Proximal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-operative Rehabilitation Protocol.

Background: Reconstructions of the proximal femur after massive resections represent one of the main challenges in orthopedic oncology. Among the possible treatments, megaprostheses represent one of the most used and reliable reconstructive approaches. Although literature about their outcomes has flourished through the last decades, a consensus rehabilitative treatment is still far from being established. Materials and methods: We evaluated the functional results of all our oncologic cases treated between 2016 and 2022 that could follow our standardized post-operative rehabilitative approach, consisting in progressive hip mobilization and early weight-bearing. Results: Twenty-two cases were included in our study. On average, their hospitalization lasted 15.1 days. The seated position was achieved on average within 3.7 days after surgery, the standing position reached 5.4 after surgery, while assisted deambulation was started 6.4 days after surgery. After a mean post-operative follow-up of 44.0 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggested a statistically significant inverse linear correlation between post-operative functionality and patients' age, resection length, and the start of deambulation. Conclusions: A correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximize patients' post-operative functional outcomes.

Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting.

BACKGROUND: Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. METHODS: In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients' post-operative functionality was assessed with the MSTS score. RESULTS: Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients' mean post-operative MSTS score was 29.6. CONCLUSIONS: Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis.

Giant atypical lipomatous tumors of the thigh: a case series.

BACKGROUND AND AIM: Atypical Lipomatous Tumors (ALTs) are low-grade locally aggressive soft tissue tumors. Deep large sized ALTs of the thigh can cause significant functional impairment due to their mass effect. Surgical resection, which is the treatment of choice for these lesions, can be a though procedure, especially if the neoplasm comes in proximity with noble structures such as large sized arteries or nerves. The aim of our study is to assess risks and effectiveness of surgical resection, evaluating complications, local recurrences and post-operative functionality. METHODS: We evaluated all the giant ALT (larger diameter of 10 cm or more) of the thigh that received surgery in our institution between 2017 and 2022. Each patient's personal data and tumor size were evaluated. The quality of surgical margins was analyzed. MRI scans were performed both pre-operatively and during patients' follow-up. Lower limb's functional status was assessed using the MSTS score before and after surgery. Intra-operative and post-operative complications were recorded, as well as local recurrences. RESULTS: Twentythree cases were included in our study. Tumors' mean major diameter was 19.1cm. The mean pre-operative MSTS score was 25.9. Only one case suffered from significant post-operative complications. Only 2 of our cases (8.7%) developed a local recurrence after surgery. The mean post-operative MSTS score was 29.1 Conclusions: A careful surgical resection can be effective in treating giant ALTs of the thigh in reason of good functional outcomes, low complications risks and reasonable local recurrence rates.

Outcomes of Surgical Treatment for Localized Tenosynovial Giant-Cell Tumor of the Foot and Ankle: A Case Series.

Background: Giant cell tumor of the tendon sheath (GCTTS), also termed Tenosynovial giant cell tumor (TGCT), is a locally aggressive tumor which originates from tendon sheaths or bursas. Around 3-5% of these tumors arise from foot and ankle. Localized lesions in this area are often manifested as firm masses or nodules with slow but continuous progression through months and years. Pain associated with weight-bearing, as well as limitations in joint motions, may be reported, depending on tumor's location. Surgery is the treatment of choice for the definitive removal of GCTTSs with the aim to eradicate the neoplasm and restore the lower limb's functionality. Methods: Thirteen cases suffering from GCTTS of the foot and ankle underwent surgical resection at our institution between 2017 and 2022. For each case we recorded pre-operative and post-operative symptoms, as well as their pre-operative and post-operative functional status according to both MSTS and AOFAS scores. Eventual complications and local recurrences were reported. Results: Each patient experienced an at least mild pain before surgical treatment. The mean pre-operative MSTS and AOFAS scores were 22.8 and 70.7, respectively. The mean tumor size was 17.7 mm. Each patient received a resection with wide margins. Two cases (15.4%) had local recurrences. None had major complications at their latest follow-up. After the surgery, the mean post-operative MSTS and AOFAS scores increased to 28.3 and 92.2, respectively. Conclusion: Resection with wide margins for foot and ankle GCTTS is effective in restoring the patients' lower limb functionality and is associated with reasonable local recurrence rates.