Surgical management of villonodular-pigmented synovitis of knee: decisional algorithm

Pigmented villonodular synovitis (PVNS) of knee is an uncommon disease defined as benign despite presenting local aggressiveness and high propensity to recurrence. Etiology is still not completely understood. It seems to be a chronic inflammation process involving synovial membranes characterized by hemosiderin deposition which leads to pain, limitation of range of motion and, if not treated, bone erosion and osteoarthritis of knee. The gold standard for treatment is surgical excision; other adjuvant or alternative therapies are described, too. We present a case series of PVNS of the knee treated with surgical excision at our institution. Functionality was assessed using the Muscoloskeletal Tumor Society (MSTS) Score for lower limbs and Oxford Knee Score (OKS). Statistical analysis were performed. At the latest follow-up, our patients' mean MSTS score was 26.4 (30-18): 27.4 for those treated with posterior approach and 26.1 for the anterior ones. Only 5% of patients suffered local complications and 15% had a local recurrence of the disease. Adequate pre-operative study and careful surgical excision, that should be tailored to each patient are the key to obtain a low recurrence rate

Bone Marrow Concentrate in the Treatment of Aneurysmal Bone Cysts: A Case Series Study

Introduction. A recent attractive option regarding mesenchymal stem cells (MSC) application is the treatment of bone cystic lesions and in particular aneurysmal bone cysts (ABC), in order to stimulate intrinsic healing. We performed a retrospective evaluation of the results obtained at our institution.Methods. The study group consisted of 46 cases with an average follow-up of 33 months. Forty-two patients underwent percutaneous treatment as the first approach; four patients had curettage as first treatment. In all cases, autologous bone marrow concentrate (BMC) was associated too. The healing status was followed up through a plain radiograph 45 days and 2 months after the procedure.Results and Conclusions.At the final follow-up, thirty-six patients healed with a Neer type II aspect, nine healed with a type I aspect, and one patient was not classified having total hip arthroplasty. Bone marrow concentrate is easy to obtain and to manipulate and can be immediately available in a clinical setting. We can assert that the use of BMC must be encouraged being harmless and having an unquestionable high osteogenic and healing potential in bone def

Ankle and Distal Tibia Megaprostheses in Orthopedic Oncology: A Report of Two Cases and Review of the Literature

Background: The distal tibia is one of the rarest sites for the onset of malignant and locally aggressive bone tumors. When diagnosed, these lesions should undergo surgical resection with wide margins to eradicate the disease. In the era of limb-sparing surgery, several reconstructive approaches have been proposed and described in modern literature for reconstructing the distal tibia and the ankle. The 3D-printed custom-made prostheses represent an innovative and promising reconstructive option. Several authors highlighted that despite being expensive and prone to some complications such as talar collapse or loosening and soft tissue necrosis, the megaprostheses of the distal tibia could lead to good functional outcomes, also allowing a better range of motion compared to the most common arthrodesis. Materials and methods: We report two cases who suffered from malignant bone tumors localized in the distal tibia and treated with wide resections and the implant of 3D printed custom-made megaprostheses to replace the distal tibia and the ankle. Results: Both patients had excellent functional results (MSTS 30/30) one year after surgery. No local recurrence occurred during the patients’ latest follow-up. Conclusions: Our results support the effectiveness of custom-made implants in replacing the distal tibia and the ankle in orthopedic oncology

PROTESI CUSTOM-MADE 3D-PRINTED NELLE RICOSTRUZIONI PELVICHE COMPLESSE: TECNICHE CHIRURGICHE E RISULTATI CLINICI

L’obiettivo del nostro studio è stato quello di valutare retrospettivamente l’efficacia della ricostruzione con protesi custom-made, a seguito di resezione pelvica massiva, in una coorte di pazienti trattati presso un unico centro ad alta specializzazione (III livello). La tecnologia della stampa 3D è stata utilizzata sia per produrre le guide di taglio personalizzate che per la realizzazione di protesi definitive in titanio di ultima generazione. Sono stati inoltre indagati una serie di fattori di rischio al fine di valutare la loro influenza rispetto allo sviluppo di complicanze

Bone Marrow Concentrate in the Treatment of Aneurysmal Bone Cysts: A Case Series Study

Introduction. A recent attractive option regarding mesenchymal stem cells (MSC) application is the treatment of bone cystic lesions and in particular aneurysmal bone cysts (ABC), in order to stimulate intrinsic healing. We performed a retrospective evaluation of the results obtained at our institution. Methods. The study group consisted of 46 cases with an average follow-up of 33 months. Forty-two patients underwent percutaneous treatment as the first approach; four patients had curettage as first treatment. In all cases, autologous bone marrow concentrate (BMC) was associated too. The healing status was followed up through a plain radiograph 45 days and 2 months after the procedure. Results and Conclusions. At the final follow-up, thirty-six patients healed with a Neer type II aspect, nine healed with a type I aspect, and one patient was not classified having total hip arthroplasty. Bone marrow concentrate is easy to obtain and to manipulate and can be immediately available in a clinical setting. We can assert that the use of BMC must be encouraged being harmless and having an unquestionable high osteogenic and healing potential in bone defects.</jats:p

Proximal humerus reconstruction after tumor resection: Endoprosthesis implant for elderly patients

Humeral reconstruction post tumor resection is a challenging quest. Reconstruction strategies depend first of all on age and general conditions of the patient, tumor dimensions, local invasion and bone quality. Many kinds of surgery are described in literature, mostly megaprosthesis, hemiartoplasty or alloprosthetic composite (APC) implants or allograft, allograft arthrodesis, clavicola pro-humeri or vascolarized fibula reconstructions. One of the most important goals of this surgery is to achieve implant stability. Surgical planning varies according to deltoid muscle, rotator cuff and axillary nerve conditions. When all these structures are conserved, an allograft or composite (anatomic or reverse arthroprosthesis) reconstruction could be a more suitable option for younger patients. When deltoid muscle function is impaired due to tumoral resection or axillary nerve disfunction, especially in elderly patients, surgeons prefer to implant endoprosthesis. The purpose of this paper is to describe the surgical technique to implant humeral megaprosthesis associated with tendon transfers and tips on how to achieve implant stability

Bilateral transient osteoporosis of the hip with unilateral fracture in a 40 years old pregnant woman

Purpose: Some physiological events in women’s life such as pregnancy and lactation can be associated to a condition known as Transient Osteoporosis of the Hip (TOH); if not promptly diagnosed it can lead to significant consequences such as femoral neck fracture. In this paper we describe a case of bilateral TOH, focusing on the importance of early treatment and how it influenced the outcome. Methods: A 40 years old post-delivery woman came to our attention for hip pain and a left femoral neck fracture was diagnosed. Magnetic resonance (MRI) showed bilateral edema of the femoral head. She underwent total hip replacement on the left side; toe-touch weight bearing and pharmacological therapy were prescribed for the right hip. Results: MRI at nine months showed complete regression of the femoral head and neck edema; the patient was clinically asymptomatic. Conclusion: If not promptly diagnosed and treated, TOH can potentially evolve in fracture. Many therapeutic strategies have been suggested since now; we believe that avoiding weight bearing on the involved hip as early as possible is the key to recovery.</jats:p

Extracorporeal Perfusion for Free Fillet Lower Leg Flap After External Hemipelvectomy for Recurrent Osteosarcoma: A New Surgical Technique

Abstract BackgroundExternal hemipelvectomy often results in exposure of noble structures such as pelvic organs, joint surfaces, iliac neurovascular bundle and bone. Consequently, reconstructive surgery is always challenging. The free fillet lower leg flap is an optimal solution since it allows the transfer of a large amount of tissue and the it determines the absence of donor site morbidities. The prolonged ischemic time represents the weak point of this flap.Methods We presented the case of a 38-year-old man with recurrent radio-induced osteosarcoma arisen on pelvic cavity and involving common iliac vessels, bladder, left ureter and left kidney. We decided to use extracorporeal circulation (ECMO) in order to reduce ischemic time of the flap, since iliac vessels were necessary ligated in the middle of oncologic resection. We perfused the popliteal-based filleted lower leg musculocutaneous free flap with homologue blood and saline solution, while the oncologic dissection was completed.ResultsThe free fillet flap remained vital in the immediate postoperative period and in the following months. The patient did not come back to a life-threatening condition at 1y follow-up. ConclusionWe believed that ECMO expand the reconstructive indications in those cases in which a complex and long-lasting oncologic resection would make impossible a free flap due to prolonged ischemic time.</jats:p