Search Results (32)

(1) Background: The reconstruction of periacetabular defects after tumor resection remains one of the most challenging procedures in orthopaedic oncology. The modular LUMiC^® system was designed to improve fixation stability and reduce implant-related complications compared with earlier hemipelvic prostheses. We investigated patient and implant survival after LUMiC^® reconstruction, complication types and functional outcomes. (2) Methods: Eighteen patients (8 men, 10 women; mean age 58.9 years) underwent LUMiC^® endoprosthetic reconstruction between 2011 and 2025. Kaplan–Meier analysis was used to estimate patient and implant survival. Complications were categorized according to Henderson. Functional results were evaluated at follow-up using MSTS and TESS. (3) Results: Mean follow-up was 35.52 months (SD 36.89). Overall implant survival was 72.2%. Instability (27.8%) and infection (16.7%) were the leading complications. Two-thirds of patients required at least one revision (mean 3.1 revisions per case). Metastatic disease reduced patient survival (p = 0.012) but did not affect implant longevity (p = 0.31). Functional outcomes were available for only 3 of 18 patients and should therefore be regarded as exploratory. Mean MSTS was 58.9% (SD 21.43) and mean TESS was 73.4% (SD 6.836). (4) Conclusions: Despite high revision rates, the LUMiC^® prosthesis provides durable fixation. Early revision does not appear to compromise implant survival. However, the small and heterogeneous cohort represents a limiting factor of this study. Full article

Severe bone loss from trauma, fractures, tumor resections, and disease are devastating injuries that do not heal completely without external, and most of the time surgical, interventions. Although surgical interventions such as bone grafts and metal prostheses are commonly employed, these conventional approaches present several limitations, including limited donors, risks of immune rejection and postoperative inflammation, and significant pain experienced by both donors and recipients. Hydrogels offer a promising alternative because of their controllable mechanical properties, biocompatibility, and structural resemblance to the extracellular matrix. In addition, hydrogels can be modified with substances such as growth factors, hormones, and drugs to facilitate accelerated bone repair. This review summarizes the recent advances in hydrogel development for bone repair, their structural design, biological functionality, and preclinical and clinical applications. Full article

Background/Objective: Endoprosthetic proximal femoral replacement is a reconstructive procedure for preserving ambulatory function following tumor resection. Different prosthetic systems for endoprosthetic proximal femoral replacement may result in different stem placement techniques, especially regarding the anteversion angle of the stem. The aim of this study was to evaluate femoral rotation and stem anteversion following endoprosthetic proximal femoral replacement using two different prosthetic systems, and to investigate their influence on postoperative quality of life. Methods: We retrospectively reviewed 30 patients who underwent endoprosthetic proximal femoral replacement at our institution between 2008 and 2022. The evaluated parameters included patient demographics, anatomical and functional stem anteversion, femoral rotation, femoral resection length, implant type, and Musculoskeletal Tumor Society score. Results: The cohort comprised 16 males and 14 females with a mean age of 65.2 ± 13.5 years. Twenty patients received the Global Modular Replacement System implants and 10 received the Kyocera Modular Limb Salvage System implants. The mean anatomical stem anteversion was 17.0 ± 17.7°, and the mean femoral rotation was 14.4 ± 22.6°. The Global Modular Replacement System implants demonstrated less variability in anatomical stem anteversion (11.7 ± 15.2°) compared to the Kyocera Modular Limb Salvage System (27.6 ± 18.4°, p = 0.02). A significant negative correlation was found between anatomical stem anteversion and femoral rotation (r = −0.78, p < 0.01), and a positive correlation between femoral rotation and functional stem anteversion (r = 0.62, p < 0.01). Musculoskeletal Tumor Society scores were available in 14 patients and correlated significantly with functional stem anteversion (r = −0.62, p = 0.02) and femoral resection length (r = −0.61, p = 0.02), but not with anatomical stem anteversion or femoral rotation alone. Conclusions: This study demonstrated that stem placement angles differ between prosthetic systems. These differences are attributable to variations in surgical implantation techniques and prosthesis design philosophies. In particular, the Global Modular Replacement System incorporates built-in anteversion, and when using such prostheses, referencing the linea aspera enables more stable restoration of the anatomical stem anteversion. Excessive reduction in anatomical stem anteversion is not recommended to avoid excessive external femoral rotation. Full article

Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. We hypothesise that antibacterial coatings and improved soft-tissue techniques reduce infection rates and enhance functional recovery. Methods: A comprehensive narrative review of PubMed, Web of Science, and the Cochrane Library was performed using the terms proximal humerus, shoulder, bone tumor, sarcoma, neoplasm, infection, megaprosthesis, and endoprosthetic replacement. Reference lists were screened manually. Case reports and series with fewer than five patients were excluded. Twenty-seven clinical studies (more than 1100 patients; mainly osteosarcoma, chondrosarcoma, and metastatic lesions) were included and qualitatively analyzed. Results: The reported infection rates ranged from 4% to 20%, with higher risk in patients receiving adjuvant therapy. Silver-coated implants reduced PJI compared with uncoated designs (e.g., 11.2% → 9.2% in primary implants; 29.2% → 13.7% in revisions) without systemic toxicity. Alternative antibacterial coatings (e.g., silver- or copper-enriched hydroxyapatite) showed promising early results but remain supported by limited clinical data. Soft-tissue stabilization with Trevira tube or synthetic mesh improved joint stability and did not increase infection risk. Functional outcomes, usually assessed by MSTS or TESS, were moderate to good (≈60–80%) overall, with better scores when the deltoid and axillary nerve were preserved or when reverse total shoulder arthroplasty was possible. Conclusions: Proximal humerus megaprosthetic reconstruction benefits from meticulous soft-tissue handling, selective use of antibacterial technologies, and multidisciplinary management. The current literature is mainly retrospective, heterogeneous, and non-comparative. Prospective multicenter studies are needed to clarify the long-term effectiveness of silver or alternative coatings, soft-tissue reconstruction techniques, and emerging custom-made 3D-printed prostheses. Full article

Background: Pelvic resections represent some of the most challenging procedures in orthopedic oncology, often necessitating the sacrifice of large bone segments and, subsequently, the loss of nearby soft tissues. Our study aims to evaluate the impact of surgical resections of pelvic bone tumors on the performance of the pelvic floor and digestive, urinary, and genital systems. Methods: We evaluated all malignant or locally aggressive pelvic bone tumors treated with bone resection in our institution between January 2017 and January 2024. The reconstructive approaches were recorded. Pre- and post-operative MRI and CT scans were used to evaluate the grade of pelvic prolapse. The prolapse of the pelvic floor was assessed with the M-line, the H-line, and the anorectal angle. Hydronephrosis was also evaluated. Urinary and fecal incontinence were evaluated with the Pelvic Floor Impact Questionnaire (PFIQ7). Results: Thirty cases were included in our study. Nine cases were treated with custom-made prostheses, five had ice-cone prostheses, two massive allografts, and one composite allograft-prosthesis. The others had no bone reconstruction. Meshes were used to reconstruct the pelvic floor in 9 cases. Patients with discontinuity of the pelvic ring had a significantly higher grade of pelvic prolapse (M-line) and worse PFIQ7 scores. Conclusions: The resection of pelvic bone tumors represents one of the main challenges in orthopedic oncology. While planning surgical demolition and performing the subsequent reconstruction, surgeons should also consider the impact of the surgical treatment on the pelvic floor and surrounding organs. Intra-operative reconstructions and post-operative rehabilitation are advisable. Full article

Background/Objectives: The aim of this systematic review was to identify the role of orthodontics in patients undergoing tumor-ablative surgery, in collaboration with maxillofacial prosthodontic rehabilitation in a multidisciplinary fashion. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024582050). The focused question was constructed using the PICO (participant, intervention, comparison, and outcome) approach. A three-stage search was performed in PubMed, Scopus, and Web of Science using Medical Subject Heading (MeSH) terms. To assess the risk of bias, the National Institute of Health (NIH) “Quality Assessment Tool for case series/reports” was used. All data was synthesized qualitatively, according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results: The initial search yielded 624 articles, of which 22 met the inclusion criteria after screening and eligibility assessment, with most being single-patient case reports and one case series involving 12 patients. The included studies primarily involved tumors in the mandible (64.5%) and maxilla (32.3%). Orthodontic treatment was initiated at various time points, ranging from one month pre-surgery to 19 years post-surgery, primarily utilizing fixed appliances (77.8%). In some studies, orthodontic appliances were used to enhance the stability of maxillofacial prostheses. The results of this study indicate that orthodontic treatment may facilitate prosthetic rehabilitation by improving conditions prior to prosthetic intervention and increasing the retention of the obturator prosthesis. Conclusions: Orthodontic treatment can enhance maxillofacial prosthetic rehabilitation after tumor-ablative surgery by optimizing jaw growth, improving occlusion, and facilitating prosthetic retention or space creation. Further research is needed to establish treatment guidelines. Orthodontic miniscrews may improve temporary prosthesis retention before final implant placement, when indicated. Full article

Three-dimensional (3D)-printing technology is revolutionizing orthopedic oncology by providing precise, customized solutions for complex bone defects following tumor resection. Traditional modular endoprostheses are prone to complications such as fretting corrosion and implant failure, underscoring the need for innovative approaches. This case series reports on three patients treated with 3D-printed, patient-specific prostheses and cutting guides. Preoperative CT and MRI data were used to design implants tailored to each patient’s anatomy, manufactured using electron beam melting technology with a titanium–aluminum–vanadium alloy. Functional outcomes showed significant improvements: in Case I, AOFAS improved from 71 to 96, and VAS decreased from 6 to 1; in Case II, AOFAS increased from 65 to 79, and VAS decreased from 5 to 3. Radiographic evaluations demonstrated stable prosthesis placement and early evidence of bone integration in Cases I and II, while in Case III, localized disease control was achieved before systemic progression. This case series highlights the transformative potential of 3D-printed prostheses in addressing the challenges of reconstructing anatomically complex defects. By enabling precise tumor resection and improving functional outcomes, this approach can advance current practices in orthopedic oncology. Further research should explore larger cohorts and use cost-effectiveness analyses to validate these findings and facilitate broader clinical adoption. Full article

(1) Background: The use of tumor megaprostheses faces challenges, but the published series are typically small and offer limited solutions. Our aim was to compile a large series; describe patient profiles and surgical techniques; analyze prosthetic survival identifying factors affecting survival; and provide a basis for future subanalyses. (2) Methods: This is a retrospective observational multicenter study that included patients with a tumor megaprosthesis in any anatomical location. Demographic, etiologic, and surgical variables were analyzed. Data on complications and survival were also collected. (3) Results: Our series includes a total of 816 prostheses (585 primary, 181 revision, and 50 second revision). The patients’ mean age was 44.2 ± 20.8 years. Primary surgeries were performed on the femur (n = 404; 69.1%), tibia (n = 79; 13.5%), humerus (n = 74; 12.6%), pelvis (n = 20; 3.4%), and scapula (n = 4; 0.7%). Survival following primary surgery was 73.3% at 10 years. No statistically significant differences were found with respect to survival from primary surgery between males and females (p = 0.194), between the different etiologies (p = 0.540), or between the lower and the upper limb (p = 0.618). In contrast, statistically significant survival differences were found when the type of fixation was analyzed (p < 0.001). (4) Conclusions: This study analyzed one of the largest series of patients treated with tumor megaprostheses, demonstrating their acceptable survival and validating them as a treatment option for bone tumors. Full article

The optimal management of bone tumors requires a multidisciplinary strategy to guarantee high-quality care. At specialized centers, the medical team responsible for managing patients with bone cancer comprises oncologists, surgeons, radiologists, pathologists, and rehabilitation specialists. The goal of treatment is to achieve long-term survival with minimal disability and pain. Postoperative rehabilitation is a fundamental therapeutic approach to enhance functionality and sustain the utmost quality of life following a limb-sparing surgery. Currently, megaprostheses are used for reconstructing bone defects after tumor resection, but in the literature, only a few studies have investigated rehabilitation outcomes in terms of functionality and impact on daily activities. This narrative review explores the functional and quality of life outcomes after the implantation of MUTARS^® prostheses in patients with lower extremity bone tumors. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: “MUTARS”, “Megaprosthesis”, “bone”, “tumors”, “metastasis”, “lower limb”, “rehabilitation”, “outcome”, and “quality of life”, and 10 studies were included. The most frequent oncological pathology was found to be primitive bone tumors treated with modular prostheses. The outcome measures used were the Henderson et al. classification, Harris Hip Scale, Musculoskeletal Tumor Society score, Visual Analog Scale, Range Of Motion, Karnofsky Performance Scale, and quality of life questionnaire. MUTARS^® is a well-established treatment option after bone tumor resection, although it involves extensive and complex post-resection reconstruction that exposes joints and tissues to substantial mechanical stress. Proper rehabilitation after MUTARS^® surgery is a fundamental therapeutic step, although there is still insufficient evidence in the literature focusing on functional and rehabilitative outcomes. Therefore, more studies and guidelines are needed to define standardized rehabilitation protocols for clinical practice after orthopedic oncologic surgery. Full article

This study aimed to retrospectively analyze the follow-up results of cases in which the adjacent joint was preserved using a custom-made uncemented short-stem design (hollow stem) with optional external flanches in tumor endoprosthetic replacement due to bone sarcomas in 13 patients (with an average age of 9.6 years) between 2017 and 2023. Reconstructions were proximal femur (n = 6), intercalary femur (n = 4), intercalary tibia (n = 2), and proximal humerus (n = 1) tumor prostheses. The hollow body was used distally in 10 of the megaprotheses, proximally in 1, and both proximally and distally in 2 of them. The average distance from the joints was 6 cm in stems with flanches and 11.8 cm in stems without flanches. No aseptic loosening or deep infection was observed during an average follow-up of 34 months. Except for one case with a tibial intercalary prosthesis that needed a revision, all cases were well osteointegrated and all lower extremity cases could bear full weight without pain. In cases where the remaining bone stock after bone resection is insufficient for a standard stem implantation, reconstruction with a patient-specific short hollow-stem design appears to be a good alternative to protect healthy joints with high prosthesis survival and low revision rates in the short-term follow-up. Full article

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2–3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient’s hemodynamic status, adequate hydration and positioning during the procedure. Full article

Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections. Full article

Megaprostheses are well-known, reliable, and effective reconstruction prostheses used in oncologic surgery for limb salvage in patients affected by primary or metastatic bone tumors. Rehabilitation plays a major role after MUTARS replacement, with the aim of improving function after surgery and maintaining the highest possible quality of life. Only a few studies have been published about the use of megaprostheses for the upper limb. The aim of this narrative review is to describe the results of functional and rehabilitative outcomes of patients affected by bone primary or metastatic bone cancer of the upper limb and surgically treated with MUTARS prostheses. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: “Mutars”, “Megaprosthesis”, “bone”, “tumors”, “metastasis”, “upper limb”, “rehabilitation”, “outcome”, “quality of life”, and 10 studies were included. The most frequent oncological pathology was found to be metastases of the proximal humerus treated with modular endoprosthesis or modular reverse implants. Outcome measures used were ROM, MSTS, ASES, DASH, Constant-Murley score, Enneking score, VAS, MEP, TESS, and WOSI. Reconstruction of the proximal humerus with the MUTARS system seemed to be a valid treatment option after bone tumor resection. Rehabilitation after MUTARS surgery is very relevant, but currently, functional and rehabilitative outcomes are inadequately represented in the literature. Hence, further studies are needed to define standardized rehabilitation protocols after oncological orthopedic surgery that can be applied routinely in clinical practice. Full article

(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with “pseudotumors” associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision. Full article

The aim of this retrospective cross-sectional study was to comprehensively assess masticatory function in maxillectomy patients with functioning removable prostheses. Their general and oral profiles, the measurement values of their oral functions, including masticatory function, and the history of tumor therapy were extracted from medical charts. The correlations of masticatory function with numerical data and the effects of tumor therapy-related factors on masticatory function were evaluated. In addition, a stepwise conditional logistic regression analysis was performed to identify the potential predictive factors comprehensively. The data from 55 maxillectomy patients revealed that the median value of masticatory function (138.0 mg/dL) was higher than the threshold (100.0 mg/dL) based on the concept of oral hypofunction. Moderate correlations of masticatory function with the number of remaining teeth, the number of functioning occlusal supports, and maximum occlusal force were found, as well as a weak correlation with maximum tongue pressure. These variables also showed statistically significant coefficients (p < 0.01). No significant effect of each tumor therapy-related factor on masticatory function was detected. A logistic regression analysis identified the number of functioning occlusal supports as a significant predictive factor. These results implied the crucial interactions of masticatory function with various factors and the specificities of maxillectomy patients. Full article