RESUMO
The ability of individuals with end-stage osteoarthritis (OA) to functionally recover from total joint arthroplasty is highly inconsistent. The molecular mechanisms driving this heterogeneity have yet to be elucidated. Furthermore, OA disproportionately impacts females, suggesting a need for identifying female-specific therapeutic targets. We profiled the skeletal muscle transcriptome in females with end-stage OA (n = 20) undergoing total knee or hip arthroplasty using RNA-Seq. Single-gene differential expression (DE) analyses tested for DE genes between skeletal muscle overlaying the surgical (SX) joint and muscle from the contralateral (CTRL) leg. Network analyses were performed using Pathway-Level Information ExtractoR (PLIER) to summarize genes into latent variables (LVs), i.e., gene circuits, and link them to biological pathways. LV differences in SX versus CTRL muscle and across sources of muscle tissue (vastus medialis, vastus lateralis, or tensor fascia latae) were determined with ANOVA. Linear models tested for associations between LVs and muscle phenotype on the SX side (inflammation, function, and integrity). DE analysis revealed 360 DE genes (|Log2 fold-difference| ≥ 1, FDR ≤ 0.05) between the SX and CTRL limbs, many associated with inflammation and lipid metabolism. PLIER analyses revealed circuits associated with protein degradation and fibro-adipogenic cell gene expression. Muscle inflammation and function were linked to an LV associated with endothelial cell gene expression highlighting a potential regulatory role of endothelial cells within skeletal muscle. These findings may provide insight into potential therapeutic targets to improve OA rehabilitation before and/or following total joint replacement.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite , Feminino , Humanos , Células Endoteliais , Articulação do Joelho , Osteoartrite/genética , Músculo EsqueléticoRESUMO
The NCCN Guidelines for Bone Cancer provide interdisciplinary recommendations for treating chordoma, chondrosarcoma, giant cell tumor of bone, Ewing sarcoma, and osteosarcoma. These NCCN Guidelines Insights summarize the NCCN Bone Cancer Panel's guideline recommendations for treating Ewing sarcoma. The data underlying these treatment recommendations are also discussed.
Assuntos
Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/terapia , Recidiva Local de Neoplasia/terapia , Sarcoma de Ewing/terapia , Amputação Cirúrgica , Biópsia , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/patologia , Quimiorradioterapia Adjuvante/normas , Quimioterapia Adjuvante/normas , Ensaios Clínicos como Assunto , Resistencia a Medicamentos Antineoplásicos , Humanos , Incidência , Imageamento por Ressonância Magnética , Oncologia/normas , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Guias de Prática Clínica como Assunto , Prognóstico , Sarcoma de Ewing/epidemiologia , Sarcoma de Ewing/patologia , Taxa de SobrevidaRESUMO
BACKGROUND: Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested. QUESTIONS/PURPOSES: Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition? METHODS: We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing. RESULTS: Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033). CONCLUSIONS: Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Assuntos
Anti-Infecciosos/uso terapêutico , Extremidades/lesões , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Pelve/lesões , Prata/uso terapêutico , Cicatrização , Ferimentos e Lesões/terapia , Adulto , Idoso , Desbridamento , Desenho de Equipamento , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Adulto JovemRESUMO
Primary bone cancers are extremely rare neoplasms, accounting for fewer than 0.2% of all cancers. The evaluation and treatment of patients with bone cancers requires a multidisciplinary team of physicians, including musculoskeletal, medical, and radiation oncologists, and surgeons and radiologists with demonstrated expertise in the management of these tumors. Long-term surveillance and follow-up are necessary for the management of treatment late effects related to surgery, radiation therapy, and chemotherapy. These guidelines discuss the management of chordoma, giant cell tumor of the bone, and osteosarcoma.
Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Humanos , Estadiamento de NeoplasiasRESUMO
Unplanned surgical excision of sarcomas remains a major treatment dilemma in the control of local disease. The purpose of this study is to develop a patient profile to identify patients at high risk for an unplanned excision. The study group consisted of 54 patients following an unplanned excision of a soft tissue sarcoma. The characteristics that were identified as high risk included the following: 20- to 40-year age range,>5 cm, trauma, and deep to fascia. It was common for the interpretation of imaging studies not to mention the possibility of sarcoma in the differential diagnosis. Patient referral was most commonly from general surgeons without specialty training in oncology. Orthopaedic surgeons should not rely solely on the radiologist's interpretation because they often lack clinical information necessary to direct them toward the diagnosis of sarcoma. This is particularly important in patients who are at high risk for unplanned excision as identified in this study. Unplanned excisions by nononcologic surgeons remain a problem; however, it appears that it is more prevalent in the general surgical community than in orthopaedics. This may be as a result of studies addressing this issue in orthopaedic journals, with emphasis of these articles at teaching institutions.
Assuntos
Salvamento de Membro/métodos , Seleção de Pacientes , Encaminhamento e Consulta , Sarcoma/cirurgia , Coxa da Perna , Adulto , Idoso , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estudos Retrospectivos , Sarcoma/patologia , Resultado do Tratamento , Adulto JovemRESUMO
The Fixion intramedullary nail technology is safe and effective in the treatment of pathologic bone fractures.
Assuntos
Pinos Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Desenho de Prótese , Resultado do TratamentoRESUMO
Synovial sarcomas comprise between 5% to 10% of all soft tissue sarcomas in adults. It has a predilection for young adults and is one of the more frequently misdiagnosed soft tissue sarcomas. It is not unusual for synovial sarcoma to present initially after a traumatic event. It most commonly occurs in close proximity to a large joint. The most common site for metastasis is the lung, followed by lymph node involvement. Synovial sarcoma rarely metastasizes to the skeleton and when it occurs, it most commonly involves the long bones. Cranial metastasis is rare and has only been described in 2 previously reported cases. Reports of other sarcomas having intracranial metastasis include rhabdomyosarcoma, angiosarcoma, fibrosarcoma, liposarcoma, Ewing's sarcoma, and clear cell sarcoma from the kidney. The synchronous or metachronous development of >or=2 primary soft tissue sarcomas has been reported. These are primary soft tissue sarcomas occurring at multiple soft tissue sites without pulmonary or lymphatic involvement. It is often difficult to distinguish between the synchronous or metachronous appearance of a second primary and soft tissue sarcoma metastasis. This article presents a case of a 17-year-old adolescent boy who presented with simultaneous enlarging masses involving the skull and thigh. Open biopsies confirmed synovial sarcoma in both regions. Staging studies, including computed tomography (CT) of his chest, abdomen/pelvis and bone scan were otherwise negative for metastasis.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Neoplasias Musculares/diagnóstico , Neoplasias Musculares/terapia , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/secundário , Adolescente , Neoplasias Encefálicas/terapia , Humanos , Masculino , Sarcoma Sinovial/terapiaRESUMO
Although autogenous bone graft remains the gold standard graft material, it is associated with an unacceptably high incidence of morbidity. Furthermore, operative time, blood loss, and length of hospitalization are often increased. In order for a graft substitute to replicate the optimal bone healing properties of autogenous graft, 3 essential elements must be present: scaffolding for osteoconduction, growth factors for osteoinduction, and progenitor cells for osteogenesis. A composite graft that combines a synthetic scaffold with osteoprogenitor cells from bone marrow aspirate (BMA) may potentially deliver the advantages of autogenous bone grafts without the procurement morbidity. Sixty consecutive patients with cavitary bone defects were treated with a composite of b-tricalcium phosphate (beta-TCP), Vitoss (Orthovita, Malvern, Pennsylvania), and BMA. The cavitary defects were measured on orthogonal views by experienced musculoskeletal radiologists. Radiographically, resorption and trabeculation increased steadily with time. This differential was slightly more noticeable in large defects with a central trabeculation occurring in advance of the peripheral region. The majority of patients progressed to unrestricted activities by 6 weeks and had returned to their usual activities by 12 weeks. No significant difference in graft incorporation rate was noted based on age, size of defect, or use of adjuvant local treatment. The use of a composite graft (ultraporous beta-TCP+BMA) in the treatment of cavitary lesions appears to be safe and effective.
Assuntos
Transplante de Medula Óssea/instrumentação , Transplante de Medula Óssea/métodos , Substitutos Ósseos/administração & dosagem , Transplante Ósseo/instrumentação , Transplante Ósseo/métodos , Fosfatos de Cálcio/administração & dosagem , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Silicatos/administração & dosagem , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
This case report describes a 36-year-old African American male with cerebral palsy and bilateral slowly enlarging knee masses. He has 90 degrees fixed flexion knee contractures bilaterally. Although he has poor communication skills, he does not have discomfort while ambulating. He has developed massive bilateral prepatellar bursitis from chronic and repetitive injury to the region bearing his body weight while ambulating. As the result of a protective response, the bursa provides a cushion for the underlying bone prominences of the tibial tubercle and patella. This compensatory mechanism has allowed the patient to have functional, painless household ambulation.
Assuntos
Bolsa Sinovial , Bursite/complicações , Bursite/fisiopatologia , Paralisia Cerebral/complicações , Patela , Adaptação Fisiológica , Adulto , Artrografia , Bolsa Sinovial/lesões , Bursite/diagnóstico , Bursite/etiologia , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Locomoção , Imageamento por Ressonância Magnética , MasculinoRESUMO
Synovial sarcoma is a characteristic subtype of soft tissue sarcomas with a predilection for young people. There may be a long delay in diagnosis or misdiagnosis, because of its insidious growth, varied presentation on imaging studies and associated joint pain, which can be confused with trauma. Diagnosis requires a tissue sample in the form of a needle or open biopsy. The needle biopsy may not be representative of the tumor, particular if it is biphasic, and it may be necessary to proceed to open biopsy. Ideally, the biopsy should be performed by the surgeon who will be performing the definitive surgical resection. Although treatment is predicated on surgery, adjuvant radiation and/or chemotherapy may be beneficial, particularly in high risk patients. Significant prognostic factors include: size > 5 cm, deep-seated location, adequacy of surgical margins, and history of recurrence. In the future, multi-institutional prospectively randomized, controlled studies will be needed to better define the role of adjuvant chemotherapy. Currently, outcome may be optimized by early suspicion and detection with referral to an orthopedic oncology specialist prior to the biopsy.
Assuntos
Sarcoma Sinovial , Neoplasias de Tecidos Moles , Biópsia , Terapia Combinada/métodos , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Morbidade , Prognóstico , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/epidemiologia , Sarcoma Sinovial/terapia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/epidemiologia , Neoplasias de Tecidos Moles/terapia , Taxa de SobrevidaRESUMO
Cancer patients rely on patient education materials (PEMs) to gather information regarding their disease. Patients who are better informed about their illness have better health outcomes. The National Institutes of Health (NIH) recommends that PEMs be written at a sixth- to seventh-grade reading level. The purpose of this study was to evaluate the readability of online PEMs of bone and soft-tissue sarcomas and related conditions. We identified relevant online PEMs from the following websites: American Academy of Orthopaedic Surgeons, academic training centers, sarcoma specialists, Google search hits, Bonetumor.org, Sarcoma Alliance, Sarcoma Foundation of America, and Medscape. We used 10 different readability instruments to evaluate the reading level of each website's PEMs. In assessing 72 websites and 774 articles, we found that none of the websites had a mean readability score at or below 7 (seventh grade). Collectively, all websites had a mean readability score of 11.4, and the range of scores was grade level 8.9 to 15.5. None of the PEMs in this study of bone and soft-tissue sarcomas and related conditions met the NIH recommendation for PEM reading levels. Concerted efforts to improve the reading level of orthopedic oncologic PEMs are necessary.
Assuntos
Neoplasias Ósseas , Compreensão , Educação de Pacientes como Assunto , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Internet , Ortopedia/educação , Estados UnidosRESUMO
Radiopharmaceuticals not only are used for diagnostic purposes but also increasingly in the treatment of many orthopaedic-related disorders. With the development of specific bone-seeking radiopharmaceuticals, the side effects of treatment are minimized, therapeutic effects are sustained, and concomitant use with other modalities may have synergistic effects. These new radiopharmaceuticals, such as strontium 89 and samarium 153-ethylene diamine tetramethylene phosphate, have been used as palliative treatment for patients with bone pain from osseous metastases. Excellent clinical responses with acceptable hematologic toxicity have been observed, and clinical results rival those of external beam radiation therapy. Radiosynovectomy has become a procedure of choice at many institutions to treat recurrent hemarthrosis and chronic synovitis in patients whose hemophilia is poorly controlled with medical management. Radiosynovectomy also remains a viable option to treat chronic synovitis secondary to inflammatory arthropathies, particularly rheumatoid arthritis.
Assuntos
Doenças Musculoesqueléticas/diagnóstico por imagem , Ortopedia/tendências , Compostos Radiofarmacêuticos/farmacologia , Humanos , Cintilografia , Samário/uso terapêutico , Radioisótopos de Estrôncio/uso terapêuticoRESUMO
The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.
Assuntos
Osteotomia , Sarcoma/terapia , Lesões dos Tecidos Moles , Deiscência da Ferida Operatória , Técnicas de Fechamento de Ferimentos/classificação , Bandagens , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Desbridamento/métodos , Humanos , Recidiva Local de Neoplasia/prevenção & controle , Tratamentos com Preservação do Órgão/métodos , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Resultados em Cuidados de Saúde , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Fatores de Risco , Sarcoma/patologia , Sarcoma/fisiopatologia , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/terapia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/fisiopatologia , Deiscência da Ferida Operatória/terapia , CicatrizaçãoAssuntos
Pinos Ortopédicos , Fixação de Fratura/instrumentação , Fraturas Espontâneas/cirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Feminino , Fêmur/cirurgia , Fixação de Fratura/métodos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Úmero/cirurgia , Masculino , Tíbia/cirurgiaRESUMO
Meningeal hemangiopericytomas are rare vascular tumors that have a propensity for recurrence and metastasis. Intracranial hemangiopericytomas are rare vascular tumors. They account for 0.5% of primary central nervous system tumors and 2% of meningiomas. Unlike usual benign meningiomas, which rarely metastasize extracranially, meningeal hemangiopericytoma has a high rate of local recurrence and distant metastasis. The treatment paradigms for hemangiopericytomas and meningiomas differ based on their biological behaviors. Hemangiopericytomas have higher rates of recurrence and metastasis compared with meningiomas. Intracranial meningeal hemangiopericytoma is characterized by clinically repeated local recurrences at the primary site. Bone, liver, lung, central nervous system, and abdominal cavity are the most commonly reported sites of metastasis in hemangiopericytomas.This article describes a case of bone metastasis with extensive involvement of the scapula from intracranial hemangiopericytoma. Bone metastasis can be seen in a relatively late phase of the disease, with metastasis to other organs. Although radiation therapy is effective in controlling pain from bone metastases in unresectable disease and those with extensive visceral metastases, aggressive local surgical control of a solitary bone metastasis may be an option for patients with limited distant disease. The diagnosis may be initially confused with clear cell meningioma and benign meningiomas. The management of bone metastasis is not well reported in the orthopedic literature.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Prótese Articular , Neoplasias Meníngeas/cirurgia , Meningioma/secundário , Meningioma/cirurgia , Escápula/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Escápula/diagnóstico por imagem , Resultado do TratamentoAssuntos
Falso Aneurisma/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Artéria Femoral/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Sarcoma/secundário , Idoso , Artéria Femoral/cirurgia , Humanos , Masculino , CintilografiaAssuntos
Fraturas Espontâneas/etiologia , Hipofosfatemia/etiologia , Mesenquimoma/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Osteomalacia/etiologia , Coxa da Perna/diagnóstico por imagem , Dor nas Costas/etiologia , Feminino , Humanos , Hipofosfatemia/sangue , Hipofosfatemia/diagnóstico por imagem , Mesenquimoma/complicações , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/complicações , Osteomalacia/sangue , Osteomalacia/diagnóstico por imagem , Radiografia , Cintilografia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m SestamibiAssuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Coristoma/diagnóstico por imagem , Rim/anormalidades , Idoso , Idoso de 80 Anos ou mais , Coristoma/patologia , Humanos , Masculino , Cintilografia , Medronato de Tecnécio Tc 99m , Tomografia Computadorizada por Raios XAssuntos
Hipofosfatemia/complicações , Mesenquimoma/patologia , Neoplasias Musculares/patologia , Osteomalacia/patologia , Sarcoma/patologia , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Seguimentos , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/terapia , Humanos , Hipofosfatemia/diagnóstico , Imuno-Histoquímica , Imageamento por Ressonância Magnética/métodos , Mesenquimoma/etiologia , Mesenquimoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Musculares/etiologia , Neoplasias Musculares/cirurgia , Procedimentos Ortopédicos/métodos , Osteomalacia/diagnóstico , Cintilografia/métodos , Sarcoma/diagnóstico , Tecnécio Tc 99m Sestamibi , Coxa da Perna , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Although advances have been made in both surgical and medical management of patients with osteosarcoma, the overall survival of patients with osteosarcoma has remained constant, with no substantial improvement in the past 15 years. Advances in imaging have had a substantial impact on surgical planning and staging. These advances have, in turn, had a major impact on the surgeon's ability to perform limb-sparing surgery. Surgical techniques have improved in terms of instrumentation, modularity of implants and availability. Limb salvage has proven to be an acceptable method of treatment both with respect to oncologic and functional outcome in those patients where a wide resection may be achieved. The use of massive allografts has been largely replaced with the use of modern oncologic endoprostheses. Biologic targets that will enable new therapies to have maximum effect on tumor cells while minimizing toxicity to the host tissues need to be identified.