Distal femoral osteoarticular allografts: long-term survival, but frequent complications.

Background: Complications are frequent with osteoarticular allografts, and their long-term survivorship in the distal femur is unclear. Thus, the benefits of osteoarticular allografting remain controversial.

Questions/purposes: We therefore determined the frequency of complications in osteoarticular allografts of the distal femur relative to their potential long-term survival.

The current practice of orthopaedic oncology in North America.

Background: The field of orthopaedic oncology in North America has been formalized over the past 30 years with the development of the Musculoskeletal Tumor Society (MSTS) and fellowship education opportunities.

Questions/purposes: To characterize current practices we assessed the fellowship education, practice setting, constitution of clinical practice, bone and soft tissue sarcoma treatment volume, perceived challenges and rewards of the career, and the nonclinical activities of orthopaedic oncologists.

Methods: Members of the MSTS and attendees of the 2009 AAOS-MSTS Specialty Day meeting were invited to participate in a twenty-three question online survey.

History of orthopedic oncology in the United States: progress from the past, prospects for the future.

Orthopedic oncology in the United States has its roots in European medicine of the 1800s in which sarcomas were first classified on the basis of their gross characteristics (1804) and amended on the basis of their histologic features (1867). Surgical management, local excision, with unacceptable mortality gave way to amputation in the 1870s and remained so, until limb-sparing resection was cautiously embarked upon in the mid 1900s. Nonsurgical adjuvant was first devised in the 1880s (as Coley's toxins) but remained largely ineffective until the advent of chemotherapy in the 1970s.

The management of adult soft tissue sarcomas.

Soft tissue sarcomas are a relatively rare, heterogeneous group of tumors arising from mesenchymal tissues and occurring almost anywhere in the body. The rate of progression and likelihood of hematogenous dissemination, usually to the lung, is determined primarily by tumor grade. The likelihood of regional spread is low.

Effects of a new allograft processing procedure on graft healing in a canine model: a preliminary study.

Graft healing in vivo can be affected by allograft processing. We asked whether a new processing technique influenced graft-host healing compared with autograft and a standard processing technique in a canine ulna model. We used bilateral intercalary allografts or autografts in the ulna of 13 skeletally mature male coonhounds.

Fibrous dysplasia. Pathophysiology, evaluation, and treatment.

Fibrous dysplasia is a common benign skeletal lesion that may involve one bone (monostotic) or multiple bones (polyostotic) and occurs throughout the skeleton with a predilection for the long bones, ribs, and craniofacial bones. The etiology of fibrous dysplasia has been linked to an activating mutation in the gene that encodes the alpha subunit of stimulatory G protein (G(s)alpha) located at 20q13.2-13.

Allograft bone decreases in strength in vivo over time.

Allograft bone is the primary source of graft material for structural oncological limb salvage procedures. Failure rates after massive allograft reconstructions have been reported as high as 60% at 10 years, which are associated with a multitude of biologic processes influencing the graft incorporation and functional capacity. It is unknown if mechanical failure is associated with a gradual loss of bulk material properties of the bone (strength and modulus), loss of bone mineral density, osteoclastic resorption of the allograft, unrepaired allograft microfractures or microcracks, and/or local stress concentration within the tissue.

A system for the surgical staging of musculoskeletal sarcoma. 1980.

Historically, an adequate surgical procedure has been the most effective means of treating the majority of primary musculoskeletal sarcomas, and amputation has figured prominently in the surgical armamentarium. 4, 7, 9, 19, 21, 29, 41 The recent evidence that certain chemotherapeutic agents may have significant anti-sarcoma activity 2, 15, 17, 38 and coincident technical advances in irradiation therapy, radiographic localization, and reconstructive surgery have fostered enthusiastic interest in extremity-saving treatments. Almost all such treatments emphasize limb salvage as an alternative to amputation and are usually performed under a protective cloak of adjunctive chemotherapy, irradiation or immunoactive agents.

Radiation therapy for giant cell tumors of bone.

For giant cell tumors of bone, does radiotherapy provide a safe and effective treatment? This retrospective review includes 24 patients with 26 histologically diagnosed tumors treated with megavoltage radiotherapy between March 1972 and July 1996. Of the 10 recurrent tumors, five had an intralesional resection, two had a biopsy, and three had no biopsy before radiotherapy. Of the 16 previously untreated tumors, one was irradiated after a marginal resection, five after an intracapsular resection, and 10 after biopsy alone.

External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis.

Purpose: To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the presentation and treatment variables predictive of locoregional control.

Methods And Materials: Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence.

Whole-lung radiotherapy for giant cell tumors of bone with pulmonary metastases.

Three patients initially diagnosed with benign giant cell tumors of bone who had lung metastases develop were treated with whole-lung radiotherapy as part of the therapeutic treatment of their distant disease. External beam therapy to 16 Gy in 10 fractions was delivered to the whole lung, with a boost of 35 to 45 Gy to sites of gross metastatic disease. One patient's lung metastases progressed after treatment, and the patient soon died.

The effect of contaminated surgical margins revisited.

The current study was done to assess the oncologic outcomes after inadvertent intraoperative contamination in the treatment of musculoskeletal sarcomas, to determine the prognostic significance of these events. Forty-three patients with malignant lesions and either positive margins or intraoperative tumor penetration are included in the study. There were 12 bone lesions and 31 soft tissue lesions.

Metal-associated angiosarcoma of bone: report of two cases and review of the literature.

Angiosarcoma is an extremely rare bone tumor. The authors report two cases of patients with angiosarcoma that developed adjacent to a stainless steel plate used for fixation of a femur fracture. In both patients, the interval between fracture treatment and the development of the neoplasm was more than 40 years.