Curettage, phenolization, and cementation in paediatric Ewing's sarcoma with a complete radiological response to neoadjuvant chemotherapy.

PURPOSE: Although wide resection is the standard treatment for Ewing's sarcoma (ES), it has complications especially in children. In this study, we compared the oncologic and functional outcomes of wide resection with extended curettage and local adjuvant therapy (phenolization and cementation), as a less extensive surgery for paediatric ES with a complete radiologic response to neoadjuvant chemotherapy. METHODS: Children aged ≤ ten years, with ES of non-expendable long-bones and complete radiologic response to neoadjuvant chemotherapy, were included in this case-control study. Twenty-six patients were treated with extended curettage and local adjuvant therapy (case group) and 17 were managed with wide resection (control group). The average follow-up period was 60.1 ± 28.7 months (range 30-168 months). Functional outcome was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: Three local recurrences (11.5%) and three distant metastases (11.5%) were observed in the case group. Two local recurrences (11.7%) and two metastases (11.7%) were recorded in the control group. The rate of local recurrence was not statistically different between the two study groups (p = 0.668). The rate of metastasis was not statistically different between the two study groups as well (p = 0.668). The complication rates were 15% in the case group and 53% in the control group (p = 0.005). The mean MSTS score was 98.3% and 74% in the case and control group, respectively (p < 0.001). CONCLUSION: The oncologic outcome of extended curettage and local adjuvant therapy in paediatric ES with complete radiological response to neoadjuvant chemotherapy is comparable to wide resection, yet it offers considerably better functional results.

Fibular strut allograft or bone cement for reconstruction after curettage of a giant cell tumour of the proximal femur : a retrospective cohort study.

AIMS: Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur. METHODS: In a retrospective study, we reviewed 26 patients with a GCT of the proximal femur in whom the bone defect had been filled with either a fibular strut allograft (n = 12) or bone cement (n = 14). Their demographic details and oncological and nononcological complications were retrieved from their medical records. Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) score. RESULTS: Mean follow-up was 116 months (SD 59.2; 48 to 240) for the fibular strut allograft group and 113 months (SD 43.7; 60 to 192) for the bone cement group (p = 0.391). The rate of recurrence was not significantly different between the two groups (25% vs 21.4%). The rate of nononcological complications was 16.7% in the strut allograft group and 42.8% in the bone cement group. Degenerative joint disease was the most frequent nononcological complication in the cement group. The mean MSTS score of the patients was 92.4% (SD 11.5%; 73.3% to 100.0%) in the fibular strut allograft group and 74.2% (SD 10.5%; 66.7% to 96.7%) in the bone cement group (p < 0.001). CONCLUSION: Given the similar rate of recurrence and a lower rate of nononcological complications, fibular strut grafting could be recommended as a method of reconstructing the bone defect left by curettage of a GCT of the proximal femur. Cite this article: Bone Joint J 2022;104-B(2):297-301.

Improvement in osseointegration of tricalcium phosphate-zircon for orthopedic applications: an in vitro and in vivo evaluation.

Similar to metallic implant, using the compact bio-nanocomposite can provide a suitable strength due to its high stiffness and providing sufficient adhesion between bone and orthopedic implant. Therefore, using zirconia-reinforced calcium phosphate composites with new generation of calcium silicate composites was considered in this study. Additionally, investigation of microstructure, apatite formation, and mechanical characteristic of synthetic compact bio-nanocomposite bones was performed. Desired biodegradation, optimal bioactivity, and dissolution of tricalcium phosphate (TCP) were controlled to optimize its mechanical properties. The purpose of this study was to prepare the nanostructured TCP-wollastonite-zirconia (TCP-WS-Zr) using the space holder (SH) technique. The X-ray diffraction technique (XRD) was used to confirm the existence of favorable phases in the composite's structure. Additionally, the effects of calcination temperature on the fuzzy composition, grain size, powder crystallinity, and final coatings were investigated. Furthermore, the Fourier-transform infrared spectroscopy (FTIR) was used for fundamental analysis of the resulting powder. In order to examine the shape and size of powder's particles, particle size analysis was performed. The morphology and microstructure of the sample's surface was studied by scanning electron microscopy (SEM), and to evaluate the dissolution rate, adaptive properties, and the comparison with the properties of single-phase TCP, the samples were immersed in physiological saline solution (0.9% sodium chloride) for 21 days. The results of in vivo evaluation illustrated an increase in the concentration of calcium ion release and proper osseointegration ratio, and the amount of calcium ion release in composite coatings was lower than that in TCP single phase. Nanostructured TCP-WS-Zr coatings reduced the duration of implant fixation next to the hardened tissue, and increased the bone regeneration due to its structure and dimensions of the nanometric phases of the forming phases. Finally, the animal evaluation shows that the novel bio-nanocomposite has increasing trend in healing of defected bone after 1 month.