Primary malignant bone tumors are extremely rare. Osteosarcoma, chondrosarcoma, Ewing's sarcoma, and myeloma are the most common malignancy in bone. Osteosarcoma and Ewing's sarcoma are common in children and adolescents, and the tumors are high lethality due to the high rate of pulmonary metastasis. While chondrosarcoma, myeloma, and chordoma are more common in middle aged and elderly people. Japanese Orthopaedic Association (JOA) published the secondary clinical practice guideline on the management of primary malignant bone tumors. We put an emphasis on explanation some important issue of this guideline for help Chinese musculoskeletal tumor professionals in clinical practice.
Humans ; Bone Neoplasms/surgery* ; Chondrosarcoma/therapy* ; Japan ; Orthopedics ; Osteosarcoma/pathology* ; Practice Guidelines as Topic ; Sarcoma, Ewing/therapy* ; Societies, Medical

OBJECTIVE: To explore the effectiveness of artificial hemi-knee prosthesis reconstruction for bone defects after resection of pediatric osteosarcoma. METHODS: A retrospective analysis was conducted on the clinical data of 18 children with osteosarcoma who met the selection criteria and were treated between January 2016 and December 2019. There were 11 males and 7 females, aged 6-10 years (mean, 8.9 years). Osteosarcoma located in the distal femur in 11 cases and the proximal tibia in 7 cases. Among them, 12 cases were conventional osteosarcoma and 6 cases were small cell osteosarcoma, with a disease duration of 1-9 months (mean, 3.1 months). All patients received 2 cycles of preoperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. After en bloc tumor segment resection, bone defects were reconstructed using custom-made artificial hemi-knee prostheses. Rehabilitation training was initiated at 8 weeks postoperatively under the protection of a knee immobilizer brace, combined with 4 cycles of adjuvant chemotherapy. During follow-up, lower limb growth length and limb shortening (compared with the healthy side) were measured, and limb function was evaluated using the Musculoskeletal Tumor Society-93 (MSTS-93) scoring system. RESULTS: All surgeries were successfully completed, with an operation time of 2.0-3.1 hours (mean, 2.4 hours) and intraoperative blood loss of 180-320 mL (mean, 230.0 mL). Incisional edge necrosis occurred in 1 case at 10 days postoperatively, while the incisions of the remaining 17 patients healed by first intention. One case developed periprosthetic infection caused by Staphylococcus aureus at 1 week postoperatively, which was cured after symptomatic treatment. All 18 patients were followed up 60-96 months (mean, 74.2 months). No local tumor recurrence was observed during follow-up. Imaging examinations showed prosthesis loosening in 2 cases, while the prosthesis of other patients were well-positioned. At last follow-up, the knee joint range of motion was 80°-120° (mean, 106.7°). The MSTS-93 score was 16-29 (mean, 24.7), with 12 cases rated as excellent, 5 good, and 1 fair. The patients' height increased by 12.8-20.0 cm (mean, 15.5 cm), the lower limb growth length was 6.0-13.0 cm (mean, 9.7 cm), and limb shortening was 1.8-4.6 cm (mean, 3.1 cm). There was no significant difference in MSTS-93 scores, lower limb growth length, or limb shortening between the distal femur group and the proximal tibia group ( P>0.05). CONCLUSION Artificial hemi-knee prosthesis reconstruction can preserve the adjacent normal epiphysis of the knee joint, maximize limb growth potential, and reduce adult limb length discrepancy, making it a suitable reconstruction option for children with knee osteosarcoma.
Humans ; Osteosarcoma/surgery* ; Male ; Child ; Female ; Knee Prosthesis ; Retrospective Studies ; Bone Neoplasms/surgery* ; Plastic Surgery Procedures/methods* ; Tibia/surgery* ; Femur/surgery* ; Arthroplasty, Replacement, Knee/methods* ; Treatment Outcome ; Chemotherapy, Adjuvant ; Femoral Neoplasms/surgery*

OBJECTIVE: To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection. METHODS: Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded. RESULTS: All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients. CONCLUSION Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.
Adult ; Female ; Humans ; Male ; Allografts/pathology* ; Bone Neoplasms/surgery* ; Bone Resorption/pathology* ; Bone Transplantation/methods* ; Femur/surgery* ; Osteosarcoma/pathology* ; Prostheses and Implants ; Retrospective Studies ; Treatment Outcome ; Young Adult ; Middle Aged

Humans ; Solitary Fibrous Tumors/pathology* ; Osteosarcoma/pathology* ; Fibrosarcoma ; Bone Neoplasms/surgery*

Bone Neoplasms/surgery* ; Hospitals ; Humans ; Neoplastic Cells, Circulating ; Osteosarcoma/surgery* ; Pilot Projects

The paper outlines the achievements and challenges in the additive manufacturing (AM) application to veterinary practice. The state-of-the-art in AM application to the veterinary surgery is presented, with the focus of AM for patient-specifi c implants manufacturing. It also provides critical discussion on some of the potential issues design and technology should overcome for wider and more eff ective implementation of additively manufactured parts in veterinary practices. Most of the discussions in present paper are related to the metallic implants, manufactured in this case using so-called powder bed additive manufacturing (PB-AM) in titanium alloy Ti–6AL–4V, and to the corresponding process of their design, manufacturing and implementation in veterinary surgery. Procedures of the implant design and individualization for veterinary surgery are illustrated basing on the four performed surgery cases with dog patients. Results of the replacement surgery in dogs indicate that individualized additively manufactured metallic implants signifi cantly increase chances for successful recovery process, and AM techniques present a viable alternative to amputation in a large number of veterinary cases. The same time overcoming challenges of implant individualization in veterinary practice signifi cantly contributes to the knowledge directly relevant to the modern medical practice. An experience from veterinary cases where organ-preserving surgery with 3D-printed patient-specifi c implants is performed provides a unique opportunity for future development of better human implants.
Alloys ; Amputation ; Animals ; Dogs ; Humans ; Osteosarcoma ; Surgery, Veterinary ; Titanium

OBJECTIVES: In order to assess clinical behavior, response to treatment, and factors influencing prognosis of Korean patients with osteosarcoma of the jaws (OSJ). MATERIALS AND METHODS: A retrospective study of clinical, and pathological records of 26 patients with OSJ treated at the Department of Oral and Maxillofacial Surgery in Yonsei University Dental Hospital from 1990 to March 2017. RESULTS: Of 26 patients, there were 9 men (34.6%) and 17 women (65.4%). Twenty-one of 26 patients had osteosarcoma of the mandible, and 5 of 26 patients had osteosarcoma of the maxilla. The histopathology of OSJ is highly variable, ranging from chondroblastic type (6 out of 26), osteoblastic type (10 out of 26), fibroblastic type (2 out of 26), to the rare variants like mixed type, small cell osteosarcoma types and more. All patients underwent gross total excision and only a few patients underwent neoadjuvant chemotherapy. Postoperative chemotherapy was given to most of the patients as adjuvant treatment or in combination with radiotherapy. The overall survival rate was 73.1% with an overall 2-year survival rate of 83.3%. The overall 5-,10-,15-year survival rates in this study were 73.5%, 73.5%, 49%, respectively. Using Kaplan-Meier analysis with log rank tests, the size of tumor (T-stage), and resection margins were found to affect the survival rate significantly. The chemotherapy was not significantly associated with improved survival rate. CONCLUSION: Surgical resection with a clear margin is the most important factor in disease survival. The role of chemotherapy and radiotherapy in OSJ remains controversial, and deserves further studies.
Chondrocytes ; Drug Therapy ; Female ; Fibroblasts ; Humans ; Jaw* ; Kaplan-Meier Estimate ; Male ; Mandible ; Maxilla ; Osteoblasts ; Osteosarcoma* ; Prognosis ; Radiotherapy ; Retrospective Studies ; Surgery, Oral ; Survival Rate

OBJECTIVES: In order to assess clinical behavior, response to treatment, and factors influencing prognosis of Korean patients with osteosarcoma of the jaws (OSJ). MATERIALS AND METHODS: A retrospective study of clinical, and pathological records of 26 patients with OSJ treated at the Department of Oral and Maxillofacial Surgery in Yonsei University Dental Hospital from 1990 to March 2017. RESULTS: Of 26 patients, there were 9 men (34.6%) and 17 women (65.4%). Twenty-one of 26 patients had osteosarcoma of the mandible, and 5 of 26 patients had osteosarcoma of the maxilla. The histopathology of OSJ is highly variable, ranging from chondroblastic type (6 out of 26), osteoblastic type (10 out of 26), fibroblastic type (2 out of 26), to the rare variants like mixed type, small cell osteosarcoma types and more. All patients underwent gross total excision and only a few patients underwent neoadjuvant chemotherapy. Postoperative chemotherapy was given to most of the patients as adjuvant treatment or in combination with radiotherapy. The overall survival rate was 73.1% with an overall 2-year survival rate of 83.3%. The overall 5-,10-,15-year survival rates in this study were 73.5%, 73.5%, 49%, respectively. Using Kaplan-Meier analysis with log rank tests, the size of tumor (T-stage), and resection margins were found to affect the survival rate significantly. The chemotherapy was not significantly associated with improved survival rate. CONCLUSION: Surgical resection with a clear margin is the most important factor in disease survival. The role of chemotherapy and radiotherapy in OSJ remains controversial, and deserves further studies.
Chondrocytes ; Drug Therapy ; Female ; Fibroblasts ; Humans ; Jaw* ; Kaplan-Meier Estimate ; Male ; Mandible ; Maxilla ; Osteoblasts ; Osteosarcoma* ; Prognosis ; Radiotherapy ; Retrospective Studies ; Surgery, Oral ; Survival Rate

BACKGROUNDFor a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method.

METHODSA retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = Lm/L, where M was the gender- and age-specific multiplier, Lmwas the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods.

RESULTSA total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley's coefficients, and Anderson's method, respectively.

CONCLUSIONSOur coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.

Adolescent ; Body Height ; physiology ; Bone Neoplasms ; surgery ; Child ; Female ; Femur ; anatomy & histology ; Humans ; Limb Salvage ; Lower Extremity ; anatomy & histology ; Male ; Models, Theoretical ; Osteosarcoma ; surgery ; Radiography ; Retrospective Studies ; Tibia ; anatomy & histology

OBJECTIVE: To explore the efficacy of the resection of periacetabular malignant tumors and the reconstruction with modular endoprosthesis.
 METHODS: From August 2006 to December 2012, 22 patients with periacetabular malignant tumors, who received the resection and reconstruction with modular prosthesis, were retrospectively reviewed. There were 11 males and 11 females, and the average age was 44 (16-65) years old. Pathological results showed there were 13 cases of chondrosarcoma, 5 cases of osteosarcoma, 2 cases of Ewing's sarcoma, 1 case of maligant fibrous histiocytoma, and 1 case of giant cell tumor. According to the classification system by Enneking, there were 11 cases of Type II+III resection, 5 cases of Type I+II+III resection, 3 cases of Type I+II resection, and 3 cases of Type II resection.
 RESULTS: All patients were followed up. The average time for follow-up was 49 (11-103) months. At the last time of follow-up, 13 patients (59%) were still alive, 9 patients (41%) died due to their primary disease. Metastasis occurred in 8 patients (36%), and local recurrence occurred in 5 patients (23%). The mean Musculoskeletal Tumor Society (MSTS) score for 13 cases of alive patients at the latest time of follow-up was (18.5±5.7) months. The mean score for 11 patients, whose limb salvage were successful, was 20.7±2.0.
 CONCLUSION Reconstruction with modular prosthesis after wide resection for periacetabular malignant tumor can achieve satisfied outcome.
Acetabulum ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Bone Neoplasms ; mortality ; surgery ; Chondrosarcoma ; mortality ; surgery ; Female ; Giant Cell Tumors ; mortality ; surgery ; Hip Prosthesis ; Histiocytoma, Malignant Fibrous ; mortality ; surgery ; Humans ; Limb Salvage ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Osteosarcoma ; mortality ; surgery ; Prosthesis Implantation ; statistics & numerical data ; Retrospective Studies ; Sarcoma, Ewing ; mortality ; surgery ; Treatment Outcome