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Rationale and objectives Myxofibrosarcoma (MFS) is a common soft tissue sarcoma in the elderly patients with both clinical and magnetic resonance imaging (MRI) peculiar features: very high recurrence rate, relatively low risk of distant metastases. On MRI it shows an infiltrative pattern (“tail sign”) and high myxoid matrix content with water-like appearance on fluid-sensitive sequences. Due to these unusual characteristics, we propose a specific MRI grading system to stratify the risk of local recurrence (LR) and offer other prognostic information. Materials and methods: Two expert radiologists retrospectively and blindly reviewed preoperative MRI of 150 patients affected by MFS of the extremities treated at a single Institution. Myxoid matrix component and contrast enhancement of the tumor were evaluated and graded with a semiquantitative method. The presence of an infiltrative pattern, the depth of the tumor (deep and/or superficial) and tumor sizes were also recorded. MRI features were analyzed separately and correlated to LR risk, sarcoma specific survival and distant metastases rate. Then, according to the statistical significance of the correlation between MRI features and prognosis a 3-grade scoring system was proposed and evaluated to assess the risk of LR. Results: Mean age was 66.1 ± 14.4 years; mean follow-up was 16 ± 28.3 months. The MRI features most associated with higher risk of LR resulted to be: lesion sizes (both volume and maximum diameter with a cut-off of 20 cm – p = 0.01), the “tail sign” (p = 0.045), and high myxoid matrix content with MRI water-like appearance (p = 0.0493). Ninety-four patients (94 of 150- 62.7%) were grade 1, 33 (22.0%) grade 2, and 23 (15.3%) grade 3. Interobserver agreement was substantial with K= 0.779 (95%CI 0.685–0.874). Higher grades of MRI grading system proposed were significantly associated with an increased LR risk, hazard ratio = 2.031 (95%CI 1.366–3.019; p Conclusion: This is the largest series evaluating MRI features as prognostic factors for MFS. The MRI grading system proposed is significantly able to stratify the risk of LR in MFS of the extremities. The system is applicable to all the standard MRI studies protocols, might help in surgical planning, and may offer prognostic information.

Background: The aim of this retrospective study is to analyze history and treatment outcomes of pathological fracture (PF) in dedifferentiated chondrosarcoma (DdChS) of the limbs. Methods: We retrospectively reviewed 175 adult patients with primary DdChS of the limbs.Disease-specific survival (OS) and local recurrence (LR) were analyzed. Results: Median age was 66 years (range, 29–91). Most DdChS (121, 69.1%) were localized in the femur. Forty-nine (28.0%) had metastasis at diagnosis; thirty-nine DdChS (22.3%) had a PF.OS rate was lower in patients with metastasis at diagnosis (8.6% Vs 41.0% at 10 years, p < 0.001). A similar OS was observed among patients with localized disease, whether with/without PF (p = 0.638), with/without chemotherapy (p = 0.543) and independently from the type of surgery (resection/amputation) (p = 0.877). Amputation reduces the risk of LR (80.0% vs 63.1% at 5 years, p = 0.039), particularly in the PF group. Conclusion: Patients with metastases have a particularly poor prognosis in DdChS, but pathological fracture does not influence prognosis in terms of survival and local control. Initial curative resection is essential in order to reduce the chance of recurrences. Amputation might be an option in patients with localized disease and a PF to reduce the risk of LR..

Background In a two-stage exchange protocol for prosthetic joint infection (PJI), bacteria surviving over the antibiotic-loaded cement spacers may cause the persistence of infection with renewed clinical symptoms following the surgery. Culture after sonication of removed prosthesis is more sensitive than conventional periprosthetic tissue culture for the microbiological diagnosis of PJI. The aim of this study was to assess whether sonication of the spacer at the time of the second-stage procedure may improve the diagnosis of persistent PJI. Methods We evaluated by microbiological culture the sonication fluid from 222 cement spacers implanted in a two-stage exchange protocol in 157 patients affected by PJI. A mean of 1.3 (range, 1–4) spacer per patient was performed. Results In 53 out of 222 spacers analyzed infection was confirmed according to the MSIS criteria. In 22 cases the infection was confirmed by both cultures on periprosthetic tissue and on sonication fluid from the spacers. In 23 cases persistent PJI was identified because of only cultures of periprosthetic tissue and 8 because of results obtained after spacer sonication. The sensitivity of periprosthetic tissue cultures was higher than that of cultures performed on sonication fluid (84.9% vs 56.6%, p Conclusions Even though sonication of cement spacers has performances inferior than those reported for prosthesis, it can be considered a complementary method to unravel persistent infection during a two-stage exchange protocol for PJI.

Background Inadequate acetabular bone stock is a major issue in total hip arthroplasty, and several treatment options are available. Stemmed cups have been used in this scenario with variable results. A novel modular polyaxial uncemented iliac screw cup (HERM-BS–Sansone cup—Citieffe s.r.l., Calderara di Reno, Bologna, Italy) has been recently introduced to overcome the drawbacks of stemmed cups. In this retrospective study, we report the results of this cup in patients with large acetabular bone defects at 2- to 7-year follow-up. Methods We evaluated a consecutive series of 121 hips (118 revisions and 3 complex primary arthroplasties) treated with this novel cup at a mean follow-up of 46 months. Kaplan–Meier survival analysis was performed with implant revision for any reason as a primary end point. Further survival analysis was performed excluding septic failures. Clinical outcome was assessed with the Harris Hip Score. Results There had been 7 reoperations: 1 for aseptic loosening, 5 for deep infection, and 1 for recurrent dislocation. In 5 cases, the cup was removed; estimated survival rate at 5-year follow-up with implant removal for any reason was 95.6% (95% confidence interval = 91-99), and 98.3% (95% CI = 96-100) excluding those failed for infection. Mean Harris Hip Score at latest follow-up was 77 points (range, 44-95; standard deviation = 11.9). Conclusion The present findings show the short-term efficacy of the iliac screw cup with respect to implant survival. A longer follow-up and a larger number of patients are necessary to confirm the encouraging preliminary results.