The results of 394 consecutive cases of knee joint radiation synovectomy (radiosynoviorthesis) using 90Y.

OBJECTIVE: The aim of this study was to assess the treatment results of 90Y radiation synovectomy for chronic exudative synovitis of knee joints. METHODS: The retrospective data consist of 394 consecutive knee radiation synovectomies performed using 6 mCi (222 MBq) of 90Y. The assessment included 3-point custom pain and joint mobility scale, evaluation of joint's circumference, binary joint's temperature evaluation, patellar ballottement test, indications for puncture and its volume in applicable cases. 21 cases had to be forfeited due to missing data regarding follow-up. RESULTS: The final analysis of 373 treatment procedures performed in 253 patients yielded following results-at 6 months after treatment, 80.9% of the patients reported at least partial pain relief (including 33.3% with complete pain relief), which increased to 86.7% at one year. The pain intensity decreased over time, however, the outcomes were worse in older patients. The probability of pain recurrence was 15% at 6 months, and 28% at one year. It was highest in post-traumatic synovitis, and lowest in pigmented villonodular synovitis. The circumference of the treated knee joints decreased over the course of follow-up, however, the decrease was significantly lower in older patients. The fraction of patients with full knee joint mobility increased from 34.6 to 40.6% at 6 months and 49.2% at one year. The percentage of patients that required articular puncture decreased from 62.8% at baseline to about 35.6% at 6 months, and 32.8% at one year. Positive patellar ballottement was found in 68.5% before treatment and remained at about 40-50% during the course of follow-up. The increased temperature of the joint was reported in 51.2% at baseline and decreased to 33% at 6 months and 28.3% at one year. CONCLUSIONS: (1) Radiation synovectomy is a safe and effective method of treatment in patients with exudative synovitis, however, the pain recurrence rate is significantly higher in post-traumatic exudative synovitis compared to pigmented villonodular, undifferentiated, and rheumatoid arthritis. (2) Our results suggest that older patients have worse treatment results with radiation synovectomy compared to younger patients.

Manifestations, diagnosis and surgical treatment of enchondroma--own experience.

BACKGROUND: An enchondroma is a rather common benign tumour of bone that originates from cartilage.The course is usually benign but they have a tendency to recur and are sometimes invasive, especially when developing in long bones. The aim of the study was to analyze the manifestations and methods of treatment as well as to assess the results of surgical treatment in patients with enchondroma. MATERIAL AND METHODS: A total of 150 patients with enchondroma, including 90 women and 60 men aged 10-74 years, were treated in the Regional Trauma Surgery Hospital in Piekary Slaskie between 1998 and 2006. RESULTS: The tumours were mostly located in phalanges of the fingers--55 cases (37%), and metacarpal bones--21 cases (14%). Multiple locations were seen in 13 patients. A total of 170 surgical procedures were performed, mostly (120 procedures) tumour resections with bone graft implantation. A recurrence of enchondroma was observed in 17 patients (11%). There was also one case of malignant transformation in to a chondrosarcoma. CONCLUSION: Total resection of the enchondroma combined with spongy bone grafting is the main treatment of chondroma.

Surgical treatment of dysplasia fibrosa and defectus fibrosus with bone allografts.

BACKGROUND: A common feature of dysplasia fibrosa and defectus fibrosus is the development of foci of disordered fibrous tissue in bone that tend to grow and displace regular bone tissue. The objective of this study was to evaluate the efficacy of surgical treatment with bone allografts in patients with fibrous dysplasia and fibrous defect of bone. MATERIAL AND METHODS: The study group consisted of 99 patients aged from 9 to 58 years (mean age 22 years), including 56 men and 43 women. A total of 145 surgical procedures were performed in this group at the Bone Tumour and Neoplasm Unit between 1999 and 2005. In all cases histopathological verification confirmed fibrous dysplasia or fibrous defect of bone. The follow-up period was from 1 to 5 years (mean 2.5 years). RESULTS: In 85 patients there were no recurrences. A total of 96 surgical procedures were performed in this group. The other 14 patients experienced recurrences and no graft remodelling. Forty-nine surgical procedures were performed in this group because of multiple (from 2 to 6) relapses of the tumours. CONCLUSIONS: 1. Resection surgery and filling the defect with bone graft in the basic tyep of treatment in fibrous dysplasia and bibrous defect of bone and leads to good outcomes. 2. Frozen cortico-cancelleous allografts are well incorporated and bone remodeling is not assocaited with inflammatory complications, resulting into good outcomes of the operative treatment.

Treatment and differential diagnosis of aneurysmal bone cyst based on our own experience.

BACKGROUND: Aneurysmal bone cyst was first described by Jaffe and Lichtenstein in 1942. Schajowicz in 1972 in his Histopathological Classification of Primary Bone Tumors (later modified by WHO in 1993) placed it in group IX - tumor-like lesions. Its etiology and pathogenesis is not completely clear. Aneurysmal bone cysts are usually found in older children and young adults, rarely before the age of 5 or after 30. The aim of the study is to evaluate aneurysmal cyst treatment outcomes in patients we have treated and present diagnostic difficulties, especially considering the giant cell tumor in differential diagnosis. MATERIAL AND METHODS: The study group consisted of 40 patients aged from 10 to 65 years (mean age 22 years), including 21 men and 19 women, who underwent surgery at the Bone Tumor and Neoplasm Unit between 1999 and 2006. The follow-up period varied from 2 to 78 months (mean 23 months). RESULTS: A single surgical procedure was performed in 25 patients. No recurrences were noted in this group. In the remaining 15 cases, the tumor relapsed between 2 and 72 months after surgery (mean 17 months). In 12 patients, the histopathological examination was inconclusive. The giant cell tumor of bone was considered as a second diagnosis in all these cases. CONCLUSIONS: 1. Surgical treatment of aneurysmal bone cysts enables radical excision of the lesion with same-time histopathological verification. 2. The basis of effective treatment of primary and recurring aneurysmal bone cysts consists in complete resection of all tissues lining the cyst and any of its components from the surrounding soft tissues. 3. An effective plan of surgical treatment of aneurysmal bone cyst aimed at reducing the risk of tumor recurrence relies crucially on precise determination of its size, characteristics and topography via imaging workup. 4. Relapses are most common in patients suffering from the aggressive or active form of aneurysmal bone cyst. 5. Tumor location in direct proximity of a joint and the presence of epiphyseal cartilage hinders complete resection of the lesion and gives rise to technical problems during surgery. 6. The diagnosis of aneurysmal bone cyst most often leads physicians to assume the presence of giant cell tumor. If this diagnosis is confirmed following surgery, the patient should be subjected to additional radiotherapy. 7. Patients suffering from aneurysmal bone cyst require a ling follow-up due to the possibility of late recurrence of the tumor.

Massive chondroma of pelvis - case report.

The case of a massive pelvis chondroma in a 15-year-old male is described. The patient was previously treated operatively due to multiple chondro-osseous exostoses. An extensive chondrous tumour was detected in the patient's pelvis and abdomen during a follow-up visit. This was accompanied by symptoms of intestinal obstruction and impaired micturition. CT scans showed an extensive tumour filling the entire minor pelvic cavity and proximal femur with impression and infiltration of the femoral blood vessels, and displacement of both ureters, colon and urinary bladder causing urinary retention. The tumour caused severe disturbances of anatomical relations leading to dysfunction of the urinary and gastrointestinal systems. After appropriate preparation, the patient underwent surgery by a multidisciplinary team comprising an orthopaedic surgeon, a general surgeon and a urologist. After laparotomy and exposure of the retroperitoneal space, a giant (about 3.5 dm3) chondro-osseous tumour was resected. After 5 weeks another operation was made and another tumour, greater than an adult man's fist, was removed from the medial aspect of the right hip. The postoperative course was uncomplicated, the patient felt immediate relief as regards the urinary and gastrointestinal disturbances. His locomotion became noticeably better. A histological examination confirmed the preliminary diagnoses of a chondroma and a chondro-osseous lesion. Outpatient follow-up and additional work-up (ultrasound, CT) showed resolution of urine retention with an appropriate urinary bladder position and tumour-free minor pelvis cavity and proximal femur.

Evaluation of methods of bone defect reconstruction after iliac tumor resections.

Background. The goal of this article is to assess the treatment efficacy of partial shoulder arthroplasty after massive proximal humerus resection following pathological fracture or primary tumor, based on the authors' own clinical material. Material and methods. We analyzed 42 cases operated between 1997 and 2005, including 11 patients with primary tumors and 31 with pathological fracture or metastatic disease. A resection ranging from 6 to 12 cm was performed due to the presence of tumor and present or imminent pathological fracture. Partial shoulder arthroplasty was performed subsequently to bone resection. The follow-up time ranged from 2 months to 7 years. Outcome was assessed by X-ray imaging, clinical examination, and the Enneking functional scale. Results. Excellent and very good outcome were obtained in 37 cases, while in 2 cases the outcome was poor. 3 patients died within 7 days after surgery. Infectious complications occurred in 2 patients but resolved after conservative therapy. More than 90% of the patients expressed a positive subjective opinion. Conclusions. Partial shoulder replacement after massive proximal humerus resection was subjectively very acceptable for the operated patients. This high rate of good and excellent outcomes in clinical tests and imaging procedures confirms the usefulness of this method, and makes this kind of treatment a valuable alternative for both the patient and the orthopedic surgeon. Complications, whether early (death) or late (tumor recurrence) result from the normal biology of the tumor.

Evaluation of methods of bone defect reconstruction after iliac tumor resections.

Background. The goal of our research was to evaluate methods of reconstructing iliac bone defects in the authors' own clinical material. Material and methods. Between 2001 and 2004 we treated 16 patients: 10 women and 6 men, ranging in age from 32 to 72 years. The follow-up period was 6-40 months. Outcome was assessed according to clinical examination and radiographic evaluation of the pelvis. Results. All patients after operative treatment were mobilized while still in hospital, and were able to walk assisted by crutches with partial weight bearing. Six patients with metastatic disease died within 18 months after surgery. Tumor progression with subsequent reoperation occurred in 1 case. In the remaining cases no tumor progression was found, other than slight lysis in the PMMA/bone border area. In patients with combined internal fixation and PMMA, there was good stabilization of the filling. In cases treated for giant cell tumor, good bone reconstruction was found radiologically. The patients with acetabular defects, who were operated with a Ganz reinforcement ring, were able to walk with weight bearing on a single crutch. No infection was found in any case. Conclusions. In our patients with periacetabular defects of the hip following resection and PMMA filling, we found no mechanical complications diminishing lower limb function. In cases with acetabular lesions the method of choice is early and thorough surgical treatment with subsequent bone grafting, implantation of a Ganz reinforcement ring, and total hip replacement.

Partial long-stem resection Austin-Moore hip endoprosthesis in the treatment of metastases to the proximal femur.

Background. The proximal femur is a frequent location of bone metastases, and pathological fractures in this area are common. A pathological fracture and/or pain associated with bone destruction are indications for surgery. Among many methods of surgical treatment, partial resection and subsequent arthroplasty appears to be the most efficient. The low cost of the implant and the relatively simple surgical technique incline us to apply long-stem (305mm) partial Austin-Moore hip prosthesis in these cases. Material and methods. Between June 2003 and February 2005 we operated 31 patients (10 men and 21 women) for pathological fracture or proximal femur metastasis. The average age of these patients was 63.8 years. The most common primary neoplasmatic focus among the women was breast cancer (17 cases, 80%), and among the men, clarocellular renal cancer (3 cases, 34%). Results. In most cases - 21 patients (67%) - we achieved excellent or good outcome according to the Merle d'Aubigne Functional Test, as well as reasonable pain relief. Endoprosthesis dislocation occurred in 2 cases and early postoperative death in 2 other cases. Conclusions. Surgical treatment is needed in cases of actual or impending pathological fracture of the proximal femur. Resection arthroplasty is the method of choice in bone metastases to proximal femur. This procedure is well tolerated by patients. The use of long-stem partial Austin-Moore hip prosthesis appears to be a good alternative to costly modular implants, while its long stem protects the femoral shaft against fractures in cases where additional metastatic lesions are found there.

Clinical experience in the application of allogenic grafts from a bone tissue bank in the surgical treatment of tumor-like bone lesions.

Background. The objective of our study was to evaluate the effectiveness of the surgical treatment of bony tumor-like lesions using bone allografts. Material and methods. The study group consisted of 266 patients, 136 males and 90 females, ranging in age from 9 to 55 years (mean 29). From 1999 to 2004, 250 surgical operations were performed, including resection of osteolytic bone tumor and filling of the bone defect with an allogenic bone graft. The results of histopathological examinations confirmed the presence of tumor-like lesions in all cases. The follow-up period was from 6 months to 4 years, with a mean period of 18 months. Results. The results were analyzed based on clinical examinations and x-rays enabling the evaluation of the bone remodeling process. In 208 patients (92%), no recurrence was observed. In an other 18 patients (8 with dysplasia fibrosa, 5 with aneurysmal bone cyst, 3 with solitary bone cyst, 2 with defectus fibrosus), 50 surgical operations were performed due to multiple recurrences of the tumor. Conclusions. A very good outcome was achieved by treating tumor-like bone lesions using allogenic bone grafts. The advantages of surgical treatment are the possibility of radical and complete resection of the lesion and histopathological evaluation of tissue samples shortly afterwards. Large and thorough resection ensures good treatment outcome.

Treatment methods for neoplastic metastates and tumor-like changes in the bodies and epiphyses of long bones using polymethyl methacrylate cement and bone grafting.

Background. The objective of our study was to evaluate the stabilization of reconstructed long bones after metastatic tumor resection and defect filling with polymethyl methacrylate (PMMA) or bone allograft. Material and methods. We studied a group of 107 patients who underwent surgery between 1996 and 2004 (55 females and 46 males). A primary neoplasmatic focus was found after histopathological examination in 58 cases, in 29 the histopathology was not evident, and in 20 cases no neoplastic tissue was found. Metastases were found within the femur in 73 cases, in the humerus in 19 cases, and in the tibia in 15 cases. Stabilization was performed using the traditional AO method, intramedullary nailing, or DHS/DCS fixation. Results. Taking into consideration clinical and radiological assessment, outcomes varied from fair to good. Better outcome was obtained in cases treated by polymethyl methacrylate (PMMA) filling combined with intramedullary nailing or DCS/DHS than in cases treated with traditional AO plating. For tumor-like lesions, complete bone graft consolidation was found after bone allograft filling in 14 of 20 cases. Conclusions. The 2 methods of long bone stabilization mentioned above, combined with polymethyl methacrylate (PMMA) or bone allograft filling, is the method of choice. Deep frozen bone grafting is possible only in cases of total tumor resection with the possibility of non-malignant tumor. The effect of reconstruction, besides fair or good outcome, included improved quality of life, less consumption of analgesics, and in many cases successful avoidance of pathological fracture.