Management of musculoskeletal tumors during pregnancy: a retrospective study.

BACKGROUND: In recent years, scientific research has increasingly focused on malignancies during pregnancy. However, the development of musculoskeletal tumors during pregnancy has only been the subject of a few studies so far. The primary aim of this study was to identify the incidence of sarcomas during pregnancy at our musculoskeletal tumor center (MSTC). Secondarily we intended to analyze these cases and discuss possible recommendations regarding diagnostic work-up as well as therapy on the basis of the literature. METHODS: All female patients who had been treated for soft tissue or bone sarcoma at our academic MSTC in the period between the years 2002 and 2010 were screened retrospectively for anamnestic annotations of pregnancy or records of pregnancy in the obstetrical database of our university hospital. The patients who met the criteria for inclusion (diagnosed sarcoma and pregnancy) were enrolled. For every pregnant patient two age-matched female control patients that suffered from tumors with the same histologic type were included. RESULTS: In the period between 2002 and 2010, 240 female patients between the age of 16 and 45 were treated for sarcoma. In eight out of the 240 cases the tumor disease developed or progressed during pregnancy. The delay in diagnosis was approximately eight months and turned out to be significantly higher for pregnant patients compared to non- pregnant controls. Each woman's tumor was misdiagnosed at least once. CONCLUSIONS: Diagnostic follow-up of pregnant women presenting with a growing or painful mass, which is suspected to be a musculoskeletal tumor, should be performed at a specialized tumor center. We recommend a multidisciplinary approach and discussing all possible consequences for mother and child intensively in accordance with the available literature.

Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors.

BACKGROUND: Malignant bone tumors of the lower extremity are more frequently found in children and adolescents than in adults. Modern treatment regimens led to high limb salvage rates and offer the choice between endoprosthetic replacement and rotationplasty in many cases. Rotationplasty has proven to be an effective, highly functional option in short- and mid-term studies. Aim of this study was to assess long-term results regarding quality of life and functionality after rotationplasty and to compare the obtained results to a representative healthy German sample cohort. METHODS: In total 12 patients who underwent rotationplasty between 1991 and 2001 were enrolled in this study. After physical examination, they were evaluated regarding health related quality of life, functional outcome and psychosocial status. While quality of life was mainly assessed using the SF-36 (The Short Form (36) Health Survey v2), functional outcome was measured using the musculoskeletal tumor society score (MSTS) as well as the Tegner activity level scale. RESULTS: Average age at the time of surgery was 19 ± 10 year. and 32 ± 11 year. at the time of follow up. Mean follow-up was 14 ± 9 years. The SF-36 scores accounted for 80.4 ± 15.7 regarding physical functioning, for 78.1 ± 24.1 regarding the physical role functioning, for 74.1 ± 17.6 regarding bodily pain and for 71.8 ± 26.1 regarding general health. SF-36 score for vitality was 75.0 ± 12.8, for social functioning 98.9 ± 3.6, 88.2 ± 23.9 for emotional role functioning and 89.6 ± 10.1 for the mental health. Comparison to a representative German sample cohort revealed significantly higher patient's scores for vitality, social functioning and mental health (p < 0.05). The overall MSTS resulted in an average of 64 ± 12 % and the Tegner activity level scale accounted for 4.1 ± 0.6 pts. CONCLUSIONS: The presented long-term results indicate that rotationplasty provides a high quality of life. Patients are satisfied with a good functional outcome regarding activities of daily life and even sports.

Primary extrahepatic alveolar echinococcosis of the lumbar spine and the psoas muscle.

Alveolar echinococcosis (AE) of human being caused by Echinococcus multilocularis is a rare but important zoonosis especially in tempered zones of middle Europe and Northern America with endemic character in many countries. Due to the long incubation period, various clinical manifestations, critical prognosis, and outcome AE presents a serious and severe disease. The primary focus of infection is usually the liver. Although secondary affection of visceral organs is possible extrahepatic AE is highly uncommon. Moreover, the involvement of bone and muscle presents with an even lower incidence. In the literature numerous cases on hepatic AE have been reported. However, extrahepatic AE involving bones and/or muscles was described very rarely. We report a case of an 80-year-old man with primary extrahepatic alveolar Echinococcosis of the lumbar spine and the psoas muscle. The etiology, diagnosis, differential diagnoses, treatment options and outcome of this rare disease are discussed in context with the current literature.

Incidence and outcome after infection of megaprostheses.

Recent advances in chemotherapy and radiation therapy in the treatment of malignant bone tumours as well as the consistent increase of revision arthroplasties have been followed by an increased use of megaprostheses. These large foreign bodies make infection a common and feared complication. Infection rates of 3 - 31% have been reported (average approx. 15%), often in conjunction with risk factors, e.g. the anatomic region (pelvis implants in particular), implant alloy, and underlying reason for implantation of a megaprosthesis. Apart from the basic principles of septic revision arthroplasty, special patient and implant factors have to be considered in infected megaprosthesis, which we have summarised in our paper (e.g. life expectancy, implant design, spacers and external stabilisation). This article further analyses the current literature available for these cases and summarises outcome after treatment of periprosthetic infections.

Wear of a highly cross-linked polyethylene liner associated with metallic deposition on a ceramic femoral head.

A 68-year-old patient underwent revision surgery for recurrent dislocation of a ceramic-on-polyethylene uncemented hip arthroplasty implanted 6 months previously. The aluminum oxide femoral head was found to have titanium deposition measuring 5 by 10 mm in an area articulating with the highly cross-linked polyethylene liner. The liner was observed to possess severe scratching produced by articulation with the titanium deposited on the ceramic head. Despite improved scratch resistance of ceramic-bearing surfaces, irregularities introduced by metallic deposition after recurrent dislocation can damage a highly cross-linked polyethylene liner.