Outcomes of Scapular Osteosarcoma.

Background/aim: Scapular osteosarcoma is a rare malignancy, and the understanding of its optimal treatment strategies and long-term outcomes remains limited. The purpose of the current study was to evaluate our institutional experience.

Patients And Methods: We reviewed 14 patients (8 females, 5 males; mean age 44±17 years) treated for scapular osteosarcoma from 1985 to 2022.

Upper Extremity Mass as First Presentation of Metastatic Urothelial Carcinoma.

A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of metastatic disease at the time of diagnosis of urothelial carcinoma is rare, with metastases to the upper extremities even less common.

Do All Postoperative Vancouver B2 Fractures Require Revision Arthroplasty With Cementless Stems?

Background: Management of periprosthetic fractures has been guided by the Vancouver classification, which recommends revision for fractures around a loose femoral implant (B2). New studies have challenged this approach, demonstrating acceptable outcomes with internal fixation. This study evaluates our experience with Vancouver B2 fractures, comparing internal fixation to femoral revision.

Dexamethasone, Glycemic Control, and Outcomes in Patients With Type 2 Diabetes Mellitus Undergoing Elective, Primary Total Joint Arthroplasty.

Background: Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.

Methods: All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified.

Patient specific implants versus conventional implants in primary total knee arthroplasty: No significant difference in patient reported outcomes at 5 years.

Background: Patient specific implants (PSI) represent a novel innovation aimed to improve patient satisfaction and function after total knee arthroplasty (TKA); however, longitudinal patient reported outcome measures (PROMs) for PSI are not well described. We sought to primarily evaluate PROMs of patients undergoing TKA with either PSI or off-the-shelf (OTS) implants at mid-term follow-up.

Methods: A retrospective review was performed on a prospectively collected cohort of 43 primary, cruciate-retaining TKAs performed with PSI (n = 23) and OTS implants (n = 20) by a single surgeon.

Soft Tissue Tumors: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective.

This article focuses on soft tissue sarcomas, including the workup, management, and potential complications in dealing with these rare mesenchymal tumors. We present the information that is critical in the decision-making process for orthopedic oncologists to help facilitate a multidisciplinary approach to these complex cases.

Skeletal Sarcomas: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective.

This article focuses on skeletal sarcomas, a group of rare, heterogenous malignant tumors. We present information on the multi-disciplinary approach to the diagnosis, staging, treatment, and surveillance of these complex tumors that are critical to enhancing function and improving survival.

Immersive Virtual Reality Used as Adjunct Anesthesia for Conversion Total Hip Arthroplasty in a 100-Year-Old Patient.

Immersive virtual reality (IVR) is an adjunctive form of anesthesia intended to distract patients from their intraoperative environment and reduce other side effects of sedating or narcotic agents. While this technology has been applied sparingly in various orthopedic procedural environments, its clinical utility has not been widely evaluated in major, nonelective surgical settings. The use of IVR in the geriatric hip fracture population represents a novel indication with potential benefit to reduced cognitive dysfunction and delirium.

A Comparison of Interobserver Reliability Between Orthopedic Surgeons Using the Centers for Disease Control Surgical Wound Class Definitions.

Background: The Centers for Disease Control (CDC) created a classification to help stratify surgical wounds based on contamination and risk of developing a surgical site infection. The classification includes four options (I to IV) depending on the level of contamination present. Although universally applied to a variety of surgical specialties, it is unknown whether the current system is reliable when considering orthopaedic surgeries.

Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures.

Background: Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral).

Reconstruction of Quadriceps Muscle Function Using the Latissimus Dorsi Muscle Transfer in an Elderly Patient: A Case Report.

Case: We report a case of a 71-year-old man diagnosed with high-grade undifferentiated pleomorphic sarcoma in the left thigh. He underwent partial resection of the quadriceps and proximal femoral bone, followed by reconstruction with a latissimus dorsi free muscle flap through end-to-end vascular and nerve anastomosis with the femoral vessels and a branch of the femoral nerve, respectively. Recovery of 3/5 knee extension function was achieved 3 months postsurgery without complications.

A Crossover Cohort of Direct Anterior vs Posterolateral Approach in Primary Total Hip Arthroplasty: What Does the Patient Prefer?

Background: The utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) continues to markedly increase. Despite proposed advantages, there are limited data regarding outcomes of staged bilateral THA via 2 different approaches in the same patient. The purpose of this study was to elucidate patient perspective on the THA approach in a crossover cohort of patients who underwent consecutive THAs via the posterolateral approach (PLA) followed by a contralateral DAA.

Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery.

Introduction: Indocyanine green (ICG) angiography is a novel technology that has been predictive of postoperative wound complications. It is unknown whether this technology can successfully predict complications after sarcoma resection. In this study, we aimed to evaluate the sensitivity and specificity of ICG angiography in predicting postoperative wound complications after soft-tissue sarcoma resection.

Robotic-Assisted versus Manual Total Knee Arthroplasty in a Crossover Cohort: What Did Patients Prefer?

Background: Robotic-assisted total knee arthroplasty represents an increasingly utilized surgical technology; however, there remains clinical question whether the technique produces improved clinical and patient-reported outcomes. The purpose of this study was to evaluate early clinical outcomes and patient preference of robotic-assisted total knee arthroplasty (rTKA) versus manual TKA (mTKA) in a direct crossover cohort of patients who underwent consecutive TKAs by each technique.

Materials And Methods: A retrospective chart review and telephone interview was performed on 36 patients who underwent both rTKA and mTKA by a single surgeon between 2012-2018.

Mycobacterium abscessus Prosthetic Joint Infections of the Knee.

complex prosthetic joint infections (PJI) of the knee are rare. We present a patient with , a nontuberculous mycobacterium (NTM), peri-prosthetic knee infection who presented with wound drainage followed by sepsis. The published peer-reviewed literature on knee PJIs due to this organism is reviewed to highlight its clinical presentation,symptomatology, microbiology, surgical interventions, antimicrobial regimens, and outcomes.

Survival, Tumor Recurrence, and Function Following Shoulder Girdle Limb Salvage at 24 to 35 Years of Follow-up.

Limb salvage is the treatment of choice for malignant shoulder girdle tumors; however, there is a paucity of data examining the long-term outcome. The authors have previously reported on a cohort of patients at short- and mid-term follow-up. The purpose of this study was to report the long-term outcome of shoulder reconstruction in terms of oncological and functional outcome.

Adamantinoma of bone: Long-term follow-up of 46 consecutive patients.

Background: Adamantinomas are rare bone tumors, commonly affecting the tibia. Due to the rare nature of disease, previous studies are small or from multiple centers. The purpose of this study is to investigate outcomes of patients with adamantinoma treated in a single institution.

Tumor-Like Conditions of the Hand and Upper Extremity.

Tumor-like conditions of the hand and upper extremity typically present as masses and can be confused as more serious conditions. The differential diagnosis of these lesions can cross over with many more commonly recognized benign and malignant upper limb tumors, and it is, therefore, important for the hand surgeon to be familiar with tumor-like conditions. The diagnosis of these lesions often can be made on clinical grounds supported by a careful physical examination and plain film radiography.

Regional anesthesia for a total knee arthroplasty on an adult patient with spastic diplegia and an intrathecal baclofen pump.

We describe the clinical presentation of a patient with spastic diplegia, and its unique perioperative challenges. Opioids and antispasmodic medications are the primary therapy for managing pain and spasticity in the perioperative setting. However, such combination results in several side-effects and their sedative properties are synergistic.

Recurrent myxoinflammatory fibroblastic sarcoma: a case report.

Myxoinflammatory fibroblastic sarcoma is a rare sarcoma which typically presents in the extremities and is treated by definitive surgery. In recurrent disease, the reported utilization of radiotherapy is increasing, and more modern techniques such as intensity-modulated radiotherapy may be improving long-term outcomes.

Osteoid osteomas of the foot and ankle: a study of patients over a 20-year period.

Osteoid osteomas (OOs) are common benign bone tumors that seldom occur in the foot or ankle. Patients typically complain of pain that is worse at night and is relieved with use of nonsteroidal anti-inflammatory drugs. Previous studies of treating these lesions in the foot and ankle have been limited to case reports.

Musculoskeletal tumor imaging: an orthopedic oncologist perspective.

Imaging of a musculoskeletal tumor or lesion is vital for the proper diagnosis and treatment of a patient. There are critical questions for the orthopedic oncologist that musculoskeletal imaging should answer. Is the lesion demonstrating benign or malignant characteristics? Where are the vital structures located in relationship to the lesion? Are there any other regional metastases? Where should an image-guided or open biopsy be performed to allow for limb salvage? What surgical resection will allow adequate margins with the goal of preserving as much function as possible? Decisions regarding biopsies and surgical planning are ideally made by a collaborative discussion between the treating orthopedic oncologist and the radiologist.