Metal Ion Release in Cancer Patients Following Megaprosthesis Salvage Surgery.

BACKGROUND: Megaprostheses contain many more modular components than conventional total hip and knee arthroplasty, which may lead to higher serum levels of metal ions. The aim of this study was to determine serum concentrations of titanium, chromium, and cobalt ions in cancer patients after limb salvage surgery with a megaprosthesis. METHODS: A retrospective, descriptive cohort analysis consisting of patients who underwent cancer-related limb salvage surgery with a megaprosthesis at our hospital between 2010 and 2020 was conducted. Baseline and follow-up data were extracted from clinical and surgical records. Blood samples were prospectively obtained. Descriptive statistics were used for the analysis. RESULTS: A total of 71 patients underwent limb salvage surgery during the study period. Of these, 22 (10 women, 12 men) were included in the study. The mean age was 52 years (range, 21 to 80). Most cases (n = 16; 72.7%) involved the femur. Most patients (n = 14, 63.6%) underwent total knee megaprosthesis surgery. Implant revision surgery was required in 45% of cases (n = 10), with a mean interval of 4.32 years between the initial and revision surgeries. The mean follow-up time after revision surgery was 4.05 years. High levels of chromium were observed in 22.7% of patients (n = 5). High cobalt levels were found in 68.2% (n = 15) of patients, with toxic levels in 9.1% (n = 2). Titanium levels were high in 77.3% (n = 17) of cases and toxic in 22.7% (n = 5). Postoperative chemotherapy was significantly associated with titanium levels (P = .017). No correlation was observed between metal ion levels and time from primary or revision surgery or time from the first to revision surgery. CONCLUSIONS: This study shows that cancer-related limb salvage surgery with megaprosthesis is associated with metal ion levels that exceed established safe thresholds. Compared to conventional hip arthroplasty, a higher proportion of the patients in this cohort presented elevated levels of metal ions. LEVEL OF EVIDENCE: III.

Pharmacogenetic Profiling in High-Risk Soft Tissue Sarcomas Treated with Neoadjuvant Chemotherapy.

Neoadjuvant chemotherapy based on anthracyclines and ifosfamide for high-risk soft tissue sarcomas (STS) of the extremities and trunk is a controversial treatment option. There are substantial interindividual differences in clinical outcomes in patients treated with neoadjuvant chemotherapy. The aim of this study was to evaluate, as biomarkers, polymorphisms in genes encoding drug-metabolizing enzymes, drug transporters, or drug targets and their association with toxicity and survival in STS patients treated with neoadjuvant chemotherapy. We analysed variants in genes involved in anthracycline metabolism (ABCB1, ABCC2, NQO1, CBR3, and SLC22A16) and in ifosfamide catabolism (ALDH1A1) in 79 treated patients. Two genes showed significant association after adjusted multivariate analysis: ABCC2 and ALDH1A1. In patients treated with anthracyclines, ABCC2 rs3740066 was associated with risk of febrile neutropenia (p = 0.031), and with decreased overall survival (OS) (p = 0.024). ABCC2 rs2273697 was associated with recurrence-free survival (RFS) (p = 0.024). In patients treated with ifosfamide, ALDH1A1 rs3764435 was associated with RFS (p = 0.046). Our pharmacogenetic study shows for the first time that variants in genes regulating the metabolism of neoadjuvant chemotherapy may be helpful to predict toxicity and survival benefit in high-risk STS treated with neoadjuvant chemotherapy. Further validation studies are needed to establish their clinical utility.

Pseudoartrosis de calcáneo en contexto de pie catastrófico / Pseudarthrose du calcanéum dans le cadre d'une fracture-luxation de pied / Calcaneal pseduarthrosis in catastrophic foot

La pseudoartrosis de calcáneo es excepcional. La incidencia es del 1,3 por ciento de todas las fracturas intraarticulares. Se relaciona con fracturas intraarticulares tratadas conservadoramente, diabetes mellitus, tabaquismo y fracturas abiertas. Presentamos un caso de pseudoartrosis de calcáneo, secuela de fractura de luxación abierta en el contexto de un pie catastrófico(AU)

Calcaneal pseudoarthrosis is rare and its incidence accounts for 1.3 percent of all the intra-articular fractures. It is associated to intra-articular fractures treated with conservative methods, diabetes mellitus, smoking and open fractures. This is a calcaneal pseudoarthrosis case as a sequel of open dislocation fracture in a catastrophic foot injure(AU)

La pseudarthrose du calcanéum est une affection assez rare. Son incidence est 1.3 pourcent de toutes les fractures interarticulaires. Elle est associée aux fractures interarticulaires traitées de façon conservatrice, au diabète sucré, au tabagisme, et aux fractures ouvertes. Un cas de pseudarthrose de calcanéum, séquelle d'une fracture-luxation ouverte du pied après accident de route, est présenté(AU)

Telangiectatic osteosarcoma.

PURPOSE: To review records of 8 patients with telangiectatic osteosarcoma (TOS) and determine whether pathologic fractures correlate with recurrence and survival. METHODS: Records of 4 men and 4 women aged 17 to 44 (mean, 28) years treated for TOS were reviewed. RESULTS; Of the 8 patients, 4 developed a pathologic fracture and 4 did not. In each group, 2 patients underwent limb salvage surgery and 2 underwent amputation. All patients received neoadjuvant and adjuvant chemotherapy with a combination of at least 2 of the following drugs: doxorubicin, methotrexate, cisplatin, and vincristin. After a mean follow-up of 5.6 (range, 2-16) years, all 4 patients with a pathologic fracture and 2 of the 4 patients without a pathologic fracture were still alive and disease-free. For the remaining patients, one died after 31 months from progression of a lung metastasis, and the other was alive with the disease and had had 2 recurrences, a lung metastasis, and an infection with Klebsiella oxytoca that eventually led to an amputation. CONCLUSION: The presence of a pathologic fracture in patients with TOS was not associated with worse outcome in terms of recurrence and survival.

Distal radioulnar joint prosthesis for the treatment of giant cell tumor of the distal ulna: a case report and literature review.

Giant cell tumor (GCT) of the distal end of the ulna is an uncommon site for primary bone tumors. When it occurs, en-bloc resection of the distal part of the ulna with or without reconstruction stabilization of the ulnar stump is the recommended treatment. We present a case of a 56-year-old man with a GCT of the distal ulna treated successfully with an en-bloc resection of the distal ulna with reconstruction using radioulnar joint prosthesis. Although the experience with this type of treatment is limited, implantation of a metallic prosthesis to replace the distal part of the ulna can also be considered as a salvage procedure for the treatment of this difficult pathology.

Arthrodesis of the metacarpophalangeal joint of the thumb using a Herbert screw.

We describe a technique for thumb metacarpophalangeal joint arthrodesis by using a Herbert screw. This method of fixation helps in avoiding some of the potential problems associated with wire fixation, tension-band arthrodesis, or plate fixation. Therefore, it eliminates the risk of pin track infection, pin breakage, and painful protrusion under the skin requiring metalwork removal.