a volume of 2 ml and through a narrower grommet or a T-tube after filling the canal with 2.5 ml. Soapy-water had the highest penetration in all VTs (1-2 ml). The initial volume of dexamethasone needed for penetration was 2.5 ml in the standard tubes. It did not pass at any volume through the narrow grommet or the T-tube. CONCLUSION In the printed 3D-model, the volume of most solutions, including water, required to provide enough pressure in order to pass through the VTs was as high as the EAC volume or exceeded it. Soapy water had the highest penetrance while Dexamethasone needed volume of 2.5 ml to pass through the VT, questioning its reliability as a passive drug delivery channel to the ME.
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Affiliation(s)
- Omer J Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Solomon Dadia
- The Surgical 3D Printing Lab, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oron Yahav
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Cavel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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22
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Gortzak Y, Vitenberg M, Frenkel Rutenberg T, Kollender Y, Dadia S, Sternheim A, Morag G, Farkash U, Rath E, Kramer M, Drexler M. Inconclusive benefit of adjuvant 90Yttrium hydroxyapatite to radiosynovectomy for diffuse-type tenosynovial giant-cell tumour of the knee. Bone Joint J 2018; 100-B:984-988. [DOI: 10.1302/0301-620x.100b7.bjj-2017-0867.r3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/27/2023]
Abstract
Aims Intra-articular 90Yttrium (90Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with 90Yttrium. Patients and Methods All patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of 90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone. Results There were 34 patients in group A and 22 in group B. Recurrence of dtTGCT was identified by MRI, which was undertaken in patients with further symptoms. At a mean follow-up of 7.3 years (2.5 to 25.4), there was residual disease in 15 patients in group A and 11 in group B (p < 0.363). The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was 85% and 83%, respectively (p < 0.91). Conclusion There were no significant differences in outcome between patients treated surgically for dtTGCT of the knee with or without an adjuvant intra-articular injection of 90Yttrium. We were unable to provide conclusive evidence of any benefits derived from the adjuvant treatment. Cite this article: Bone Joint J 2018;100-B:984–8.
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Affiliation(s)
- Y. Gortzak
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M. Vitenberg
- Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | | | - Y. Kollender
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S. Dadia
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A. Sternheim
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G. Morag
- Orthopedic Surgery Division and Tel-Aviv
Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | - U. Farkash
- Orthopedic Surgery Department, Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer Sheva
Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
| | - E. Rath
- Orthopedic Surgery Division and Tel-Aviv
Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | - M. Kramer
- Orthopedic Surgery Department, Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer Sheva
Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
| | - M. Drexler
- Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer
Sheva Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
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23
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Scaglioni M, Chang E, Gur E, Barnea Y, Meller I, Kollander Y, Bickels J, Dadia S, Zaretski A. The role of the fibula head flap for joint reconstruction after osteoarticular resections. J Plast Reconstr Aesthet Surg 2014; 67:617-23. [DOI: 10.1016/j.bjps.2014.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/31/2013] [Accepted: 01/12/2014] [Indexed: 11/26/2022]
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Soyfer V, Corn BW, Kollender Y, Issakov J, Dadia S, Flusser G, Bickels J, Meller I, Merimsky O. Hypofractionated adjuvant radiation therapy of soft-tissue sarcoma achieves excellent results in elderly patients. Br J Radiol 2013; 86:20130258. [PMID: 23709514 DOI: 10.1259/bjr.20130258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] Open
Abstract
OBJECTIVE Adjuvant radiation therapy (RT) is an essential part of combined limb-sparing treatment of soft-tissue sarcoma (STS). Elderly or medically unfit patients often have difficulty in completing 6-7 weeks of standard fractionated daily treatment. Our aim was to evaluate the efficacy of a hypofractionated adjuvant approach with RT for STS in elderly and debilitated patients. METHODS 21 elderly patients were treated with a short course of adjuvant RT (39-48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for local or distant recurrence and side effects of RT. RESULTS At a mean 26 months of follow-up, three local recurrences (14%) were detected. Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long-term side effects. CONCLUSION Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients. ADVANCES IN KNOWLEDGE The results of this study might provide an alternative to commonly used standard fractionation of radiotherapy in sarcoma patients.
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Affiliation(s)
- V Soyfer
- Department of Oncology, Tel Aviv Sourasky Medical Center, Ashdod, Israel
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25
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Merimsky O, Soyfer V, Corn BW, Dadia S, Kollender Y. Hypofractionated adjuvant radiation therapy of soft tissue sarcoma in elderly patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e21521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21521 Background: Adjuvant radiation therapy is an essential part of combined limb sparing treatment of STS. The recommended dose of radiation lies in the range of 60 Gy in standard fractionation of 1.8-2 Gy. Elderly or medically unfit patients often have difficulty in completing 6-7w of daily treatment. A prolonged course of radiation may be interrupted by acute side effects, which sometimes demands further extension of the overall course or even discontinuation of treatment. We intended to evaluate the efficacy of a hypofractionated adjuvant approach with radiation therapy for STS in the elderly and debilitated patients. Methods: 21 elderly patients were treated with a short course of adjuvant RT (39 to 48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for the local or distant recurrence and side effects of RT. Results: Overall, the hypofractionated irradiation regimen of 39-48 Gy in 13-16 fractions was well tolerated with only 3 patients developing Grade 2-3 acute toxicity (mainly dermatitis). Three patients suffered from delayed Grade 2-3 toxicity (chronic pain, skin atrophy, teleangiectasiae) scaled according to CTSC. The mean time from the surgery until the initiation of RT was 65 days (SD 21.6). Mean RT time was 18.4 (SD 3) days. No delay of treatment due to acute toxicity was registered. All patients except for one were able to receive RT in the ambulatory setting. With a mean follow-up of 532 days (SD: 325), three local recurrences (14%) were detected. Three of eight patients with distant metastases died of sarcoma (graph 1). One patient with metastatic disease in the lung received salvage stereo tactic radiation therapy and was still alive 6 month after completion of SBRT with no evidence of disease. At a mean 532 days of follow up three local recurrences (14%) were detected .Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long term side effects. Conclusions: Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients.
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Rakhman E, Shmain D, White I, Ekstein MP, Kollender Y, Chazan S, Dadia S, Bickels J, Amar E, Weinbroum AA. Repeated and Escalating Preoperative Subanesthetic Doses of Ketamine for Postoperative Pain Control in Patients Undergoing Tumor Resection: A Randomized, Placebo-Controlled, Double-Blind Trial. Clin Ther 2011; 33:863-73. [DOI: 10.1016/j.clinthera.2011.05.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2011] [Indexed: 10/18/2022]
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27
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Meller I, Weinbroum A, Bickels J, Dadia S, Nirkin A, Merimsky O, Issakov J, Flusser G, Marouani N, Cohen N, Kollender Y. Fifteen years of bone tumor cryosurgery: A single-center experience of 440 procedures and long-term follow-up. Eur J Surg Oncol 2008; 34:921-927. [DOI: 10.1016/j.ejso.2007.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 11/01/2007] [Indexed: 11/25/2022] Open
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28
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Gofman A, Issakov J, Kollender Y, Soyfer V, Dadia S, Jiveliouk I, Flusser G, Bickels J, Meller I, Merimsky O. Synovial sarcoma of the extremities and trunk: a long-lasting disease. Oncol Rep 2008; 18:1577-81. [PMID: 17982647 DOI: 10.3892/or.18.6.1577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] Open
Abstract
Synovial sarcoma (SS) of an extremity or trunk is relatively rare and is approached by limb sparing surgery (LSS), radiation therapy (RT) and chemotherapy. We conducted a retrospective analysis of the clinical and histopathological data of 73 patients with proven SS. At a median follow-up time of 6 years, local recurrence was seen in 17.8 and systemic recurrence 35.6% of patients (local-only, 6.8; systemic-only, 24.6; combined, 11%). The 10-year local recurrence-free survival (LRFS), systemic recurrence-free survival (SRFS) and overall survival (OS) rates were 78, 68 and 61%, respectively. LRFS was significantly better in patients treated with isolated limb perfusion (ILP); SRFS was influenced by the delay until diagnosis. The practical aspects of our observations are the need for long-term follow-up in order to diagnose recurrences, the fact that not all local or distant recurrences are necessarily associated with a shortening of OS time and the important role of induction ILP with TNF in cases of extremity SS.
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Affiliation(s)
- A Gofman
- National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 64239, Israel
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30
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Merimsky O, Soyfer V, Goffman A, Issakov J, Bickels J, Dadia S, Kollender Y, Meller I. Synovial sarcoma of the extremities and trunk: A long lasting disease. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10073 Background: Synovial sarcoma (SS) of an extremity or trunk is a relatively rare type of soft tissue sarcoma. SS most commonly affects adolescents and young adults. SS usually originates at an extremity, carries a t(X;18)(p11;q11) translocation, and approached by limb sparing surgery, radiation therapy, and chemotherapy. Methods: A retrospective analysis of clinical and histopathological data of 73 patients with proven SS, treated at the National Unit of Orthopedic Oncology, from January 1991 through December 2004 was performed. Results: At a median follow-up time of 6 years, a local-recurrence was observed in 17.8% of the patients, while systemic recurrence in 35.6% (local-only in 6.8 %, systemic-only in 24.6 %, and combined in 11%). Accumulation of events of local and systemic recurrence following a limb sparing approach, did not reach a plateau even after 192 months from diagnosis. The 10-year local recurrence free survival (LRFS), the 10-year systemic recurrence-free survival (SRFS), and the 10-year overall survival (OS) were 78%, 68%, and 61%, respectively. The median SRFS time was 180 months, while the median LRFS and OS have not been reached yet. LRFS was significantly better for ILP treated patients; SRFS was influenced by a shorter delay in diagnosis. Conclusions: The practical aspects of our observations are the need for long-term follow-up for diagnosis of recurrence, the fact that not all local or distant recurrences are necessarily associated with shortening of overall survival, and the important role of induction ILP with TNF in cases of extremity SS. No significant financial relationships to disclose.
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Affiliation(s)
- O. Merimsky
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - V. Soyfer
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - A. Goffman
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - J. Issakov
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - J. Bickels
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - S. Dadia
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Y. Kollender
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - I. Meller
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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