Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma

Rotationplasty is an established technique that is indicated as part of the surgical reconstruction for certain patients with primary bone tumors around the knee who undergo tumor resection. There is considerable variation in the application of rotationplasty by surgeons as well as acceptance of the procedure by patients who may be candidates for this procedure. We qualitatively studied the decision-making process of families of patients who had undergone rotationplasty by interviewing 4 patients and their families using semi-structured interviews. Thematic analysis identified the following themes that were important in the decision-making process: (1) the desire for good information sources, (2) finding value in meeting with other patients who had been faced with a similar decision, (3) prioritizing function over cosmesis, (4) a desire to limit the need for revision surgeries, and (5) accepting that a return to normalcy is not an option with a surgery. Physicians and patients faced with a similar decision can benefit from a better understanding of the process, and by the normalization of anxieties and concerns that they may experience.

Demographic, clinico-pathological features and management pattern of primary bone tumors in a tertiary care hospital of South India

<p><strong>Background</strong>: Primary bone tumors are very rare tumors. The true incidence of bone tumors is not well established and is under reported due to rarity and lack of accurate registries. Hence it is essential to study about the demographic, clinico-pathological features and the pattern of surgical management of bone tumors. The aim of this study is to analyze the demographic and clinico-pathological features of primary bone tumors that were managed by surgery.</p><p><strong>Methods</strong>: A retrospective analysis of all patients with primary bone tumor who were treated by surgery from 2012 to 2019 was done. The age, sex distribution, histopathology, location of the tumor and surgical procedure done were analyzed.</p><p><strong>Results</strong>: Among 103 patients analyzed, 66 (64%) were men and 37 (36%) were women. Primary bone tumors most commonly presented in 11 to 20 years of age with 35 (33.9%) patients occurring in this age group. Osteosarcoma was the most common primary bone tumor and it occurred in 49 (47.6%) patients, out of which 34 (69.3%) patients were below 20 years of age. Giant cell tumor was the most common benign bone tumor and it occurred in 22 patients, out of which nine (40.9%) patients were of age 21 to 30 years. Distal femur was the most common site with 39 (37.9%) patients. The limb preservation rate for malignant appendicular bone tumors was 69.0%.</p><p><strong>Conclusions</strong>: The diagnosis of bone tumor depends not only on histopathological features but also needs correlation with age, clinical features, tumor location and radiological features for confirmation of diagnosis.</p>

Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques

Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary.

Proximal Femur Versus Acetabular Extra-articular Resection of the Hip Joint for Primary Malignant Bone Tumors : A Retrospective Comparative Review of 33 Cases

Introduction Extra-articular resection (EAR) of the hip joint is prone to significant complications and morbidity. Thus, this study evaluates the cumulative incidences and main reasons of reoperation following EAR of primary bone tumors of the hip to determine whether the outcomes are different between EAR of the pelvis and that of the proximal femur. Patients and methods Thirty-three patients presented with a PMBT of the proximal femur or pelvis were included in this study. Among all PMBTs, 58% originated from the pelvis and 42% were from the proximal femur. Twenty patients had chondrosarcomas (61%), 10 had osteosarcomas (30%), and 3 had sarcomas of another histological subtype (9%). Results The mean follow-up was of 76 months (range: 24–220 months). The cumulative probabilities of revision for any reason was 52% (95% confidence interval [CI]: 30%–70%) five years after surgery. The five-year cumulative probabilities of revision were 13% (95% CI: 4%–27%), 24% (95% CI: 10%–42%) and 34% (95% CI: 14%–56%) for mechanical, infectious and tumoral reasons, respectively. The five-year cumulative probabilities of revision for any reason were 78% (95% CI: 37%–94%) and 14% (95% CI: 2%–38%) for the pelvis and proximal femur, respectively ( p = 0.004). Posterior column preservation was significantly associated with more mechanical complications even after adjusting for the resection site ( p = 0.043). Conclusion Half of patients undergoing EAR of the hip joint for PMBT of the proximal femur or acetabulum will require another operation. EAR of the pelvis is associated with significantly worse outcome than EAR of the proximal femur.

Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are gaining more importance. The aim of the present paper is to analyze surgical indications based on our experience and on the evidences in the literature. Methods: all patients affected by osteoblastoma who underwent surgical excision in January 2009 and December 2018 were reviewed; eleven patients were enrolled in the study. The epidemiological aspects, size of the disease and site of onset, symptoms, surgery type, indications, and results are reported for every case. Results: all treatments were based on a preoperative diagnosis; pain was constant in all cases. Intralesional surgeries were performed in 9 out of 11 cases; the remaining 2 cases underwent wide resection. No early or late complications occurred after the surgical procedure. The indications for surgery were lesions very close to nerves or joints, unclear diagnosis, risk of fracture, lesion too large for radiofrequency thermoablation, or failure of minimally invasive treatments. At a medium follow-up of 88 months, no local recurrences were verified. Conclusions: osteoblastoma is a rare tumor with difficult diagnosis. Identification is based on symptoms, imaging, and histology. When possible, minimally invasive techniques is preferred for treatment but surgery is still considered the gold standard.