Osteoid osteoma of the foot : Presentation, treatment and outcome of a multicentre cohort.

BACKGROUND: Osteoid osteomas of the foot are rare, with a varying and atypical clinical as well as radiological presentation impeding early diagnosis and treatment. The aim of the present multicentre study was to 1) analyze epidemiological, clinical and radiological findings of patients with foot osteoid osteomas and to 2) deduce a diagnostic algorithm based on the findings. METHODS: A total of 37 patients (25 males, 67.6%, mean age 23.9 years, range 8-57 years) with osteoid osteomas of the foot were retrospectively included, treated between 2000 and 2014 at 6 participating tertiary tumor centres. Radiographic images were analyzed, as were patients' minor and major complaints, pain relief and recurrence. RESULTS: Most osteoid osteomas were located in the midfoot (n = 16) and hindfoot (n = 14). Painful lesions were present in all but one patient (97.3%). Symptom duration was similar for hindfoot and midfoot/forefoot (p = 0.331). Cortical lesions required fewer x­rays for diagnosis than lesions at other sites (p = 0.026). A typical nidus could be detected in only 23/37 of x­rays (62.2%), compared to 25/29 CT scans (86.2%) and 11/22 MRIs (50%). Aspirin test was positive in 18/20 patients (90%), 31 patients (83.8%) underwent open surgery. Pain relief was achieved in 34/36 patients (outcome unknown in one), whilst pain persisted in two patients with later confirmed recurrence. CONCLUSIONS: As previously reported, CT scans seem to be superior to MRIs towards detection of the typical nidus in foot osteoid osteomas. In patients with unclear pain of the foot and inconclusive x­rays, osteoid osteoma should be considered as differential diagnosis.

Epidemiology of musculoskeletal tumors in a national referral orthopedic department. A study of 3482 cases.

AIM OF THE STUDY: Musculoskeletal tumors are relatively rare, and their geographic distribution varies greatly around the world. In this study, we present the incidence, age distribution and localization of musculoskeletal tumors diagnosed and/or treated at a tertiary referral orthopedic department, catering to an entire Southeastern European country. METHODS: This was a retrospective study of prospectively collected data, in which all patients diagnosed and/or treated for musculoskeletal tumors at our Department in the period of 30 years (1981-2010) were included. RESULTS: Data of a total of 3482 patients with musculoskeletal tumors were collected. Average age of patients was 33.5 years (range, 2 months-88 years), with even distribution according to sex. Malignant tumors were seen in 20.7% of patients, more often in men (56.9%). Most common malignant tumors were osteosarcoma (estimated incidence: 1.68/million/year), chondrosarcoma (0.79/million/year) and Ewing sarcoma (0.76/million/year). Benign tumors and tumor-like lesions were found in 79.3% of patients, with slight female predominance. Most common benign bone lesions were osteochondroma (5.81/million/year), simple bone cyst (2.13/million/year), and enchondroma (2.05/million/year). CONCLUSION: This report represents a first of its kind in our region, and gives representative results to be compared to other middle and south European countries. Further nationwide studies are needed to improve strategies in bone tumor diagnosis and treatment.

[GIANT CELL TUMOR OF BONE: RESULTS AND TREATMENT COMPLICATIONS]. / GIGANTOCELULARNI TUMORI KOSTI: REZULTATI I KOMPLIKACIJE LIJECENJA.

Giant cell tumor of bone (GCT) is mostly benign, locally aggressive tumor with a high recurrence rate. GCT is treated primarily surgically, and the approach is determined according to localization and local tumor behavior. The aim of this study was to analyze results and complications of surgical treatment of GCT at atertiary orthopedic clinical center in Croatia. We analyzed all patients treated at University Department of Orthopedics, Zagreb University Hospital Center, during a 15-year period. From 1995 to 2009, 39 patients were surgically treated for GCT. Four patients were lost from follow up. In patients with low-grade GCT (n = 12, 34%), we performed marginal-intralesional resection, whereas in patients with locally aggressive GCT we performed en bloc resection and reconstruction with tumor endoprosthesis or bone allograft (n = 22, 63%). In one patient, the only treatment was tumor irradiation. Complications were evident in one-third of our patients. The most common complications were tumor recurrence (n = 6, 50% of all complications) and deep infection (n = 2, 17% of all complications). We performed amputation in two patients in whom osteosarcoma was revealed under GCT radiologic and histologic appearance. We performed 84 operations in 35 patients, not counting primary biopsy. In conclusion, treatment of GCT is complex, with a high incidence of tumor recurrence. Diagnosis and treatment are best provided through a multidisciplinary approach in highly specialized centers for orthopedic oncology.

Stability of Endler cementless polyethylene acetabular cup: long-term follow-up.

AIM: To investigate the possible influence of demographic and biomechanical factors on stability of the Endler cementless polyethylene acetabular cup. METHODS: This was a retrospective cohort study. Seventy-two patients (25 men, 47 women) bearing 82 Endler prostheses, all of which were implanted by the same surgeon in the period between 1985 and 1991, were invited for a control visit (final visit) in July 2003. During time between the surgery and the final visit, the patients were followed-up regularly and assessed for clinical and radiological signs of the Endler cup instability based on Krugluger and Eyb's criteria. The Kaplan-Meier product limit method and the Cox proportional hazard regression analysis were used to investigate the survival of the cup (time since implantation till the diagnosis of instability) and possible influence of the following factors: age and body mass index at the time of surgery, gender, achieved acetabular cup inclination angle, and acetabuloplasty and/or trochanter osteotomy performed during surgery. RESULTS: The median follow-up period was 15 years (range 5-18). Cumulative survival rates at 5, 10, 15, and 18 years were 97.6% (95% CI=94.2-100), 74.4% (95% CI=64.9-83.8), 53.7% (95% CI=42.9-64.5), and 44.5% (95% CI=29.5-59.6), respectively. The median survival time was 18 years (13-18). Unsatisfactory acetabular cup inclination angle (<41 or >49 degrees) was a negative predictor of the cup survival (P=0.026), whereas the interaction between the inclination angle and an unsatisfactory body mass index (>upper normal limit) was of borderline significance (P=0.056). The analyzed demographic and biomechanical factors apparently explained only a minor part of the survival variability (R(2)=0.173). CONCLUSION: This study further documents the impact of the acetabular cup inclination angle achieved at surgery on the Endler cup survival. However, it also suggests that the prosthesis survival might be influenced by other, non-biomechanical factors.

[Emergencies in total hip replacement]. / Hitna stanja kod totalnih endoproteza kuka.

Over the last three decades total hip replacement became one of the most common surgical procedures in orthopaedic surgery. According to the number of large joint endoprosthesis, hip replacement is on the first place. Lately, the number of revisional and special tumoral endoprosthesis is increasing, with more severe complications. Dislocation is a leading early complication of total hip arthroplasty. Dislocations after primary total hip arthroplasties occur at an overall incidence of 1-3%, and at 15-20% in revision and tumoral procedures. Closed reduction and eventually immobilization is the method of treatment. If closed reposition in not possible, revision surgery must be performed. Periprosthetic fractures are, as every other fracture, indication for a surgical treatment. Depending on the type of fracture the method of treatment is either open reduction and internal fixation or removal of the primary and implantation of revision endoprosthesis. Deep infection following total joint replacement remains one of the most serious complications, often needing surgical treatment. Treatment consists of incision and debridement. If there is a fever, increased erythrocyte sedimentation and CRP with signs of sepsis, endoprosthesis must be removed. A haematoma appearance after surgical procedure is an emergency which needs a surgical treatment--haematoma evacuation in order to prevent further complication, on the first place infection. Fractured endoprosthesis is one of the most severe complication in the total hip replacement, and need to be surgically treated as soon as possible with endoprosthesis replacement. Aseptic loosening can also be considered as a relative emergency in surgical treatment of total hip replacement. Longer waiting for reoperation can cause losing valuable bone mass needed for revisional endoprosthesis implantation and fixation. Although emergencies in hip replacement are not very common, they must be recognized and eventually surgically treated as soon as possible.

[Emergencies by tumors of locomotors systems in child and adults]. / Hitna stanja kod tumora sustava za kretanje u djece i odraslih.

Tumours of locomotors system regardless whether they are primary or secondary, malign or benign, are regarded as urgent conditions in orthopaedics. The goal is early identification, urgent processing and diagnosing within as short period of time as possible in order to start the appropriate treatment. Since such tumours are most common in childhood and with teenagers, when anamnesis and clinical data cannot be specific and they are various, it is an imperative to identify and diagnose them early.