Enhancing surgical margins: A key to survival in pelvic chondrosarcoma.

Introduction: Pelvic chondrosarcoma, originating in the cartilaginous tissue of the pelvis, presents unique surgical challenges due to its proximity to critical neurovascular structures and essential organs. The aim of this study was to explore the effect of changes in practice and improvements in understanding on the outcomes for patients undergoing surgery for pelvic chondrosarcoma.

Material And Methods: The study comprised a retrospective analysis of 216 patients making up 2 patient cohorts drawn from a single centre over 2 time periods (2003-2012 and 2013-2022).

A pictographic guide for decision making in surgery for pelvic bone sarcoma.

Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial.

Unusual soft tissue metastases in a patient with chondrosarcoma: a case report.

Chondrosarcoma (CS) is the second most frequent primary malignant bone tumour, characterized by production of non-osteoid cartilage matrix. Up to more than 30% of patients with CS present distant metastases, and the lungs represent the preferred site. Hence, CS soft tissue metastases and superficial cutaneous lesions are extremely rare.

Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors?

Background: Peripheral osteochondral tumors are common, and the management of tumors presenting in the pelvis is challenging and a controversial topic. Some have suggested that cartilage cap thickness may indicate malignant potential, but this supposition is not well validated.

Questions/purposes: (1) How accurate is preoperative biopsy in determining whether a peripheral cartilage tumor of the pelvis is benign or malignant? (2) Is the thickness of the cartilage cap as determined by MRI associated with the likelihood that a given peripheral cartilage tumor is malignant? (3) What is local recurrence-free survival (LRFS), metastasis-free survival (MFS), and disease-specific survival (DSS) in peripheral chondrosarcoma of the pelvis and is it associated with surgical margin?

Methods: Between 2005 and 2022, 289 patients had diagnoses of peripheral cartilage tumors of the pelvis (either pedunculated or sessile) and were treated at one tertiary sarcoma center (the Royal Orthopaedic Hospital, Birmingham, UK).

An unusual cystic presentation of pelvic skeletal Ewing sarcoma: a case series.

Ewing sarcoma (ES) is the second most common primary malignant bone tumour in children and adolescents. About 14.5% of primary malignancies develop in pelvic bones, where they typically have worse prognoses than extremity or acral sarcomas.

Incidence of avascular necrosis of native femur following hip transposition surgery for periacetabular malignancies: a single-centre experience.

Background: Hip transposition surgery after surgical resection of large pelvic tumours is a well-established alternate to endoprosthetic reconstruction. The major goals of surgery are to ensure adequate resection margins with limb salvation, albeit with acceptable levels of morbidity. While surveillance is aimed at diagnosing local recurrence or distant metastasis primarily, other complications may occasionally be seen.

An unusual case of metastatic melanoma in subcutaneous tissue presenting as a solitary cystic mass with fluid levels.

Malignant melanoma is a common and often aggressive neoplasm of the skin arising from melanocytes. Metastatic melanoma is known for its diverse clinical manifestations, and can present with atypical features prior to diagnosis of the primary lesion, which can pose a diagnostic challenge. We report a rare case of metastatic melanoma in a 67 year-old male who presented with a painless, enlarging mass in the right axilla over a 4 week period.

Periostitis Ossificans: Largest Case Series with Review of Literature.

 Periostitis ossificans (PO) are rare, benign ossifying surface lesions characterized by the centripetal ossification with osseous and soft-tissue edema. Their clinicoradiological appearances can easily mimic those of more sinister or infective surface lesion.  This study aimed to explore the various anatomical locations and muscle attachment at the site of PO, and evaluate the role of complementary image findings in patients presenting at our tertiary orthopaedic referral center.

Intraosseous conventional central chondrosarcoma does not metastasise irrespective of grade in pelvis, scapula and in long bone locations.

Background: Histological grade has been regarded as the most important prognostic factor in conventional central chondrosarcoma. To evaluate whether the presence of an extraosseous tumour component is associated with a decreased metastasis-free survival or disease-specific survival and alternatively to develop a simple prognostic and clinical decision-making tool.

Material And Methods: We searched two prospectively maintained international sarcoma centre databases for primary non metastatic central conventional chondrosarcomas of all grades in pelvis, scapula or long bone location, undergoing curative treatment, diagnosed between 2000 and 2020.

Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review.

Background: Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours.

Aims: In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted.

Assessing ChatGPT's ability to pass the FRCS orthopaedic part A exam: A critical analysis.

Unlabelled: AI technology has made significant advancements in recent years, with the notable development of ChatGPT in November 2022. Users have observed evidence of deductive reasoning, logical thinking, and coherent thought in ChatGPT's responses. This study aimed to determine if ChatGPT has the capability to pass the Orthopaedic Fellow of the Royal College of Surgeons (FRCS Orth) Part A exam.

Iliotibial band friction syndrome after knee cementoplasty: a case report.

Iliotibial band pathologies can result in lateral knee pain. These are commonly seen in runners and cyclists. Lateral knee pain following knee arthroplasty can be due to distal iliotibial band enthesopathy or impingement by the femoral component.

Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee.

Aims: Intra-articular (IA) tumours around the knee are treated with extra-articular (EA) resection, which is associated with poor functional outcomes. We aim to evaluate the accuracy of MRI in predicting IA involvement around the knee.

Methods: We identified 63 cases of high-grade sarcomas in or around the distal femur that underwent an EA resection from a prospectively maintained database (January 1996 to April 2020).

Outcomes of distal radial endoprostheses for tumour reconstruction: a single centre experience over 15 years.

We report a retrospective study over a 15-year period, between 2005 and 2020, evaluating clinical and functional outcomes in patients who underwent reconstruction of the distal radius with an endoprosthetic replacement following excision of both malignant and aggressive benign bone tumours. Data was collected retrospectively from a prospectively maintained electronic database, and prospectively via telephone patient consultation. Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were assessed at a minimum of 1 year postoperatively.

Clear Cell Chondrosarcoma-Oncological Outcomes in an Asian Cohort.

Clear cell chondrosarcoma is a rare subtype of chondrosarcoma, included in the category of low-grade (grade 1) sarcomas of the bone. We evaluated the results of treatment of these rare tumours at our institute and documented their outcomes in a hitherto unreported ethnic (Asian) cohort. Of the 480 extremity and pelvic chondrosarcomas diagnosed between January 2006 and December 2017 at our institute, 12 (2.

Outcomes of soft-tissue sarcoma in nonagenarians.

Aims: Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients.

Methods: Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99).

Importance of Skeletal Staging in Chondrosarcoma of Bone: Results of Survey on Current Practices Among Musculoskeletal Oncologists.

Purpose: There are no clear guidelines for staging of conventional chondrosarcoma. We conducted an online survey to determine the current practices for skeletal staging for conventional chondrosarcoma among practicing oncologists and to assess any discrepancy in practices and with the published literature.

Methodology: A simple ten-question online survey (e-mails and WhatsApp) was conducted among practicing oncologists over a period of 3 weeks using online portal (surveymonkey.

Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis?

Aims: Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis.

Methods: We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018.

Pelvic Ewing sarcoma: Should all patients receive pre-operative radiotherapy, or should it be delivered selectively?

Background: Locally recurrent disease following surgical resection of Ewing sarcoma (ES) confers a poor prognosis. Limited evidence is available evaluating non-selective use of pre-operative radiotherapy (RT) for patients with pelvic ES and its effect on local control and survival.

Patients And Methods: 49 consecutive patients with pelvic ES were identified retrospectively from a prospectively collated database.

'Umbrella construct' - an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours.

Aim: Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique '' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated.

Navigation-assisted pelvic resections and reconstructions for periacetabular chondrosarcomas.

Objectives: Survival in patients with chondrosarcomas has not improved over 40 years. Although emerging evidence has documented the efficacy of navigation-assisted surgery, the prognostic significance in chondrosarcomas remains unknown. We aimed to assess the clinical benefit of navigation-assisted surgery for pelvic chondrosarcomas involving the peri-acetabulum.

Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma?

Background: Staging of a bone sarcoma before initiating treatment helps orthopaedic oncologists determine the intent of treatment and predicting the prognosis. As per National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, there are no exclusive recommendations for chondrosarcoma staging. They are staged similar to other bone sarcomas even though skeletal metastases are extremely rare in chondrosarcomas.

Principles of Management of Spine Metastasis.

Background: With evolution of medicine, radiation therapy and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. The most common site of skeletal metastases from other primary malignant neoplasms is the spine, hence, understanding the epidemiology of metastatic spine disease and its presentation is essential for developing a diagnostic and treatment strategy which eventually results in optimum care to reduce disease-related morbidity.

Purpose: With this review article we intend to describe an evidence-based review on the presentation, diagnosis and treatment of metastatic spinal disease.