Between 2015 and 2050, the World Health Organization (WHO) estimates that the proportion of the world’s population over 60 years will become nearly double from 12% to 22%. WHO also proposes that osteoarthritis (OA) is one of the most significant causes of disability, emphasizing the requirement of comprehensive public health action on the fundamental shift for ageing and health. Knee OA (KOA) is one of the main problems for the aged-society in terms of incidence, impairment in the quality of daily living (QOL), and economics.
{"title":"Early knee osteoarthritis—definition, pathogenesis, diagnosis, treatment, and prevention","authors":"Y. Uchio","doi":"10.21037/aoj.2019.08.06","DOIUrl":"https://doi.org/10.21037/aoj.2019.08.06","url":null,"abstract":"Between 2015 and 2050, the World Health Organization (WHO) estimates that the proportion of the world’s population over 60 years will become nearly double from 12% to 22%. WHO also proposes that osteoarthritis (OA) is one of the most significant causes of disability, emphasizing the requirement of comprehensive public health action on the fundamental shift for ageing and health. Knee OA (KOA) is one of the main problems for the aged-society in terms of incidence, impairment in the quality of daily living (QOL), and economics.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.08.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46169444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Reconstructive techniques following acetabular reconstruction for pelvic primary and metastatic malignancy are technically difficult and are known to have high complication rates. Previous studies of outcomes following pedestal acetabular prosthesis have shown that the most common complications were dislocation and infection with rates ranging from 10–26% and 11–47% respectively. Methods: A case series review of all acetabular reconstructions performed between 2003 and 2016 using a pedestal prosthesis was performed using data from the Royal Orthopaedic Hospital oncology database. Patient demographics and primary diagnoses were recorded, as was length of follow up, complications rate, patient and implant survivorship. Results: We identified 52 cases of acetabular reconstruction for pelvic malignancy between 2003 and 2016. The average follow-up was 4 ½ years with a 27% complication rate. The deep infection rate was 8% with half of these requiring removal of implants. The dislocation rate was 12%. The use of intra-operative computer navigation reduced the rate of dislocation by half when compared to cases where navigation was not used. Conclusions: The complication rates associated with a stemmed acetabular endoprosthesis are to other reconstructive techniques for acetabular defects. There was a significant decrease in dislocation rate when intra-operative navigation was used. Similarly, the rate of deep infection was also one of the lowest reported in literature. When used for metastatic pelvic disease there was a 100% implant survivorship.
{"title":"Pelvic reconstruction using pedestal endoprosthesis—experience from Europe","authors":"M. Lowe, L. Jeys, R. Grimer, M. Parry","doi":"10.21037/aoj.2019.06.04","DOIUrl":"https://doi.org/10.21037/aoj.2019.06.04","url":null,"abstract":"Background: Reconstructive techniques following acetabular reconstruction for pelvic primary and metastatic malignancy are technically difficult and are known to have high complication rates. Previous studies of outcomes following pedestal acetabular prosthesis have shown that the most common complications were dislocation and infection with rates ranging from 10–26% and 11–47% respectively. \u0000 Methods: A case series review of all acetabular reconstructions performed between 2003 and 2016 using a pedestal prosthesis was performed using data from the Royal Orthopaedic Hospital oncology database. Patient demographics and primary diagnoses were recorded, as was length of follow up, complications rate, patient and implant survivorship. Results: We identified 52 cases of acetabular reconstruction for pelvic malignancy between 2003 and 2016. The average follow-up was 4 ½ years with a 27% complication rate. The deep infection rate was 8% with half of these requiring removal of implants. The dislocation rate was 12%. The use of intra-operative computer navigation reduced the rate of dislocation by half when compared to cases where navigation was not used. Conclusions: The complication rates associated with a stemmed acetabular endoprosthesis are to other reconstructive techniques for acetabular defects. There was a significant decrease in dislocation rate when intra-operative navigation was used. Similarly, the rate of deep infection was also one of the lowest reported in literature. When used for metastatic pelvic disease there was a 100% implant survivorship.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.06.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liying Sun, Yingzhao Huang, Sen Zhao, Wenyao Zhong, Mao Lin, Yang Guo, Yuehan Yin, N. Wu, Zhihong Wu, W. Tian
Congenital upper limb anomalies (CULA) are a common birth defect and a significant portion of complicated syndromic anomalies have upper limb involvement. Mostly the mortality of babies with CULA can be attributed to associated anomalies. The cause of the majority of syndromic CULA was unknown until recently. Advances in genetic and genomic technologies have unraveled the genetic basis of many syndromes-associated CULA, while at the same time highlighting the extreme heterogeneity in CULA genetics. Discoveries regarding biological pathways and syndromic CULA provide insights into the limb development and bring a better understanding of the pathogenesis of CULA. The aim of this review is to provide an overview of the genetic basis of syndromic CULA and discuss the role of biological pathways in syndromic CULA.
{"title":"Advances in understanding the genetics of syndromes involving congenital upper limb anomalies","authors":"Liying Sun, Yingzhao Huang, Sen Zhao, Wenyao Zhong, Mao Lin, Yang Guo, Yuehan Yin, N. Wu, Zhihong Wu, W. Tian","doi":"10.21037/AOJ.2019.06.03","DOIUrl":"https://doi.org/10.21037/AOJ.2019.06.03","url":null,"abstract":"Congenital upper limb anomalies (CULA) are a common birth defect and a significant portion of complicated syndromic anomalies have upper limb involvement. Mostly the mortality of babies with CULA can be attributed to associated anomalies. The cause of the majority of syndromic CULA was unknown until recently. Advances in genetic and genomic technologies have unraveled the genetic basis of many syndromes-associated CULA, while at the same time highlighting the extreme heterogeneity in CULA genetics. Discoveries regarding biological pathways and syndromic CULA provide insights into the limb development and bring a better understanding of the pathogenesis of CULA. The aim of this review is to provide an overview of the genetic basis of syndromic CULA and discuss the role of biological pathways in syndromic CULA.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.06.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45383981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Eck, C. Klein, H. Rahmi, K. Scheidt, M. Schultzel, Brian K. Lee, J. Itamura
Background: Proximal humerus fractures are common in the population over age 65. Several studies have demonstrated high morbidity and mortality rates associated with several osteoporotic fracture types. The purpose of this study was to investigate and compare the risk factors, morbidity, mortality and cost of proximal humerus, distal radius, hip and vertebral compression fractures. Methods: From the Medicare Registry, patients diagnosed with a proximal humerus, distal radius, hip or vertebral compression fracture based on the ICD-9 coding were identified. Sex, race, age, fracture type, healthcare cost, mortality, blood transfusion requirement, and comorbidities were documented. Results: Between 2010 and 2014 there were 50,237,330 inpatient claims and 1,183,966 (2.4%) of those were specifically for 1 of the 4 osteoporotic fracture types. Mortality rate during index admission for all four fractures combined was 2.2%. Mortality rate was 1% for proximal humerus, as compared to 0.4% for distal radius, 2.5% for hip and 1.8% for vertebral compression fractures. The highest cost was associated with hip fractures and the lowest cost with distal radius fractures. The hip and vertebral compression fracture patients had the most documented comorbidities. Patients were more likely to be female (OR 2.105, 95% CI: 2.096–2.113), white (OR 2.600, 95% CI: 2.582–2.617), and over 84 years of age (OR 5.979, 95% CI: 5.957–6.001) in all fracture types. Conclusions: Proximal humerus fractures carry similar risk factors, morbidity, mortality, and health care costs as other osteoporotic fracture types. The findings of the present study are clinically relevant, as life expectancy continues to increase and the Medicare population continues to grow. This will lead to an increase in the incidence of osteoporotic fractures. Proper screening and treatment of osteoporosis may help prevent some of these fractures.
{"title":"Morbidity, mortality and cost of osteoporotic fractures—should proximal humerus fractures be taken as seriously as hip fractures?","authors":"C. Eck, C. Klein, H. Rahmi, K. Scheidt, M. Schultzel, Brian K. Lee, J. Itamura","doi":"10.21037/AOJ.2019.01.01","DOIUrl":"https://doi.org/10.21037/AOJ.2019.01.01","url":null,"abstract":"Background: Proximal humerus fractures are common in the population over age 65. Several studies have demonstrated high morbidity and mortality rates associated with several osteoporotic fracture types. The purpose of this study was to investigate and compare the risk factors, morbidity, mortality and cost of proximal humerus, distal radius, hip and vertebral compression fractures. Methods: From the Medicare Registry, patients diagnosed with a proximal humerus, distal radius, hip or vertebral compression fracture based on the ICD-9 coding were identified. Sex, race, age, fracture type, healthcare cost, mortality, blood transfusion requirement, and comorbidities were documented. Results: Between 2010 and 2014 there were 50,237,330 inpatient claims and 1,183,966 (2.4%) of those were specifically for 1 of the 4 osteoporotic fracture types. Mortality rate during index admission for all four fractures combined was 2.2%. Mortality rate was 1% for proximal humerus, as compared to 0.4% for distal radius, 2.5% for hip and 1.8% for vertebral compression fractures. The highest cost was associated with hip fractures and the lowest cost with distal radius fractures. The hip and vertebral compression fracture patients had the most documented comorbidities. Patients were more likely to be female (OR 2.105, 95% CI: 2.096–2.113), white (OR 2.600, 95% CI: 2.582–2.617), and over 84 years of age (OR 5.979, 95% CI: 5.957–6.001) in all fracture types. Conclusions: Proximal humerus fractures carry similar risk factors, morbidity, mortality, and health care costs as other osteoporotic fracture types. The findings of the present study are clinically relevant, as life expectancy continues to increase and the Medicare population continues to grow. This will lead to an increase in the incidence of osteoporotic fractures. Proper screening and treatment of osteoporosis may help prevent some of these fractures.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.01.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47055364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Compress implant is used to achieve compliant fixation for endoprosthetic reconstruction during limb salvage. Failures, when they occur, are typically at the bone-implant interface. We describe a case of implant failure at a modular junction near a cold-welded taper adapter, blocking access to the spindle nut. Salvage of the anchor plug was performed in this case to avoid re-cutting the remaining bone.
{"title":"A technique for anchor plug salvage in the setting of a cold welded taper adapter following compress implant failure","authors":"S. Campbell, Allison K. Roe, R. Avedian","doi":"10.21037/aoj.2019.08.01","DOIUrl":"https://doi.org/10.21037/aoj.2019.08.01","url":null,"abstract":"The Compress implant is used to achieve compliant fixation for endoprosthetic reconstruction during limb salvage. Failures, when they occur, are typically at the bone-implant interface. We describe a case of implant failure at a modular junction near a cold-welded taper adapter, blocking access to the spindle nut. Salvage of the anchor plug was performed in this case to avoid re-cutting the remaining bone.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.08.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41772913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Campbell, R. Steffner, Andrea K. Finlay, D. Mohler, R. Avedian
Background: The use of compliant fixation for endoprosthetic implants is gaining popularity. Previous work has shown that anti-rotation pins improve rotational stability at the bone-implant interface, but there is concern that these pins lead to increased risk of mechanical failure. We asked: (I) are anti-rotation pins used with the Compress implant associated with mechanical failure? (II) Are anti-rotation pins associated with less effective osseointegration? Methods: We performed retrospective review of cases using a Compress implant from 2004–2016. Mechanical failure rates and bone growth at the bone-implant interface were compared between pin and no-pin cohorts. Regression models were used to examine patient and surgical factors associated with mechanical failure. Results: Anti-rotation pins were not associated with mechanical failure (P=1.0, odds ratio 1.17, 95% confidence interval: 0.12–15.40). Anti-rotation pins were not associated with impaired osseointegration at any time point (P=1.0 at 3–6 months, P=0.33 at 6-9 months, P=0.34 at 9–12 months, P=0.40 at 12–24 months, P=0.28 at 24–48 months, P=1.0 at >48 months). No patient or surgical variables were predictors of mechanical failure. Conclusions: Anti-rotation pins were not associated with mechanical failure or impaired osseointegration.
{"title":"Anti-rotation pins for the compress implant do not increase risk of mechanical failure or impair osseointegration","authors":"S. Campbell, R. Steffner, Andrea K. Finlay, D. Mohler, R. Avedian","doi":"10.21037/AOJ.2019.08.02","DOIUrl":"https://doi.org/10.21037/AOJ.2019.08.02","url":null,"abstract":"Background: The use of compliant fixation for endoprosthetic implants is gaining popularity. Previous work has shown that anti-rotation pins improve rotational stability at the bone-implant interface, but there is concern that these pins lead to increased risk of mechanical failure. We asked: (I) are anti-rotation pins used with the Compress implant associated with mechanical failure? (II) Are anti-rotation pins associated with less effective osseointegration? Methods: We performed retrospective review of cases using a Compress implant from 2004–2016. Mechanical failure rates and bone growth at the bone-implant interface were compared between pin and no-pin cohorts. Regression models were used to examine patient and surgical factors associated with mechanical failure. \u0000 Results: Anti-rotation pins were not associated with mechanical failure (P=1.0, odds ratio 1.17, 95% confidence interval: 0.12–15.40). Anti-rotation pins were not associated with impaired osseointegration at any time point (P=1.0 at 3–6 months, P=0.33 at 6-9 months, P=0.34 at 9–12 months, P=0.40 at 12–24 months, P=0.28 at 24–48 months, P=1.0 at >48 months). No patient or surgical variables were predictors of mechanical failure. \u0000 Conclusions: Anti-rotation pins were not associated with mechanical failure or impaired osseointegration.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42537820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keisuke Yoshida, Tomoki Nakamura, Tomohito Hagi, K. Asanuma, A. Sudo
Metastasis of osteosarcoma to the pancreas is quite rare, and there have been no reports of metastasis-induced acute pancreatitis (MIAP) due to pancreatic metastasis of osteosarcoma. Here, we present two cases of MIAP due to pancreatic metastasis of osteosarcoma. Case 1: a 47-year-old woman was referred to our hospital due to osteosarcoma at left femur. She felt back pain 2 years postoperatively. An abdominal CT showed a 7 cm mass in the pancreatic head. Considering that the acute pancreatitis due to pancreatic metastasis, palliative radiotherapy was performed. Although abdominal pain was improved, she had died of multiple metastasis after 2 months. Case 2: a 42-year-old woman was referred to our hospital due to osteosarcoma at left femur. She felt abdominal and back pain 6 months after initial treatment. CT scans showed a large mass in the pancreatic tail. The mass increased rapidly over a short duration and complicated the acute pancreatitis. Palliative radiotherapy (30 Gy/10 fractions) was performed. After 1 month, the patient died of lung metastases. In previous reports, all patients with pancreatic metastases from osteosarcoma developed metastases at other sites, such as the lungs and bone. Therefore, we suggest that follow-up examinations at the abdominal lesion may be necessary for patients with metastatic disease.
{"title":"Acute pancreatitis due to pancreatic metastasis of osteosarcoma: a report of two cases","authors":"Keisuke Yoshida, Tomoki Nakamura, Tomohito Hagi, K. Asanuma, A. Sudo","doi":"10.21037/aoj.2019.09.05","DOIUrl":"https://doi.org/10.21037/aoj.2019.09.05","url":null,"abstract":"Metastasis of osteosarcoma to the pancreas is quite rare, and there have been no reports of metastasis-induced acute pancreatitis (MIAP) due to pancreatic metastasis of osteosarcoma. Here, we present two cases of MIAP due to pancreatic metastasis of osteosarcoma. Case 1: a 47-year-old woman was referred to our hospital due to osteosarcoma at left femur. She felt back pain 2 years postoperatively. An abdominal CT showed a 7 cm mass in the pancreatic head. Considering that the acute pancreatitis due to pancreatic metastasis, palliative radiotherapy was performed. Although abdominal pain was improved, she had died of multiple metastasis after 2 months. Case 2: a 42-year-old woman was referred to our hospital due to osteosarcoma at left femur. She felt abdominal and back pain 6 months after initial treatment. CT scans showed a large mass in the pancreatic tail. The mass increased rapidly over a short duration and complicated the acute pancreatitis. Palliative radiotherapy (30 Gy/10 fractions) was performed. After 1 month, the patient died of lung metastases. In previous reports, all patients with pancreatic metastases from osteosarcoma developed metastases at other sites, such as the lungs and bone. Therefore, we suggest that follow-up examinations at the abdominal lesion may be necessary for patients with metastatic disease.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.09.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43074901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The megaprosthesis is designed to reproduce the form and function of a removed large segment of pelvis. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients’ functional abilities. The essential challenges in pelvic reconstruction using endoprostheses include modularity, early stability, biocompatibility, biomechanical compatibility, and durable fixation; these can, ideally, be overcome by osseointegration of the interface and adapting to the physiological condition. The history of pelvic megaprostheses presents unique concepts distinct from those related to other extremities, and improvements that have been made over the past decades will guide the future development of new pelvic endoprostheses. In this review, we try to present the evolution of the pelvic megaprosthesis, focusing on the design style, biomechanical advancement, and the recent development of 3D-printing technology that promise better results and fewer complications. General orthopedic surgeons can also benefit from a general update in this specific area.
{"title":"The evolution of pelvic endoprosthetic reconstruction after tumor resection","authors":"T. Ji, Wei Guo","doi":"10.21037/AOJ.2019.06.01","DOIUrl":"https://doi.org/10.21037/AOJ.2019.06.01","url":null,"abstract":"The megaprosthesis is designed to reproduce the form and function of a removed large segment of pelvis. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients’ functional abilities. The essential challenges in pelvic reconstruction using endoprostheses include modularity, early stability, biocompatibility, biomechanical compatibility, and durable fixation; these can, ideally, be overcome by osseointegration of the interface and adapting to the physiological condition. The history of pelvic megaprostheses presents unique concepts distinct from those related to other extremities, and improvements that have been made over the past decades will guide the future development of new pelvic endoprostheses. In this review, we try to present the evolution of the pelvic megaprosthesis, focusing on the design style, biomechanical advancement, and the recent development of 3D-printing technology that promise better results and fewer complications. General orthopedic surgeons can also benefit from a general update in this specific area.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.06.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49354715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roel-Jan W. J. Zuidhof, C. Löwik, J. Ploegmakers, P. Dijkstra, M. Wouthuyzen-Bakker, P. Jutte
The use of tumor megaprostheses in patients with bone tumors has provided a successful limb salvaging treatment option in oncology patients. Unfortunately, the prevalence of periprosthetic infection is much higher after oncologic joint arthroplasty than after regular joint arthroplasty, ranging from 7% to 28%. This increased risk of infection is caused by local and systemic immunodeficiency due to chemotherapy and radiotherapy, long duration of surgery, large wound areas and the use of large implants. This review focused on specific issues regarding infected megaprostheses in oncology patients, aiming to give directions for the prevention, diagnosis and treatment of infected megaprostheses.
{"title":"Periprosthetic joint infection in orthopaedic surgical oncology","authors":"Roel-Jan W. J. Zuidhof, C. Löwik, J. Ploegmakers, P. Dijkstra, M. Wouthuyzen-Bakker, P. Jutte","doi":"10.21037/AOJ.2019.05.01","DOIUrl":"https://doi.org/10.21037/AOJ.2019.05.01","url":null,"abstract":"The use of tumor megaprostheses in patients with bone tumors has provided a successful limb salvaging treatment option in oncology patients. Unfortunately, the prevalence of periprosthetic infection is much higher after oncologic joint arthroplasty than after regular joint arthroplasty, ranging from 7% to 28%. This increased risk of infection is caused by local and systemic immunodeficiency due to chemotherapy and radiotherapy, long duration of surgery, large wound areas and the use of large implants. This review focused on specific issues regarding infected megaprostheses in oncology patients, aiming to give directions for the prevention, diagnosis and treatment of infected megaprostheses.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.05.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47861157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tumour surgeons have to achieve a negative resection margin for the best oncological outcomes with the reduced risk of local recurrence and improved patient survival. Given that the pelvic bone has a complex geometry with intricately related vital neurovascular structures, surgeons may resect tumours with more margin than oncologically necessary when taking into account the inaccuracy in planning and resection. The lesser normal bone may be retained for reconstruction to restore limbs function. Therefore, bone sarcoma locating near the acetabulum is often resected including the entire acetabulum. Partial acetabular resection of bone sarcoma with pelvic reconstruction has been described in selected patients with periacetabular tumours in a few case series. Early promising results were reported with the advantages of preserving more host bone for reconstruction without compromising the oncological resection margin and increasing the risk of local recurrence when the surgeries were performed with good preoperative planning and guided resection under computer navigation guidance. This article is to review the pelvic reconstruction after partial acetabular resection of bone sarcoma, its pathoanatomy, surgical considerations, current evidence and limitations.
{"title":"Pelvic reconstruction after partial acetabular resection of bone sarcoma","authors":"K. Wong, X. Niu, Hai-rong Xu, Yuan Li, S. Kumta","doi":"10.21037/AOJ.2019.04.02","DOIUrl":"https://doi.org/10.21037/AOJ.2019.04.02","url":null,"abstract":"Tumour surgeons have to achieve a negative resection margin for the best oncological outcomes with the reduced risk of local recurrence and improved patient survival. Given that the pelvic bone has a complex geometry with intricately related vital neurovascular structures, surgeons may resect tumours with more margin than oncologically necessary when taking into account the inaccuracy in planning and resection. The lesser normal bone may be retained for reconstruction to restore limbs function. Therefore, bone sarcoma locating near the acetabulum is often resected including the entire acetabulum. Partial acetabular resection of bone sarcoma with pelvic reconstruction has been described in selected patients with periacetabular tumours in a few case series. Early promising results were reported with the advantages of preserving more host bone for reconstruction without compromising the oncological resection margin and increasing the risk of local recurrence when the surgeries were performed with good preoperative planning and guided resection under computer navigation guidance. This article is to review the pelvic reconstruction after partial acetabular resection of bone sarcoma, its pathoanatomy, surgical considerations, current evidence and limitations.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.04.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46032206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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