Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis.

PURPOSE: The aim of this study is to evaluate the safety and effectiveness of CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histiocytosis (LCH) in a multi-institutional study. MATERIALS AND METHODS: This IRB-approved study included patients from three institutions. We retrospectively reviewed clinical, procedural, and imaging data for corticosteroid injections performed to treat osseous LCH. Location of the lesion, lesion maximum dimension and volume, corticosteroid type and dose, and time interval between injection and change in lesion size/volume and symptoms were recorded. Generalized estimating equations (accounting for multiple lesions per subject) were used to evaluate the association between predictors (dose, maximum lesion dimension, and lesion volume) and outcomes (time to partial and complete radiographic resolution, and time to pain control). This analysis was adjusted by anatomic site. RESULTS: Forty corticosteroid injections were performed in 36 patients (20 (56%) females, and 16 (44%) males, ages 12 ± 11 (2-57) years). Mean lesion maximum dimension was 3.2 ± 1.7 cm, and volume was 10 ± 17 cm3. Imaging and clinical follow-up were available for 22/40 (55%) and 34/40 (85%) of injections, respectively. All lesions responded to corticosteroid injection. Times to partial and complete imaging resolution were 13 ± 9 and 32 ± 13 weeks, respectively, and time to pain resolution was 22 ± 14 weeks. There were no complications. CONCLUSION: CT-guided corticosteroid injection is a safe and effective treatment for LCH. Pain resolution was achieved in all patients and imaging did not show progressive disease in any of the patients.

EPIDEMIOLOGICAL PROFILE AND EVOLUTION IN MUSCULOSKELETAL TUMORS AT THE LEVEL OF THE ELBOW.

Objective: To present the epidemiological profile of bone and soft tissue tumors that affect the elbow region treated at an oncology referral center in Brazil. Methods: Retrospective observational case series study to evaluate the results of elbow cancer undergoing clinical and/or surgical treatment with the first visit from 1990 to 2020. The dependent variables were benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor. Independent variables were sex, age; presence of symptoms (pain/increase in local volume/fracture); diagnosis; treatment and recurrence. Results: In total, 37 patients were included, 51.35% of whom were female, with a mean age at diagnosis of 33.5 years. Soft tissue neoplasms correspond to 51% of cases against 49% of bone tumors. Among the symptoms, the general prevalence of pain was 56.75%, the general increase in local volume occurred in 54.04% of the patients and the presence of fractures in 13.43%. Surgical treatment occurred in 75.67% of cases and recurrence in 16.21% of cases. Conclusion: The tumors that affect the elbow in our series correspond mostly to benign tumors, involving bone or soft tissues, with a higher occurrence in young adult patients. Level of Evidence IV, Case Series.

Objetivo: Apresentar o perfil epidemiológico dos tumores ósseos e de partes moles que acometem a região do cotovelo. Métodos: Estudo observacional retrospectivo de série de casos para avaliação dos resultados de neoplasia do cotovelo submetidos a tratamento clínico e/ou cirúrgico cujo primeiro atendimento se deu entre 1990 e 2020. As variáveis dependentes foram: tumor ósseo benigno, tumor ósseo maligno, tumor de partes moles benigno, tumor de partes moles maligno. A variáveis independentes foram: sexo; idade; presença de sintomas (dor, aumento de volume local, fratura); lateralidade; diagnóstico; tratamento; e recidiva. Resultados: Foram incluídos 37 pacientes, sendo 51,35% do sexo feminino, com média de idade ao diagnóstico de 33,5 anos. As neoplasias de partes moles correspondem a 51% dos casos contra 49% de tumores ósseo. Dentre os sintomas a prevalência geral de dor foi de 56,75%, foi observado o aumento geral de volume local em 54,04% pacientes e a presença de fraturas em 13,43%. O tratamento cirúrgico ocorreu em 75,67% dos casos e a recidiva em 16,21%. Conclusão: Nesta série, os tumores que acometem o cotovelo são majoritariamente tumores benignos, de acometimento ósseo ou de partes moles, com maior ocorrência em pacientes adultos jovens. Nível de Evidência IV, Série de Casos.

JUXTACORTICAL OSTEOSARCOMA: CLINICAL EVOLUTION AND DEDIFFERENTIATION RELATED FACTORS.

Objective: Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma. Methods: Retrospective cohort study performed over a period of 25 years, using data from medical records of patients diagnosed with parosteal osteosarcoma. The data were submitted to statistical analysis by Fisher's exact test and Student's t-test. Results: Of the 326 patients treated for osteosarcoma, we identified 17 patients diagnosed with parosteal osteosarcoma. Of these, 4 (23.5%) were not actually diagnosed with parosteal osteosarcoma and 4 did not have the minimum data required for analysis, being excluded from the study. Of the 9 patients studied, we observed that 3 (33.3%) evolved with tumor dedifferentiation to high-grade osteosarcoma. Moreover, 2 (66.7%) had local recurrence and 2 (66.7%) metastases. Conclusion: Age, sex, and the tumor size were not directly related to the dedifferentiation from parosteal osteosarcoma to high-grade osteosarcoma. The most aggressive clinical evolution - presence of local recurrences and metastasis - in parosteal osteosarcoma occurred in tumors with dedifferentiation, however, we cannot associate each other as cause and effect, but as related factors. Level of Evidence IV, Case Series.

Objetivo: Avaliar fatores de risco relacionados à evolução clínica e à desdiferenciação do osteossarcoma justacortical (parosteal, paraosteal) em osteossarcoma de alto grau. Métodos: Estudo de coorte retrospectiva realizado num período de 25 anos. Foram utilizados dados de prontuários de pacientes com diagnóstico de osteossarcoma parosteal que, em seguida, foram submetidos à análise estatística pelo Teste Exato de Fisher e pelo Teste t de Student. Resultados: Foram tratados 326 pacientes com diagnóstico de osteossarcoma, dos quais 17 (5,21%) receberam diagnóstico de osteossarcoma parosteal, 4 (1,22%) foram diagnosticados com osteossarcoma convencional e 4 (1,22%) não tinham dados mínimos necessários para análise, sendo excluídos do estudo. Dos 9 (2,76%) pacientes estudados, 3 (0,92%) evoluíram com desdiferenciação do tumor para osteossarcoma de alto grau. Dois (0,84%) pacientes apresentaram recidiva local e 2 (0,84%%) apresentaram metástases. Conclusão: Os fatores idade, sexo e volume do tumor não estão diretamente relacionados com a desdiferenciação do osteossarcoma parosteal para osteossarcoma de alto grau. Apesar de a evolução clínica mais agressiva - presença de recidivas locais e metástase - no osteossarcoma parosteal ter ocorrido nos tumores com desdiferenciação, não é possível estabelecer uma relação de causa e efeito, apenas considerá-las como fatores relacionados. Nível de Evidência IV, Série de Casos.

EPIDEMIOLOGICAL PROFILE AND EVOLUTION OF ANKLE MUSCULOSKELETAL TUMORS.

Objective: Characterizing ankle tumors, presenting the epidemiological profile of these lesions. Methods: Retrospective observational case series study to evaluate the results of clinical and/or surgical treatments of patients with ankle tumors whose first visit occurred from 1990 to 2020. The dependent variables were: benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor, and infection. The independent variables were: sex, age; presence of symptoms (pain/local volume increase/fracture), duration of symptoms until treatment, diagnosis, treatment, and recurrence. Results: In total, 70 patients were included-58.5% were women, with a mean age at the time of diagnosis of 21.66 years. Among all cases, 76% were bone tumor, 14% were soft tissue tumor, and 10% were infection. The mean age at the time of diagnosis was 21.7 ± 2.29 years. The overall prevalence of pain was 77.1%. In total, 55.6% patients had a general local volume increase 13.4% had fractures. The mean time from symptoms to treatment was 17.4 ± 4.61 months and the mean diagnosis time was 10.13 ± 0.86 months. Of all cases, 73.44% underwent surgical treatment and 22.64% had recurrence. Conclusion: In this series, ankle tumors corresponded mainly to bone tumors. Benign tumors were the most prevalent type of tumor and the highest occurrence was among young people. Level of Evidence IV, Case Series.

Objetivos: Caracterizar tumores da região do tornozelo apresentando o perfil epidemiológico destas lesões. Métodos: Estudo observacional retrospectivo de série de casos para avaliação dos resultados de neoplasias do tornozelo submetidos a tratamento clínico e/ou cirúrgico em que o primeiro atendimento tenha ocorrido entre 1990 e 2020. As variáveis dependentes foram: tumor ósseo benigno, tumor ósseo maligno, tumor de partes moles benigno, tumor de partes moles maligno e infecção. As variáveis independentes foram: sexo, idade, presença de sintomas (dor/aumento de volume local/fratura), tempo de sintomas até o atendimento, diagnóstico, tratamento e recidiva. Resultados: Foram analisados 70 pacientes, sendo 58,5% do sexo feminino, com média de idade no momento do diagnóstico de 21,66 (21,7 ± 2,29) anos. As neoplasias ósseas correspondem a 76% dos casos, seguidas de tumor de partes moles com 14% e de infecção com 10%. A prevalência geral de dor foi de 77,1%. O aumento geral de volume local ocorreu em 55,6% pacientes e presença de fraturas em 13,4%. A média de tempo de sintomas até o atendimento foi de 17,4 ± 4,61 meses e a média de tempo para o diagnóstico foi de 10,13 ± 0,86 meses. O tratamento cirúrgico ocorreu em 73,44% dos casos e a recidiva em 22,64%. Conclusão: Os tumores ao nível do tornozelo nesta série correspondem majoritariamente a tumores ósseos, com prevalência do benigno e maior ocorrência em jovens. Nível de Evidência IV, Série de Casos.

Risk Factors Related to Poor Outcomes in the Treatment of Non-conventional Periprosthetic Infection.

Objectives To identify the main risk factors related to poor outcomes after the treatment for periprosthetic infection. Materials and Methods Medical records from 109 patients who underwent non-conventional endoprosthesis surgeries (primary and revision procedures) from January 1, 2007, to December 31, 2018, were retrospectively evaluated. In total, 15 patients diagnosed with periprosthetic infection were eligible to participate in the study. Variables including gender, age at diagnosis, affected bone, surgery duration, white blood cell (WBC) count before endoprosthesis placement, urinary tract infection during the first postoperative year, and time elapsed from endoprosthesis placement to infection diagnosis were related to outcomes using the Fisher exact test (for the bicategorical variables) or analysis of variance (ANOVA, for the tricategorical variables). The mean times from diagnosis to final outcome were compared using the Student t -test. Results These risk factors did not show a statistically significant correlation with the outcomes. The data revealed a trend towards a difference between the mean time for the onset of infection and the final outcome. Due to the limited sample, we believe that studies with larger cohorts can prove this trend. Conclusion We identified that the time from endoprosthesis placement to the onset of the symptoms of infection tends to be related to the outcome and evolution of the patient evolution during the treatment for periprosthetic infection. Although apparently correlated, other associated factors were not statistically linked to poor treatment outcomes.

Biopsy Path Contamination in Primary Bone Sarcomas.

OBJECTIVE: To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. MATERIALS AND METHODS: The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. RESULTS: Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. CONCLUSION: The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.

Epidemiological characteristics of patients with pelvic tumors submitted to surgical treatment.

OBJECTIVE: Describe the epidemiological profile of patients with primary or secondary neoplastic lesions in the pelvis who required a surgical procedure such as hemipelvectomy. METHODS: This study retrospectively evaluated 69 patients located in the database of a São Paulo educational institution, subject to surgical hemipelvectomy treatment between January 1990 and December 2013. All patients had previous diagnosis of bone tumor (primary or metastatic) in the pelvis (ilium, ischium, pubis, and/or sacrum). RESULTS: Analyzing the data obtained in this study, it was observed that these are partly similar to those found in the literature, with primary bone malignancies as the main diagnosis; general injuries affecting the pelvic area I (pelvic bone) and its most frequent complication, infection. The differences are mainly due to rarity of the bone tumors evaluated in this study, and the type of surgical procedure in question, which is even more unusual. CONCLUSION: Building a picture that conveys the reality of each diagnosis and that indicates which characteristics of these patients would better resemble an absolute or relative indication for the realization of hemipelvectomy is harder by the rarity of these cases.

OBJETIVO: Traçar o perfil epidemiológico dos pacientes com lesões neoplásicas na pelve, primárias ou secundárias, para as quais foi necessário procedimento cirúrgico do tipo hemipelvectomia. MÉTODOS: Foram avaliados, retrospectivamente, 69 pacientes localizados no banco de dados de uma instituição de ensino de São Paulo, submetidos a tratamento cirúrgico tipo hemipelvectomia entre janeiro de 1990 e dezembro de 2013. Todos os pacientes apresentavam diagnóstico prévio de tumor ósseo (primário ou metastático) na pelve (ílio, ísquio, púbis e/ou sacro). RESULTADOS: Ao analisar os dados obtidos no presente estudo, observou-se que esses são em parte semelhantes aos encontrados na literatura mundial, apresentam como principal diagnóstico as neoplasias malignas ósseas primárias. Em geral, as lesões acometeram a zona I pélvica (osso ilíaco) e a complicação mais frequentemente observada foi a infecção. As diferenças encontradas são devidas principalmente à raridade dos tumores ósseos avaliados nesses estudos e ao tipo de procedimento cirúrgico em questão, esses ainda mais incomuns. CONCLUSÃO: Construir um panorama que transmita a realidade de cada diagnóstico e indique quais as características que esses pacientes apresentam que mais se aproximariam como indicações relativas ou absolutas para o procedimento de hemipelvectomia encontra na raridade desses casos o seu maior obstáculo.

Epidemiological profile and evolution in musculoskeletal tumors at the level of the elbow / Perfil epidemiológico e evolução nos tumores musculoesqueléticos ao nível do cotovelo

ABSTRACT Objective: To present the epidemiological profile of bone and soft tissue tumors that affect the elbow region treated at an oncology referral center in Brazil. Methods: Retrospective observational case series study to evaluate the results of elbow cancer undergoing clinical and/or surgical treatment with the first visit from 1990 to 2020. The dependent variables were benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor. Independent variables were sex, age; presence of symptoms (pain/increase in local volume/fracture); diagnosis; treatment and recurrence. Results: In total, 37 patients were included, 51.35% of whom were female, with a mean age at diagnosis of 33.5 years. Soft tissue neoplasms correspond to 51% of cases against 49% of bone tumors. Among the symptoms, the general prevalence of pain was 56.75%, the general increase in local volume occurred in 54.04% of the patients and the presence of fractures in 13.43%. Surgical treatment occurred in 75.67% of cases and recurrence in 16.21% of cases. Conclusion: The tumors that affect the elbow in our series correspond mostly to benign tumors, involving bone or soft tissues, with a higher occurrence in young adult patients. Level of Evidence IV, Case Series.

RESUMO Objetivo: Apresentar o perfil epidemiológico dos tumores ósseos e de partes moles que acometem a região do cotovelo. Métodos: Estudo observacional retrospectivo de série de casos para avaliação dos resultados de neoplasia do cotovelo submetidos a tratamento clínico e/ou cirúrgico cujo primeiro atendimento se deu entre 1990 e 2020. As variáveis dependentes foram: tumor ósseo benigno, tumor ósseo maligno, tumor de partes moles benigno, tumor de partes moles maligno. A variáveis independentes foram: sexo; idade; presença de sintomas (dor, aumento de volume local, fratura); lateralidade; diagnóstico; tratamento; e recidiva. Resultados: Foram incluídos 37 pacientes, sendo 51,35% do sexo feminino, com média de idade ao diagnóstico de 33,5 anos. As neoplasias de partes moles correspondem a 51% dos casos contra 49% de tumores ósseo. Dentre os sintomas a prevalência geral de dor foi de 56,75%, foi observado o aumento geral de volume local em 54,04% pacientes e a presença de fraturas em 13,43%. O tratamento cirúrgico ocorreu em 75,67% dos casos e a recidiva em 16,21%. Conclusão: Nesta série, os tumores que acometem o cotovelo são majoritariamente tumores benignos, de acometimento ósseo ou de partes moles, com maior ocorrência em pacientes adultos jovens. Nível de Evidência IV, Série de Casos.

Epidemiological profile and evolution of ankle musculoskeletal tumors / Perfil epidemiológico e evolução nos tumores musculoesqueléticos ao nível do tornozelo

ABSTRACT Objective: Characterizing ankle tumors, presenting the epidemiological profile of these lesions. Methods: Retrospective observational case series study to evaluate the results of clinical and/or surgical treatments of patients with ankle tumors whose first visit occurred from 1990 to 2020. The dependent variables were: benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor, and infection. The independent variables were: sex, age; presence of symptoms (pain/local volume increase/fracture), duration of symptoms until treatment, diagnosis, treatment, and recurrence. Results: In total, 70 patients were included-58.5% were women, with a mean age at the time of diagnosis of 21.66 years. Among all cases, 76% were bone tumor, 14% were soft tissue tumor, and 10% were infection. The mean age at the time of diagnosis was 21.7 ± 2.29 years. The overall prevalence of pain was 77.1%. In total, 55.6% patients had a general local volume increase 13.4% had fractures. The mean time from symptoms to treatment was 17.4 ± 4.61 months and the mean diagnosis time was 10.13 ± 0.86 months. Of all cases, 73.44% underwent surgical treatment and 22.64% had recurrence. Conclusion: In this series, ankle tumors corresponded mainly to bone tumors. Benign tumors were the most prevalent type of tumor and the highest occurrence was among young people. Level of Evidence IV, Case Series.

RESUMO Objetivos: Caracterizar tumores da região do tornozelo apresentando o perfil epidemiológico destas lesões. Métodos: Estudo observacional retrospectivo de série de casos para avaliação dos resultados de neoplasias do tornozelo submetidos a tratamento clínico e/ou cirúrgico em que o primeiro atendimento tenha ocorrido entre 1990 e 2020. As variáveis dependentes foram: tumor ósseo benigno, tumor ósseo maligno, tumor de partes moles benigno, tumor de partes moles maligno e infecção. As variáveis independentes foram: sexo, idade, presença de sintomas (dor/aumento de volume local/fratura), tempo de sintomas até o atendimento, diagnóstico, tratamento e recidiva. Resultados: Foram analisados 70 pacientes, sendo 58,5% do sexo feminino, com média de idade no momento do diagnóstico de 21,66 (21,7 ± 2,29) anos. As neoplasias ósseas correspondem a 76% dos casos, seguidas de tumor de partes moles com 14% e de infecção com 10%. A prevalência geral de dor foi de 77,1%. O aumento geral de volume local ocorreu em 55,6% pacientes e presença de fraturas em 13,4%. A média de tempo de sintomas até o atendimento foi de 17,4 ± 4,61 meses e a média de tempo para o diagnóstico foi de 10,13 ± 0,86 meses. O tratamento cirúrgico ocorreu em 73,44% dos casos e a recidiva em 22,64%. Conclusão: Os tumores ao nível do tornozelo nesta série correspondem majoritariamente a tumores ósseos, com prevalência do benigno e maior ocorrência em jovens. Nível de Evidência IV, Série de Casos.

Juxtacortical osteosarcoma: clinical evolution and dedifferentiation related factors / Osteossarcoma justacortical: evolução clínica e fatores relacionados à desdiferenciação

ABSTRACT Objective: Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma. Methods: Retrospective cohort study performed over a period of 25 years, using data from medical records of patients diagnosed with parosteal osteosarcoma. The data were submitted to statistical analysis by Fisher's exact test and Student's t-test. Results: Of the 326 patients treated for osteosarcoma, we identified 17 patients diagnosed with parosteal osteosarcoma. Of these, 4 (23.5%) were not actually diagnosed with parosteal osteosarcoma and 4 did not have the minimum data required for analysis, being excluded from the study. Of the 9 patients studied, we observed that 3 (33.3%) evolved with tumor dedifferentiation to high-grade osteosarcoma. Moreover, 2 (66.7%) had local recurrence and 2 (66.7%) metastases. Conclusion: Age, sex, and the tumor size were not directly related to the dedifferentiation from parosteal osteosarcoma to high-grade osteosarcoma. The most aggressive clinical evolution - presence of local recurrences and metastasis - in parosteal osteosarcoma occurred in tumors with dedifferentiation, however, we cannot associate each other as cause and effect, but as related factors. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar fatores de risco relacionados à evolução clínica e à desdiferenciação do osteossarcoma justacortical (parosteal, paraosteal) em osteossarcoma de alto grau. Métodos: Estudo de coorte retrospectiva realizado num período de 25 anos. Foram utilizados dados de prontuários de pacientes com diagnóstico de osteossarcoma parosteal que, em seguida, foram submetidos à análise estatística pelo Teste Exato de Fisher e pelo Teste t de Student. Resultados: Foram tratados 326 pacientes com diagnóstico de osteossarcoma, dos quais 17 (5,21%) receberam diagnóstico de osteossarcoma parosteal, 4 (1,22%) foram diagnosticados com osteossarcoma convencional e 4 (1,22%) não tinham dados mínimos necessários para análise, sendo excluídos do estudo. Dos 9 (2,76%) pacientes estudados, 3 (0,92%) evoluíram com desdiferenciação do tumor para osteossarcoma de alto grau. Dois (0,84%) pacientes apresentaram recidiva local e 2 (0,84%%) apresentaram metástases. Conclusão: Os fatores idade, sexo e volume do tumor não estão diretamente relacionados com a desdiferenciação do osteossarcoma parosteal para osteossarcoma de alto grau. Apesar de a evolução clínica mais agressiva - presença de recidivas locais e metástase - no osteossarcoma parosteal ter ocorrido nos tumores com desdiferenciação, não é possível estabelecer uma relação de causa e efeito, apenas considerá-las como fatores relacionados. Nível de Evidência IV, Série de Casos.

Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil.

OBJECTIVE: To report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. MATERIALS AND METHODS: The medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. RESULTS: Clinical follow-up was available for all cases at a median of 29 months (range 6-60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). CONCLUSION: CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus.

OBJETIVO: Avaliar os resultados da ressecção percutânea do nidus guiada por tomografia computadorizada em 18 casos de osteoma osteoide. MATERIAIS E MÉTODOS: Os prontuários médicos de 18 crianças, adolescentes e adultos jovens diagnosticados com osteoma osteoide e submetidos a ressecção percutânea do nidus guiada por TC, entre novembro de 2004 e março de 2009, foram revisados retrospectivamente para coleta de dados demográficos, local da lesão, evolução clínica e complicações após o procedimento. RESULTADOS: A mediana de tempo de seguimento de todos os pacientes foi 29 meses (intervalo de 6­60 meses). Dezessete pacientes não apresentaram recorrência da dor no pós-operatório. Apenas um paciente teve recorrência dos sintomas 12 meses após a ressecção percutânea e foi retratado com sucesso, pela mesma técnica, resultando numa taxa de sucesso secundário de 18/18 (100%). CONCLUSÃO: A ressecção guiada por tomografia computadorizada do nidus é uma alternativa segura e eficaz para a ressecção cirúrgica do nidus em pacientes com osteoma osteoide.

Postural assessment of patients with non-conventional knee endoprosthesis.

OBJECTIVE: To investigate the correlation between the sagittal and frontal alignment and possible postural asymmetries found in patients submitted to total knee stent placement for osteosarcoma. METHODS: TWENTY TWO INDIVIDUALS WERE DIVIDED INTO TWO GROUPS ACCORDING TO TUMOR LOCATION: femur group (13 patients) and tibia group (nine patients), who were evaluated through postural analysis software (SAPO). RESULTS: No statistically significant difference was found between groups, supporting previous result showing that both groups present the same postural asymmetries. CONCLUSION: We conclude that both groups have the same postural imbalances, especially the knee of the affected limb that presents hyperextension and center of gravity shifted anteriorly and laterally to the non-affected limb, indicating changes in weight bearing and influencing the gait pattern and balance. Level of Evidence II, Prospective Comparative Study.

Biopsy Path Contamination in Primary Bone Sarcomas / Contaminação do trajeto de biópsia em sarcomas primários ósseos

Abstract Objective To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and Methods The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. Results Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. Conclusion The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.

Resumo Objetivo Determinar a incidência da contaminação do trajeto de biópsia nos pacientes com sarcomas primários ósseos, bem como as características clínicas que influenciaram neste desfecho. Método Foram avaliados retrospectivamente os laudos anatomopatológicos de pacientes tratados pelo Serviço de Oncologia Ortopédica do Departamento de Ortopedia e Traumatologia dessa instituição. Resultado Dentre os 148 pacientes incluídos no presente estudo, apenas um apresentou contaminação por células neoplásicas em seu trajeto de biópsia. Conclusão O procedimento de biópsia óssea em pacientes com sarcomas primários ósseos apresenta grande segurança no quesito contaminação quando feito em centros especializados no tratamento dessas patologias.

Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases.

OBJECTIVE: to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. METHOD: a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months. RESULTS: in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3° of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. CONCLUSION: the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.

OBJETIVO: avaliar os resultados das cirurgias assistidas por navegação (CAN) nas artroplastias totais de joelho. MÉTODO: foram avaliados 196 pacientes submetidos à artroplastia total de joelho com auxílio da navegação por computador. Avaliados no intraoperatório os espaços (gaps) de extensão e de flexão, o alinhamento pós-operatório e o questionário funcional da Knee Society Score (KSS) pré-operatório e pós-operatório com seguimento médio de 22 meses. RESULTADOS: dos pacientes, 86,7% apresentaram bom alinhamento do eixo mecânico (dentro de 3° de varo ou valgo em relação ao eixo mecânico) e 96,4% apresentaram ambos os gaps de flexão e extensão balanceados. No pré-operatório, 97% dos pacientes apresentavam KSS funcional ruim ou insuficiente, no pós-operatório 77,6% apresentavam KSS funcional bom ou excelente. CONCLUSÃO: a navegação proporcionou a obtenção de implantes alinhados e balanceados com importante melhoria da função nos pacientes. Foram evidenciados sua utilidade no estudo, o entendimento e o aperfeiçoamento do conhecimento na execução das artroplastias.

Epidemiological characteristics of patients with pelvic tumors submitted to surgical treatment / Características epidemiológicas dos pacientes com tumores pélvicos submetidos a tratamento cirúrgico

ABSTRACT Objective: Describe the epidemiological profile of patients with primary or secondary neoplastic lesions in the pelvis who required a surgical procedure such as hemipelvectomy. Methods: This study retrospectively evaluated 69 patients located in the database of a São Paulo educational institution, subject to surgical hemipelvectomy treatment between January 1990 and December 2013. All patients had previous diagnosis of bone tumor (primary or metastatic) in the pelvis (ilium, ischium, pubis, and/or sacrum). Results: Analyzing the data obtained in this study, it was observed that these are partly similar to those found in the literature, with primary bone malignancies as the main diagnosis; general injuries affecting the pelvic area I (pelvic bone) and its most frequent complication, infection. The differences are mainly due to rarity of the bone tumors evaluated in this study, and the type of surgical procedure in question, which is even more unusual. Conclusion: Building a picture that conveys the reality of each diagnosis and that indicates which characteristics of these patients would better resemble an absolute or relative indication for the realization of hemipelvectomy is harder by the rarity of these cases.

RESUMO Objetivo: Traçar o perfil epidemiológico dos pacientes com lesões neoplásicas na pelve, primárias ou secundárias, para as quais foi necessário procedimento cirúrgico do tipo hemipelvectomia. Métodos: Foram avaliados, retrospectivamente, 69 pacientes localizados no banco de dados de uma instituição de ensino de São Paulo, submetidos a tratamento cirúrgico tipo hemipelvectomia entre janeiro de 1990 e dezembro de 2013. Todos os pacientes apresentavam diagnóstico prévio de tumor ósseo (primário ou metastático) na pelve (ílio, ísquio, púbis e/ou sacro). Resultados: Ao analisar os dados obtidos no presente estudo, observou-se que esses são em parte semelhantes aos encontrados na literatura mundial, apresentam como principal diagnóstico as neoplasias malignas ósseas primárias. Em geral, as lesões acometeram a zona I pélvica (osso ilíaco) e a complicação mais frequentemente observada foi a infecção. As diferenças encontradas são devidas principalmente à raridade dos tumores ósseos avaliados nesses estudos e ao tipo de procedimento cirúrgico em questão, esses ainda mais incomuns. Conclusão: Construir um panorama que transmita a realidade de cada diagnóstico e indique quais as características que esses pacientes apresentam que mais se aproximariam como indicações relativas ou absolutas para o procedimento de hemipelvectomia encontra na raridade desses casos o seu maior obstáculo.

Fifteen Years' Experience of the Brazilian Osteosarcoma Treatment Group (BOTG): A Contribution from an Emerging Country.

PURPOSE: Little information is available regarding the tumor features, prognostic factors, and treatment results in children and adolescents and young adults (AYAs) with osteosarcoma diagnosed in developing countries. We reviewed the results of three observational cohorts of osteosarcoma patients treated in an emerging country. METHODS: A total of 604 patients below the age of 30 years with high-grade osteosarcoma were prospectively enrolled in the Brazilian Osteosarcoma Treatment Group (BOTG) studies III, IV, and V. Gender, age, time from onset of symptoms to diagnosis, primary tumor site, presence or absence of metastases at diagnosis, tumor size, type of surgery (limb-sparing or amputation), treatment protocol, and histological response were correlated with survival. RESULTS: The estimated 5-year overall survival and event-free survival (EFS) rates for the 553 eligible patients were 49% and 39% respectively; of the 390 non-metastatic patients included in the total, overall- and event-free survival were 59% and 48% respectively. Metastases at diagnosis, primary tumor site, type of surgery, and histological response were significant predictors of overall survival and EFS in univariate and multivariate analysis, whereas tumor size and treatment protocol lost prognostic significance in multivariate analysis. CONCLUSION: We report on the outcome of three consecutive studies for the treatment of osteosarcoma carried out in Brazil over 15 years. Although the survival rates presented are below those reported in current literature, it represents the result of a favorable experience gathered from the national collaborative work.

Reliability of the "American Knee Society Score" (AKSS).

OBJECTIVE: To analyze the reproducibility of the "American Knee Society Score" (AKSS) scale, and determine its measurement, in order to make it useful for the evaluation of patients with osteoarthritis or who have undergone total knee arthroplasty. METHODS: In the first interview, the AKSS was applied along with the SF-36 and WOMAC (examiner 1). After thirty minutes the same patients answered only the AKSS. After a two week break, a third additional interview with AKSS was applied (examiner 2). RESULTS: We selected 58 patients with a mean age of 67.4 years. In the analysis of reproducibility, by ICC, there was strong inter-examiner and intra-examiner correlation for two AKSS components. In the individual items analysis there was good correlation for "Pain", "Range of Motion", "Flexion contracture" and all items of the AKSS Function component. Validation through the Pearson coefficient showed good correlation between AKSS "Pain," WOMAC "pain" and SF-36 "Pain domain", and good correlation between the AKSS and SF-36 "Functional Capacity domain". CONCLUSION: The AKSS adapted to Brazilian culture is useful and reliable for the evaluation of individuals with osteoarthritis or those who have undergone TKA.