Unrecognized Chondrosarcoma as a Cause of Total Hip Arthroplasty Failure.

BACKGROUND: Total hip arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. The most frequent THA indications are osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening is the most common indication to revision surgery. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most prevalent location. Wide resection is the treatment of choice.We report 3 cases of unrecognized high-grade CS in the setting of primary or revision THA and reviewed the literature on this rare clinical presentation. METHODS: A systematic literature review on CS in the setting of THA, published between 1980 and 2020, was performed on PubMed, Embase, Medline, Ovid SP, and Web of Science, using the guidelines set in the Preferred Reporting Items for Systematic Reviews and Mata-analyses (PRISMA). RESULTS: Case series: Three patients were referred to our sarcoma center after failure of THA due to unrecognized high-grade CS. All 3 had rapid fatal outcome. Literature review: Fifty-nine articles were identified, of which 8 were included in the study. They confirmed that primary or revision THA failure due to unrecognized CS is extremely rare, with only few cases reported in the literature. CONCLUSIONS: Before proceeding to primary or revision arthroplasty, diagnosis must be ascertained. Atypical presentation of a common pathology, such as osteoarthritis, avascular necrosis, or aseptic loosening of an endoprosthesis, should raise suspicion for another cause to symptoms, and additional workup be performed. As our cases demonstrated, unrecognized or inadequately managed bone sarcoma may lead to poor or even fatal outcome.

Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients.

INTRODUCTION: Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. MATERIAL AND METHODS: Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. RESULTS: The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. CONCLUSION: The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques.

Oncological outcome, functional results and costs after unplanned excision of musculoskeletal soft tissue sarcoma.

BACKGROUND: Treatment of soft tissue sarcomas (STS) should only be initiated once the diagnosis is fully established. Resection of tumors of unknown nature should be avoided. Nevertheless, specialized centers continue to face numbers of unplanned excisions (UPE) in STS. AIM: To compare oncologic and functional outcomes, number of surgeries, length of hospital stay and treatment costs of UPE versus planned excision (PE) in STS. METHOD: A retrospective single tertiary center study was performed on 201 patients. Survival, local and distant recurrence rates were compared between PE (n = 137) and UPE (n = 64). In a subgroup analysis of 60 patients, functional outcome (MSTS and TESS scores), and socio-economic impact (number of surgeries, length of hospital stay and treatment costs) in "functional planned excision" (fPE) group (n = 30) and "functional unplanned excision" (fUPE) group (n = 29) were compared. RESULTS: There was no significant difference in oncological outcome between PE and UPE. In the subgroup analysis, we found a non-significant difference in functional outcome. Patients in the fUPE had significantly more surgeries (3.5 vs. 1.4; p < 0.00001) and costs of their management was 64% higher than fPE (p = 0.048). Hospital stay was longer after fUPE but not statistically significant (18.3 days vs. 11.8 days; p = 0.13). CONCLUSION: Even though oncological and functional outcomes are comparable after PE and UPE of STS, the number of surgeries, length of hospital stay and treatment costs were higher in patients with UPE. Our data underscore the importance of specialized STS treatment centers including multidisciplinary management.

[Surgical treatment of proximal femur metastases]. / Traitement chirurgical des métastases du fémur proximal.

Aging of the population results in an increase of the incidence of cancer and bone metastases. The proximal femur is one of the most frequent locations of bone metastases. A pathological fracture has a major impact on the quality of life and potentially on survival. In case of impending fracture, prophylactic fixation is therefore strongly recommended. The management of metastases of the proximal femur depends on multiple parameters, life expectancy and fracture risk being the most important ones. If survival is estimated to be less than 6 weeks, surgery is generally not indicated. Beyond 6 weeks, surgical indication essentially depends on location of the metastases on the proximal femur and the presence of a fracture.

L'augmentation de l'espérance de vie s'accompagne d'une croissance de l'incidence des cancers et des métastases osseuses. Le fémur proximal est un des sites les plus fréquents de métastases osseuses. Une fracture pathologique dans cette localisation a un impact majeur sur la qualité de vie et potentiellement sur la survie du patient. Un traitement chirurgical prophylactique est ainsi recommandé en cas de risque de fracture imminente. La prise en charge des métastases fémorales proximales se décide en fonction de multiples paramètres, dont la survie théorique et le risque de fracture sont les plus importants. Si la survie est estimée à moins de 6 semaines, une chirurgie n'est en général pas indiquée. Au-delà, l'indication chirurgicale dépend essentiellement de la localisation des lésions et de la présence d'une fracture associée.

Entrapment of the Sciatic Nerve Over the Femoral Neck Stem After Closed Reduction of a Dislocated Total Hip Arthroplasty.

Sciatic nerve injury is a rare but potentially extremely disabling complication of posterior dislocated total hip arthroplasty. Initial closed reduction is recommended followed by a careful neurovascular examination. This procedure and the following stability testing are usually safe and typically associated with a very low complication rate. We report the case of sciatic nerve entrapment around the neck of the femoral stem after closed reduction of a posteriorly dislocated total hip arthroplasty. Immediate postreduction palsy led to surgical exploration, identification, neurolysis of the sciatic nerve and safe reduction was performed. Patient outcome was marked by complete sensitive sciatic nerve recovery, but complete loss of motor sciatic nerve function. This case highlights the importance of careful postreduction neurovascular assessment and prompt surgical exploration when indicated.

[Olecranon fractures]. / Fractures de l'olécrâne.

Olecranon fractures represent 5 % of all adult fractures. Management is most often surgical. Conservative treatment is recommended for non-displaced fractures or patients who would be poor surgical candidates. Prolonged immobilization of the elbow may cause joint stiffness, whereas surgical treatment can be complicated by loss of reduction or wound issues with secondary infection of the material. In this article, we discuss the pathology and the principles of treatment based on the literature, to allow the general practitioner to guide the patient towards the most suitable treatment.

Les fractures de l'olécrâne représentent 5 % de l'ensemble des fractures. Leur prise en charge est le plus souvent chirurgicale et le traitement conservateur est réservé aux fractures non déplacées ou à des patients qui seraient de mauvais candidats à la chirurgie. L'immobilisation prolongée du coude peut être responsable d'une raideur articulaire, alors qu'un traitement chirurgical peut entraîner des complications comme le démontage de l'ostéosynthèse ou des problèmes de cicatrisation avec infection précoce du matériel. Dans cet article, nous voulons rappeler les connaissances anatomopathologiques ainsi que les principes du traitement, basés sur la littérature, afin de permettre au médecin d'orienter son patient vers le traitement le plus adapté.