Multifocal Ewing's sarcoma.
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The authors present an account of a group of 51 patients to whom an individual endoprosthesis of the knee joint was implanted on account of a tumour. A primary bone tumour was involved in 42 cases and a metastatic process in 9 cases. Twenty-four endoprostheses were cemented, 26 were implanted without cement. The mean follow-up period was 43 months. Functional results excellent and good in 61%, poor results only in 5%.
Ninety-three consecutive prosthetic reconstructions performed for limb salvage after the resection of sarcomas of the lower extremity were reviewed to determine how long the reconstructions lasted, how successful they were in avoiding amputation in the long term, how significant a problem was aseptic loosening, and what was the associated patient survival. Reconstruction was of the proximal femur in 16, distal femur in 61 and proximal tibia in 16 patients. Minimum follow-up time was 24 months, with a median of 66 months and mean of 80 months. If any event leading to the removal of the prosthesis is considered a reason for failure, the event-free prosthetic survival at five years for the proximal femur was 88%, distal femur 59%, and proximal tibia 54%. Limb survival at five years was significantly better, with the proximal femur at 88%, distal femur at 88%, and proximal tibia at 78% intact. Aseptic loosening survival was better than the event free prosthetic survival, which demonstrates the influence of factors such as sepsis (hematogenous) or wound necrosis that lead to prosthetic removal. Aseptic loosening survivorship of the proximal femur at five years was 100%; distal femur, 78%; and the proximal tibia, 73%. At five years, patient survival was low for the proximal femur (62%) and distal femur (75%) but notably better for the proximal tibia (93%). Prosthetic, extremity, and patient survival differed depending on the site. Wound necrosis was a significant cause of prosthetic removal and loss of limb early in this series, but the more aggressive use of soft tissue procedures has improved this.(ABSTRACT TRUNCATED AT 250 WORDS)
Since the introduction of more effective adjuvant therapies in the area of primary and secondary bone tumors, limb salvage procedures have become more and more important. At the Orthopedic Department of the Technical University, Munich, 52 special knee prostheses have been implanted in patients with malignant tumors of the distal femur and proximal tibia. On the basis of the ISOLS criteria, the functional results achieved were excellent in 14%, good in 47%, satisfactory in 35%, and poor in only 5% of patients after an average follow-up period of 43 months (range: 3-156 months). The perioperative complication rate was 27%, and late complications were material fatigue and wear. In the case of primary tumors, a customized prostheses, and in the case of secondary tumors a modular system is recommended. Individual treatment planning is essential.
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This paper presents 5 patients with repeated recurrence of osteosarcoma (RROS). The primary focus of 3 patients were in the distal portion of femur, and 2 patients were in the proximal portion of tibia. Three patients, whose chest X ray film were negative, were treated by amputation and chemotherapy. Two patients had isolated metastatic focus 1.5 cm in diameter in lung, were treated by amputation after 1 week of chemotherapy and then treated by lobectomy after 2 weeks of chemotherapy. After operation, the chemotherapy was carried out for 3 courses of treatment. The roentgenogram of chest and affected limb were taken once every two months. There were metastatic focuses found in the lung of 1 patient and in the distal portion of femur of 2 patients. One patient was operated on for 4 times. Up to now, 3 patients have been living for 5 years and 2 patients for 6 years after operation.
Paget's disease is uncommon in patients younger than 50 years of age. Multifocal giant cell tumors arising in bone affected by Paget's disease have been described previously in 37 cases. A case of a 38-year-old man with polyostotic Paget's disease and multifocal giant cell tumors responsive to steroid therapy is presented.
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