Search

Synovial leukocyte count analysis is an important tool in the diagnosis of PJI. However, results can be poor if metallosis is present. The issue of metallosis was established for some rotating hinge knee arthroplasty designs. This was a retrospective single-center analysis that included 108 patients who had a single-design metal-on-metal rotating hinge knee arthroplasty who underwent revision surgery and had prior synovial fluid analysis performed. The diagnostic accuracy of leukocyte count and the percentage of polymorphonuclear neutrophiles (% PMN) were investigated. Patients who had a PJI had a higher median leukocyte count and % PMN compared to aseptic revisions (7,905/μL (interquartile range (IQR) 2,419 to 37,400) and 85% (IQR 70.3 to 93.8) versus 450 (IQR 167 to 1,215) and 46% (IQR 28.5 to 67.4%), P <.001). The respective areas under the curves were 0.916 (95% confidence interval 0.862 to 0.970) for leukocyte count and 0.821 (95% confidence interval 0.739 to 0.902) for % PMN. We calculated an optimal cut-off value of 1,200 leukocytes/μL (Sensitivity 94.5%/specificity 75.5%) and 63% PMN (Sensitivity 85.5%/specificity 73.6%) to define PJI. Established thresholds were less sensitive, but more specific. The "infection likely" scenario of the European Bone and Joint Infection Society (EBJIS) definition was closest to the calculated thresholds. Currently used thresholds for leukocyte cell count and %PMN to define PJI were less sensitive and specific in the diagnosis of PJI in metal-on-metal RHK knees. Surgeons must consider lower cut-off values when evaluating such implants for PJI. [ABSTRACT FROM AUTHOR]

The diagnosis of persistent infection prior to second-stage reimplantation in 2-stage exchanges for periprosthetic joint infection (PJI) can be challenging as there is no optimal diagnostic tool. This study investigates the usefulness of pre-reimplantation serum C-reactive protein (CRP) and interleukin-6 (IL-6) and its change between both stages to identify patients who have subsequent PJI. There were 125 patients who underwent planned 2-stage exchange for chronic knee or hip PJI from a single center retrospectively identified. Patients were included if preoperative CRP and IL-6 were available for both stages. Subsequent PJI was defined as 2 positive microbiological cultures at reimplantation or subsequent surgery or death due to PJI during follow-up. Prior to reimplantation, the median serum CRP (total knee arthroplasties [TKAs]: 1.0 versus 0.5 mg/dL, P =.028; total hip arthroplasties [THAs]: 1.3 versus 0.5 mg/dL, P =.015) and median IL-6 (TKA: 8.0 versus 6.0 pg/mL, P =.052; THA: 7.0 versus 6.0 pg/mL, P =.239) were higher in patients who had subsequent PJI. The IL-6 and CRP values showed moderate sensitivity (TKA/CRP: 66.7%; THA/CRP: 58.8%; TKA/IL-6: 46.7%; THA/IL-6: 35.3%) and good specificity (TKA/CRP: 66.7%; THA/CRP: 81.0%; TKA/IL-6: 86.3%; THA/IL-6: 83.3%). The change in CRP and IL-6 between the stages did not differ between the groups, respectively. Serum CRP and IL-6 show low to moderate sensitivity and good specificity in the diagnosis of subsequent PJI prior to reimplantation, which questions their usefulness as a rule-out test. Furthermore, the change in between stages does not appear to identify subsequent PJI. [ABSTRACT FROM AUTHOR]

Chronic periprosthetic joint infection after revision hip and knee arthroplasties can lead to subsequent massive femoral bone loss. In these cases, resection of the residual femur and placement of an antibiotic total femoral spacer can be an option to salvage the limb. This is a single-center retrospective analysis of 32 patients (median age 67 years; range 15-93; 18 women) who underwent placement of a total femur spacer for chronic periprosthetic joint infection with massive femoral bone loss between 2010 and 2019 as part of a planned two-stage exchange. The median follow-up period amounted to 46 months (range, 1-149). Implant and limb survival were analyzed using Kaplan-Meier survival estimates. Potential risk factors for failure were analyzed. There were 34% (11 of 32) of patients having a spacer-associated complication, and 25% underwent revision for this reason. After the first stage, 92% were considered infection-free. There were 84% of patients who underwent second-stage reimplantation of a total femoral arthroplasty using a modular megaprosthetic implant. Infection-free implant survival was 85% after 2 years and 53% after 5 years. There were 44% of patients who underwent amputation after a median time of 40 months (range, 2-110). Most commonly, coagulase-negative staphylococci were cultured at first-stage surgery, while polymicrobial growth was most common at reinfection. Total femur spacers can lead to infection control in over 90% of cases with a reasonable complication rate for the spacer itself. However, the reinfection and subsequent amputation rate after second-stage megaprosthetic total femoral arthroplasty is around 50%. [ABSTRACT FROM AUTHOR]

Background: Unsuspected positive cultures (UPCs) may be found at the time of planned aseptic revision surgery and have previously been associated with decreased implant survival. However, reported rates vary greatly, and potential risk factors are widely unknown. This study investigates the rate of UPCs, implant survival, as well as potential risk factors for UPCs and revision.Methods: This is a retrospective, single-center study on 434 cases of total hip arthroplasty (THA 277) and knee revision arthroplasty (TKA 157) performed between 2010 and 2017. Microbiology culture results, revision-free survival (RFS) and infection-free (IFS) survival, and the potential impact of UPCs as well as patient- or procedure-related risk factors were investigated at a minimum follow-up of 24 months (median 41 months).Results: A total of 37% of patients had a positive culture (160/434). 27% (119/434) had a solitary positive culture, and 9% (41/434) had ≥2 positive cultures of the same species. Most commonly, coagulase-negative staphylococci were cultured. Overall, 32% (13/41) of patients with ≥2 positive cultures underwent revision for infection compared with 6% (17/274) of patients with negative cultures. RFS and IFS were reduced if ≥2 cultures were positive. Single positive cultures had no impact on RFS or IFS. Male sex, elevated serum C-reactive protein, and obesity were independently associated with finding ≥2 UPCs in revision THA.Conclusion: Appearance of ≥2 UPCs in aseptic revision leads to reduced RFS and IFS. Males, obese patients, and patients with elevated serum C-reactive protein planned for THA revision should be considered for extended diagnostics to rule out periprosthetic joint infection. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common and serious complication of inpatient hospital care in older patients. The current approaches to prevention and treatment followed in German hospitals are inconsistent. The aim of this study was to test the effectiveness of a standardized multiprofessional approach to the management of delirium in inpatients. Methods: The patients included in the study were all >65 years old, were treated for at least 3 days on an internal medicine, trauma surgery, or orthopedic ward at Münster University Hospital between January 2016 and December 2017, and showed cognitive deficits on standardized screening at the time of admission (a score of ≤=25 on the Montreal Cognitive Assessment [MoCA] test). Patients in the intervention group received standardized delirium prevention and treatment measures; those in the control group did not. The primary outcomes measured were the incidence and duration of delirium during the hospital stay; the secondary outcomes measured were cognitive deficits relevant to daily living at 12 months after discharge (MoCA and Instrumental Activities of Daily Living [I-ADL]). Results: The data of 772 patients were analyzed. Both the rate and the duration of delirium were lower in the intervention group than in the control group (6.8% versus 20.5%, odds ratio 0.28, 95% confidence interval [0.18; 0.45]; 3 days [interquartile range, IQR 2-4] versus 6 days [IQR 4-8]). A year after discharge, the patients with delirium in the intervention group showed fewer cognitive deficits relevant to daily living than those in the control group (I-ADL score 2.5 [IQR 2--4] versus 1 [IQR 1-2], P = 0.02). Conclusion: Structured multiprofessional management reduces the incidence and duration of delirium and lowers the number of lasting cognitive deficits relevant to daily living after hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Spouses are the primary caregivers of patients living with osteoarthritis (OA). Little is known about how the quality of life (QoL) of OA patients' partners change after total joint replacement surgery (TJR).Methods: Preoperative health status and 12-month postoperative outcomes were evaluated and compared in 24 couples using the Short-Form 36 (SF-36), knee or hip specific Osteoarthritis Outcome Score (OOS) and accelerometry for the assessment of habitual physical activity (PA) and sedentary behavior (SB). Correlations between the changes in the patients' OOS subscales scores, habitual activity, and their partners' SF-36 scores were calculated.Results: Following TJR the patients' OOS subscale scores showed positive changes (P < .001). The SF-36 physical component summary (PCS) score improved (P < .001), while the mental component summary (MCS) score as well as PA and SB remained unchanged (P ≥ .093). Their partners' PCS, MCS, and SB did not change (P ≥ .286), whereas the PA even decreased (P = .027). Correlation analyses showed positive results for the changes in the patients' OOS subscale pain and the changes in their partners' MCS (r = 0.355, P = .048) as well as the changes in the patients' OOS subscale activities of daily living and the changes in the PCS of their partners (r = 0.406, P = .027). In contrast to the results described above, changes in the patients' PA were negatively correlated with changes in their partners' PCS (r = -0.389, P = .033).Conclusion: TJR has a positive influence on QoL but not the habitual activity of OA patients. Their partners, on the other hand, show no changes in QoL and even a slight decrease in habitual activity. [ABSTRACT FROM AUTHOR]

Background: Two-stage exchange using antibiotic-loaded spacers is a common approach in treating periprosthetic joint infections. Acute kidney injury (AKIN) can be a systemic complication of this procedure. This study investigates the prevalence of AKIN and identifies potential risk factors.Methods: This is a single-center retrospective analysis of patients undergoing 2-stage exchange using a spacer in 285 patients treated between 2010 and 2017. Risk factors were evaluated using parametric and nonparametric analyses and a multivariate, binary logistic regression model.Results: Thirty-three percent of patients (95/285) developed an AKIN postoperatively. Twenty-four percent (23/95) of these patients had an acute on chronic kidney failure with a previously impaired renal function. In multivariate analysis, a higher age (hazard ratio [HR], 1.034; 95% confidence interval [CI], 1-1.068; P = .046) and a higher baseline creatinine level (HR, 1.94; 95% CI, 1.237-3.052; P = .004) were risk factors for AKIN. Treatment with vancomycin in the spacer or systemically was not associated with AKIN while a high vancomycin blood level (HR, 1.91; 95% CI, 0.913-3.992; P = .086) and fungal infections were (HR, 3.482; 95% CI, 0.968-12.521; P = .056). Furthermore, in univariate analysis, a higher median Charlson comorbidity index (4 vs 3, P = .007), a lower preoperative hemoglobin (10.9 vs 11.7 g/dL, P = .008), and a higher number of blood transfusions (1 vs 0, P = .004) were associated with AKIN.Conclusion: AKIN is common in patients undergoing 2-stage exchange. Associated patient factors, particularly in patients with chronic renal dysfunction, should be optimized. The general use of glycopeptide antibiotics was no risk factor for AKIN. [ABSTRACT FROM AUTHOR]

Background: Soft tissue deficiency in total knee arthroplasty infection is a potentially devastating complication. Gastrocnemius muscle flaps can be used to address this problem. We aim at reporting survival rates of these reconstructions and identify risk factors for failure.Methods: A retrospective evaluation of all flaps performed at a single center between 2006 and 2019 was performed. Clinical and microbiological results were assessed in 43 cases after a median follow-up period of 53 months (25%-75% interquartile range 18-79). Function was assessed using the Oxford Knee Score. We analyzed the infection-free survival and identified risk factors using survival comparison and (non-)parametric testing.Results: Infection-free survival was 71% at 2 years and 63% at 5 years. The rate of subsequent amputation was 16% with a mortality rate of 26% during follow-up. Four patients did not undergo reimplantation and 11 patients received an arthrodesis implant. There were no failures of the flap itself. The Charlson Comorbidity index was the only relevant risk factor for reinfection. Coagulase-negative staphylococci were most common organisms identified. Postoperative function was limited with a mean Oxford Knee Score of 20.Conclusion: Gastrocnemius flap coverage is a valid option for soft tissue reconstruction in periprosthetic infections to retain a functioning limb despite a high complication rate and the risk of subsequent amputation. [ABSTRACT FROM AUTHOR]

• Hemipelvectomy (PI-II) after rotationplasty on the same leg resulted in a good functional result in a 16 year old male patient with osteosarcoma. • For hemipelvectomy, the musculus gluteus maximus is essential for soft tissue coverage, therefore supplying structures must be preserved. • The triradiate cartilage of the acetabulum closes around a bone age of 12 years in boys and then is no sufficient barrier for an osteosarcoma. The hip transposition is a limb salvage procedure for periacetabular malignancies. Here we present the case of a patient that already had a preexisting ipsilateral rotationplasty. A 16 year old male patient with an Osteosarcoma of the left distal femur was treated with wide surgical resection of the tumor and rotationplasty (Salzer/Winkelmann type A1). Despite adjuvant chemotherapy (EURAMOS protocol) he was diagnosed with metachronous metastases in the lung and in the left ilium affecting the acetabulum. As a limb salvage procedure the patient received an internal hemipelvectomy Enneking PI-II and an attachment of the femoral head with a Trevira tube to the sacrum using suture anchors. After six weeks a prosthesis was fitted and gradually full weight bearing was allowed. The patient achieved a good functional result as he was able to walk freely for three more years before he passed away. The hip transposition procedure does not require the implantation of a large tumor prosthesis and thus avoids the problem of an increased risk of infection. Even with preexisting ipsilateral rotationplasty a good functional outcome that allowed the patient full weight bearing could be achieved. If there are already existing deformities, such as rotationplasty on the same leg, the hip transposition procedure can be considered for periacetabular malignancies, as it can achieve satisfactory results. [ABSTRACT FROM AUTHOR]

Background: Many people have leg-length discrepancies of greater or lesser severity. No evidence-based studies on the need for treatment are currently available. Methods: This review is based on publications retrieved by a selective search in the PubMed database, as well as on published recommendations from Germany and abroad and on the authors' own clinical experience. Results: If the two legs are of different lengths, this is generally because one leg is too short. It is debated whether leg-length discrepancy causes pain or long-term musculoskeletal disturbances. A direct connection to back pain is questionable, but a mildly elevated incidence of knee arthritis seems likely. The evidence base on the indications for treatment of leg-length discrepancy is poor; only informal consensus recommendations are available. There are a wide variety of conservative and surgical treatment options. The final extent of a leg-length discrepancy first noted during the growing years can be estimated with predictive algorithms to within 2 cm. The treatments that can be considered include a shoe insert, a high shoe, or an orthosis, surgically induced slowing of growth by blockade of the epiphyseal plates around the knee joint, or leg lengthening with osteotomy and subsequent distraction of the bone callus with fully implanted or external apparatus. Changes in leg length exert marked mechanical stress on the soft tissues. If the predicted leg-length discrepancy exceeds 5 cm, initial leg-lengthening treatment can already be considered during the patient's growing years. Conclusion: It must be discussed with each patient individually whether the treatment should be conservative or surgical. The extent of the discrepancy is not the sole determining factor for the mode of treatment. The decision to treat is always elective. [ABSTRACT FROM AUTHOR]

Background: Hemiarthroplasty megaprosthetic proximal femur reconstruction after tumor resection is a widespread procedure in orthopedic oncology. One potential complication is acetabular wear requiring secondary acetabular revision. The study's purpose is to investigate prevalence of acetabular erosion, secondary revisions, and potential risk factors.Methods: We retrospectively identified 112 patients who underwent proximal femur replacement after resection of a malignant bone tumor and had radiological follow-up longer than 12 months. Patient demographic, surgical, and oncologic factors were recorded, acetabular wear was measured using the classification proposed by Baker, and prosthetic failure was classified using the International Society on Limb Salvage classification. Functional assessment was performed using the Musculoskeletal Tumor Society Score and Harris Hip Score.Results: Prevalence of acetabular wear was 28.6%. Secondary conversion to total hip arthroplasty was required in 5 patients (4.6%), all treated for primary bone tumors. No patient treated for metastatic tumor had higher grade acetabular wear or required revision. Significant risk factors for the development of acetabular wear were age under 40 (P = .035) and longer follow-up (63 vs 43 months, P = .004). Other patient, surgical, or adjuvant treatment-related factors were not associated with acetabular revision or acetabular wear. The dislocation rate in the patient cohort was 0.9%.Conclusion: Bipolar hemiarthroplasty proximal femoral replacement represents a durable reconstruction after tumor resection. Hip instability is rare. Acetabular erosion is rare and can be successfully treated with conversion to total hip arthroplasty. Young patients with long-term survival over 10 years are at risk. In reconstruction for metastases, instability and acetabular wear are rare. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to identify clinical characteristics of patients with shoulder dislocations caused by an epileptic seizure.Methods: In our retrospective analysis, we identified 15 patients, recorded over an 8-year period, who were diagnosed with shoulder dislocations in the setting of a bilateral tonic-clonic seizure.Results: Patients were almost exclusively male (13/15) and drug-naïve patients suffering their first or second seizure (14/15). Epilepsy was diagnosed in five of these 14 patients after further diagnostic tests, four patients were diagnosed with a provoked or acute symptomatic seizure and five patients with an unprovoked seizure. Treatment with anticonvulsant drugs (AED) was initiated in 10/15 patients after the first seizure, without recommendation for tapering, although long-term treatment was retrospectively judged to be appropriate for only four of those cases. Posterior dislocations - usually rare - were seen in 12/15 patients and often required complex orthopedic interventions.Conclusions: We conclude that in particular posterior shoulder dislocations are often caused by a first seizure and should always raise the suspicion of an epileptic seizure even in the absence of a clear history. AED treatment likely has a protective effect against this type of injury, even if seizure-freedom is not achieved. [ABSTRACT FROM AUTHOR]

The distal humerus is a rare location of bone tumors. Because of the complexity of the elbow joint, poor soft-tissue coverage, and proximity of nerves and vessels, resection and endoprosthetic reconstruction are demanding. This retrospective study evaluated the clinical results after distal humeral resection and megaprosthetic reconstruction in 12 patients with an average age of 46 years. All patient files were reviewed for clinical information, and postoperative function and patients' contentment were assessed using the Musculoskeletal Tumor Society score. The predominant diagnoses were bone and soft-tissue sarcoma (n = 6), giant cell tumor (n = 2), and renal cell carcinoma metastasis (n = 2). Local recurrence was the reason for secondary amputation in all cases (n = 3). The prosthetic survival rate after surgery was 82% at 2 years and 64% at 5 years. Reconstruction failure was mainly caused by aseptic loosening of the humeral stem, occurring in 27% (n = 3), followed by aseptic loosening of the ulnar stem in 9% (n = 1) and periprosthetic infection in 9% (n = 1). The mean Musculoskeletal Tumor Society score was 24 points (range, 20-30 points). An extension lag of more than 10° was noted in 6 patients (55%). Our results suggest that limb salvage with a distal humeral replacement can achieve good functional results in most patients, although the complication rate with special emphasis on the loosening rate of the humeral stem is high. However, limb salvage was not achieved in 27% of patients because of local recurrence. [ABSTRACT FROM AUTHOR]

• Limb-preserving treatment in young children suffering malignant bone tumors remains challenging. • MUTARS® Humero pro Femur replacement represents a salvage procedure. • Distal humerus component serves as a hinged knee joint after 180° rotation. • Satisfactory complication rates and functional results. • Subsequent conversion to conventional tumor endoprosthesis. Limb-preserving surgery in young children suffering malignant bone tumor of the femur is challenging due to the specific anatomical conditions. Extendable tumor endoprostheses are often oversized, while custom-made endoprostheses do not provide the intraoperatively required variability regarding reconstruction length. Allo- and autograft replacements, on the other hand, show high complication and revision rates. We report a novel reconstructive procedure after resection of malignant bone tumors of the femur in young children, and present our preliminary results of this technique. [ABSTRACT FROM AUTHOR]

We report outcomes of 28 patients after stump-lengthening procedures (SLPs) with modular tumor endoprostheses following high-thigh amputation and hip disarticulation over 11 years. Mean follow up was 41.3 months (range 7.4 to 133.6 months). Mean Musculoskeletal Tumour Society Score was 56% (n = 11); ten out of eleven patients alive used an exoprosthesis regularly. Complications occurred in 15 patients with infection being most common. In 2 cases, the prostheses had to be explanted. Our data suggest that SLP facilitates post-operative rehabilitation and prosthesis usage. Modular endoprostheses for stump-lengthening allow optimization of remnant soft-tissue envelope, reducing the risk of stump perforation. [ABSTRACT FROM AUTHOR]

• Giant cell tumor of bone (GCTB) is a rarely metastasizing, locally aggressive tumor. • GCTB recurs frequently after intralesional curettage. • Denosumab is a potential neoadjuvant treatment option for borderline resectable lesions. Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4–5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence. In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24–404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed. The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10–77) years and a mean follow-up of 65.6 (24–404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases). GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent. [ABSTRACT FROM AUTHOR]

Abstract: We reviewed outcomes and discussed surgical difficulties encountered in 10 patients who had modular endoprosthesis for limb preserving salvage of failed allograft reconstruction after malignant tumor resection. Mean allograft survival time before failure was 127.4 months (range, 14-264 months). Mean length of follow-up since endoprosthesis revision surgery was 62.8 months (range, 16-132 months). There was one endoprosthesis failure, resulting in a mean endoprosthesis survival time of 56.9 months (range, 16-132). Complications included arterial laceration, nerve injury, periprosthetic crack fracture, aseptic loosening, and infection. Modular endoprosthesis remain a viable option that should be considered in any limb preserving salvage of failed allograft reconstructions. However, altered anatomy, poor/short remnant host bone, periprosthetic fractures, inadequate soft tissue coverage and infection remain important difficulties encountered. [Copyright &y& Elsevier]

• SBCs can mostly be treated conservatively. • In ABCs a biopsy is compulsory. • ABCs can be treated by polidocanol instillations adequately. This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different. The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases. The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and effectiveness of combined transarterial embolization and percutaneous sclerotherapy in the treatment of refractory and nonresectable aneurysmal bone cysts (ABCs) as assessed by imaging and clinical outcomes.Materials and Methods: This retrospective, single-center study included 16 consecutive patients (9 women and 7 men; median age, 17 years [range, 6-25 years]) who underwent combined transarterial embolization (using ethylene vinyl alcohol) and percutaneous sclerotherapy (using ethanol gel and polidocanol) for refractory and nonresectable ABCs. The median follow-up was 27.3 months (range, 6.7-47.5 months). Grade of mineralization (5-point Likert scale), grade of fluid-fluid levels (FFLs; 4-point Likert scale), and contrast-enhancing lesion volume were evaluated before and after treatment. The quality of life was determined before and after treatment using the Musculoskeletal Tumor Society (MSTS) score and the 36-Item Short Form Survey (SF-36) health questionnaire.Results: A mean of 1.6 ± 0.7 transarterial embolizations and 3.2 ± 1.7 percutaneous sclerotherapies were performed. No adverse events were observed. All patients showed either partial or complete response; no patient showed ABC recurrence. The grade of mineralization (3.7 ± 0.7 after therapy vs 1.4 ± 0.5 at baseline; P < .0001) and grade of FFL (3.5 ± 0.8 after therapy vs 1.9 ± 0.6 at baseline; P < .0001) significantly improved after therapy compared with baseline. The mean contrast-enhancing lesion volume significantly decreased after treatment compared with baseline (45.9 mm³ ± 96.1 vs 156.0 mm³ ± 115.3, respectively; P = .0003). The MSTS scores (28.8 ± 1.8 after treatment vs 14.1 ± 8.6 at baseline; P < .0001) and SF-36 findings revealed a significant improvement in the quality of life after treatment compared with baseline, leaving most patients without relevant constraints.Conclusions: Combined transarterial embolization and percutaneous sclerotherapy is a minimally invasive, safe, and effective treatment option for refractory and nonresectable ABCs. Treatment fostered bone mineralization and significantly improved patients' quality of life. [ABSTRACT FROM AUTHOR]

Abstract: We retrospectively reviewed 197 patients who underwent reconstruction with a megaprosthesis of the lower extremity. A cobalt-chrome alloy system was used in 77 patients and a titanium alloy system in 120 patients. The overall infection rate was 20.8% (n = 41). Separated into the 2 prosthesis systems used, an infection rate of 31.2% was found in the patients with a cobalt-chrome-alloy prosthesis and 14.2% in the titanium alloy group of patients (P < .01). Early infection occurred in 5.1% (n = 10) and late infection in 15.7% (n = 31). Selecting 2 identical subgroups for further analysis, the cobalt-chrome alloy prostheses were associated with a significantly higher infection rate, with 5 infections of 26 megaprostheses vs 1 infection of 36 titanium megaprostheses (P < .05). [Copyright &y& Elsevier]

• Chondroblastoma represents a rare pathology. • An aggressive intralesional curettage leads to low recurrence rates. • Hydrogen peroxide as adjuvant lowers the risk of local recurrence. Chondroblastoma is a rare benign cartilaginous bone tumor that represents 1–2% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and includes intralesional curettage with or without adjuvants. Local recurrence rates vary between less than 10% up to more than 30%. In this retrospective study between 2009 and 2020 we analysed 38 cases of chondroblastoma with a mean follow-up of 27.9 months who underwent a surgical treatment in our institution. Epidemiological data, radiographic and histological examinations, different surgical techniques, complications and local recurrence were evaluated to comment on the question if curettage with or without adjuvants is a sufficient way of therapy. The study includes 25 male (65.8%) and 13 female (34.2%) patients with a mean age of 17.2 (11–51) years. The most common location of manifestation was the proximal epiphyseal humerus (34.2%), followed by the proximal tibia (26.3%) and the distal femur (15.8%). Joint involvement occurred in 28 patients (73.7%). In all cases intralesional curettage was performed; in 25 cases (65.8%) the resulting cavity was filled with bone substitute, in 7.9% (3 cases) with bone cement and in 10.5% (4 cases) with autogenous bone graft. Adjuvant hydrogen peroxide was used in 64.9% of the cases. The overall recurrence rate was 39.5% (15 cases). The following subgroup analysis showed a recurrence rate of 100% (4/4 cases) after curettage and defect reconstruction with autogenous bone. In the case of intralesional curettage and filling of the cavity with bone substitute but without use of adjuvant the recurrence rate was 50% (4/8 cases). A low recurrence rate of 11.8% (2 cases) was observed in the case of intralesional curettage, using hydrogen peroxide as adjuvant (17 cases) and bone substitute for defect reconstruction. Chondroblastoma represents a rare pathology. Therapeutically an aggressive intralesional curettage with use of hydrogen peroxide as adjuvant and filling up the defect with bone substitute leads to low recurrence rates. [ABSTRACT FROM AUTHOR]

The article describes the case of van Neck-Odelberg disease in a 12-year-old boy who had a three-month history of intermittent pain in the left inguinal region, with topics mentioned such as aseptic bony necrosis of the ischiopubic synchondrosis, self-limiting diseases, and pubic bones.

The article describes the case of a 29-year-old woman diagnosed with Gorham-Stout syndrome (GSS), a rare mono- or polyostotic disease in which idiopathic intraosseous angiomatous proliferation leads to progressive resorption of bone. Case highlights include exacerbation of the initially intermittent symptoms after childbirth, outcome of radiography of the pelvis, and clinical amelioration of GSS on administration of bisphosphonates.

The article describes the case of an 81-year-old man with a progressive, mobile swelling over the acromioclavicular (AC) joint, with topics mentioned such as magnetic resonance imaging, osteoarthritis, and AC joint cyst.

A letter to the editor is presented in response to the article "The Uses and Limitations of Whole-Body Magnetic Resonance Imaging," by Gerwin Schmidt, Dietmar Dinter, Maximilian F. Reiser and Stefan O. Schoenberg, in the previous issue.