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BACKGROUND: Ceramic femoral heads with titanium sleeves are commonly used in revision total hip arthroplasty (rTHA). Companies advise against combination with a retained femoral component from another manufacturer. However, no data are available. The aim of this study was to evaluate and compare the implant failure and revision rates of ceramic heads with a 12/14 titanium sleeve used on manufacturer-compatible versus non-compatible retained femoral components. METHODS: A retrospective single-center cohort analysis was performed using a prospectively maintained institutional arthroplasty registry. We identified 439 patients who received a titanium 12/14 ceramic head during rTHA between January 1st, 2007 and December 31st, 2022. There were 229 manufacturer-compatible and 210 manufacturer-non-compatible retained femoral stems, according to the company's official product compatibility list. Implant failure and re-revision rates were evaluated. RESULTS: After a median follow-up of 6.6 years (IQR (Interquartile-range): 4.5 to 9.3), there was no significant difference (P = 0.770) in the re-revision rate between the manufacturer-compatible group (17.0%) and the non-compatible group (18.1%). Revision-free survival after rTHA was 81.2% in the manufacturer-compatible group and 78.9% in the manufacturer-non-compatible group after 15 years (P = 0.653). Most re-revisions occurred in the first year after rTHA, with 29 of 229 (12.7%) in the manufacturer-compatible group and 24 of 210 (11.4%) in the manufacturer-non-compatible group (P = 0.705). We observed only one implant failure in the manufacturer-non-compatible group, but this was not related to a mismatch problem. CONCLUSION: Although legal uncertainties remain, this study showed no increased risk of implant failure or revision rates when a ceramic femoral head with a 12/14 titanium sleeve was used on a non-compatible femoral stem from a manufacturer.
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BACKGROUND: There is only sparse knowledge on the psychological burden of patients who have periprosthetic joint infections. The aim of our study was to assess the need for psychological support following total joint arthroplasty of the hip and knee. A special focus was set on patients who had aseptic and septic complications. METHODS: A total of 13,976 patients who underwent total hip (n = 6,926) or total knee arthroplasty (n = 7,050) between January 1, 2012 and December 31, 2019 at a single institution were retrospectively evaluated for the postoperative need for a psychological consultation. Data were collected on age, sex, type of surgery, and indications for revision procedures. The need for a psychological consultation was assessed during the daily postoperative visits, which were further coordinated by 2 institutional psychologists. RESULTS: The average age was 68 years (range, 12 to 100), and there were 63.5% women. The overall rate of psychological consultations was 1.7%. Patients who had a septic indication for revision surgery had an 18.7-fold higher rate of postoperative psychological consultations compared to patients following primary surgery and a 5.4-fold higher rate compared to patients who had an aseptic indication. In detail, this rate was 1.0% in the primary subgroup, compared to 7.7% following revision arthroplasty (P < .001). In the revision subgroup, the rate was 17.9% for septic and 3.3% for aseptic revision arthroplasty cases (P < .001). Postoperative psychological consultations were twice as frequent in women (2.1%) compared to men (1.0%), P < .001. CONCLUSIONS: The present study raises awareness of the markedly high psychological burden in revision arthroplasty cases, in the view of the high estimated number of unknown cases. There is a significant correlation between periprosthetic joint infectionsand the postoperative need for a psychological consultation, with women being at an even higher risk. Health care providers should aim at offering psychological support for patients who have a septic complication, with affected patients being at risk for psychological stress. LEVEL OF EVIDENCE: IV.
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PURPOSE: Unexpected-positive-intraoperative-cultures (UPIC) are common in presumed aseptic revision-total-knee-arthroplasties (rTKA). However, the clinical significance is not entirely clear. In contrast, in some presumably septic rTKA, identification of an underlying pathogen was not possible, so-called unexpected-negative-intraoperative-cultures (UNIC). The purpose of this study was to evaluate the potential use of synovial alpha-defensin (AD) levels in these patients. METHODS: Synovial AD levels from 143 rTKAs were evaluated retrospectively from our prospectively maintained institutional periprostetic joint infection (PJI) biobank and database. The 2018-International Consensus Meeting (ICM) criteria was used to define the study groups. Samples from UPICs with a minimum of one positive intraoperative culture (ICM 2- ≥ 6) (n = 20) and UNIC's (ICM ≥ 6) (n = 14) were compared to 34 septic culture-positive samples (ICM ≥ 6) and 75 aseptic culture-negative (ICM 0-1). Moreover, AD-lateral-flow-assay (ADLF) and an enzyme-linked-immunosorbent-assay (ELISA) in detecting the presence of AD in native and centrifuged synovial fluid specimens was performed. Concentration of AD determined by ELISA and ADLF methods, as well as microbiological, and histopathological results, serum and synovial parameters along with demographic factors were analysed. RESULTS: AD was positive in 31/34 (91.2%) samples from the septic culture-positive group and in 14/14 (100%) samples in the UNIC group. All UPIC samples showed a negative AD result. Positive AD samples were highly associated with culture positive and histopathological results (p < 0.001). No high-virulent microorganisms (0/20) were present in the UPIC group, compared to infected-group (19/34; 55.9%). High virulent microorganisms showed a positive AD result in 89.5% (17/19) of the cases. Methicillin resistant Staphylococcus epidermis (MRSE) infections had significantly higher AD levels than with methicillin susceptible S. epidermdis (MSSE) (p = 0.003). ELISA and ADLF tests were positive with centrifuged (8/8) and native (8/8) synovial fluid. CONCLUSION: AD showed a solid diagnostic performance in infected and non-infected revisions, and it provided an additional value in the diagnosis of UPIC and UNIC associated to rTKAs. Pathogen virulence as well as antibiotic resistance pattern may have an effect on AD levels. Centrifugation of synovial fluid had no influence on ADLF results.
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Artroplastia de Quadril , Artroplastia do Joelho , Infecção Hospitalar , Staphylococcus aureus Resistente à Meticilina , Infecções Relacionadas à Prótese , alfa-Defensinas , Humanos , Sensibilidade e Especificidade , Estudos Retrospectivos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Artroplastia do Joelho/efeitos adversos , Líquido Sinovial/química , Biomarcadores/análiseRESUMO
PURPOSE: Despite advances of three-dimensional imaging pelvic radiographs remain the cornerstone in the evaluation of the hip joint. However, large inter- and intra-rater variabilities were reported due to subjective landmark setting. Artificial intelligence (AI)-powered software applications could improve the reproducibility of pelvic radiograph evaluation by providing standardized measurements. The aim of this study was to evaluate the reliability and agreement of a newly developed AI algorithm for the evaluation of pelvic radiographs. METHODS: Three-hundred pelvic radiographs from 280 patients with different degrees of acetabular coverage and osteoarthritis (Tönnis Grade 0 to 3) were evaluated. Reliability and agreement between manual measurements and the outputs of the AI software were assessed for the lateral-center-edge (LCE) angle, neck-shaft angle, sharp angle, acetabular index, as well as the femoral head extrusion index. RESULTS: The AI software provided reliable results in 94.3% (283/300). The ICC values ranged between 0.73 for the Acetabular Index to 0.80 for the LCE Angle. Agreement between readers and AI outputs, given by the standard error of measurement (SEM), was good for hips with normal coverage (LCE-SEM: 3.4°) and no osteoarthritis (LCE-SEM: 3.3°) and worse for hips with undercoverage (LCE-SEM: 5.2°) or severe osteoarthritis (LCE-SEM: 5.1°). CONCLUSION: AI-powered applications are a reliable alternative to manual evaluation of pelvic radiographs. While being accurate for patients with normal acetabular coverage and mild signs of osteoarthritis, it needs improvement in the evaluation of patients with hip dysplasia and severe osteoarthritis.
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Impacto Femoroacetabular , Osteoartrite , Humanos , Reprodutibilidade dos Testes , Inteligência Artificial , Articulação do Quadril/diagnóstico por imagem , Acetábulo , Software , Estudos RetrospectivosRESUMO
INTRODUCTION: Patients who require a spacer exchange as part of a two-stage procedure for the treatment of periprosthetic hip and knee joint infections (PJI) have high failure rates. Little is known about the clinical impact of microbiological results and changes in the microbiological spectrum and resistance pattern in these patients. MATERIAL AND METHODS: Between 01/2011 and 12/2019, 312 patients underwent a total of 327 two-stage revision arthroplasties at our institution. A spacer exchange was required in 52/312 (16.7%) patients (27 knee/25 hip). Microbiological results, antibiotic resistance patterns, patient's host factors as well as re-revision and re-infection rates at a median follow-up of 47.8 months (range 12.2-116.7 months) were analyzed. A propensity score (PS)-matched analysis of patients who underwent spacer exchange and patients treated with standard two-stage procedure was performed. RESULTS: We found a high number of microbiological spectrum changes in patients with multiple culture positive procedures between explantations and spacer exchanges (10/12 [83.3%]), spacer exchanges and reimplantations (3/4 [75%]) as well as between reimplantations and subsequent re-revision surgeries (5/6 [83.3%]). In 9/52 (17.3%) patients, same microorganisms were detected repeatedly in two different procedures. We observed changes in the antibiotic resistance patterns in 6/9 (66.7%) of these patients. High re-infection rates were found in patients with culture positive reimplantations (10/12 [83.3%]), and low re-infection rates were found in patients with culture negative reimplantations (2/40 [5%]; p < 0.001). Between patients with and without spacer exchange, no differences were found in the re-revision rates (13/52 [25%] with vs. 13/52 [25%] without; p = 1.00) as well as re-infection rates (12/52 [23.1%] with vs. 8/52 [15.4%] without; p = 0.32). CONCLUSIONS: Changes in microbiological spectrum and antibiotic resistance patterns between stages are common in patients who require a spacer exchange. If eradication of the microorganism at reimplantation can be accomplished, comparable re-revision rates to standard two-stage procedures can be achieved.
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Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Reinfecção/tratamento farmacológico , Reinfecção/etiologia , Estudos Retrospectivos , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Reoperação/métodos , Infecções Relacionadas à Prótese/microbiologia , Antibacterianos/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVES: The unique properties of dalbavancin (DAL) emphasize the need to explore its clinical benefits to treat periprosthetic joint infections (PJIs). The present study aimed to compare the treatment outcome of dalbavancin with Standard of Care (SoC) in hip and knee PJIs. METHODS: Eighty-nine patients were selected for each group of this study based on our prospectively maintained PJI database. A 1:1 propensity score-matching was performed between patients who received at least two doses of dalbavancin and those who received SoC. Patients were matched based on demographics, joint, patient risk factors, Musculoskeletal Infection Society (MSIS) criteria, surgical management and type of infection. Treatment outcome was evaluated considering re-infection and re-revision rates, safety and tolerability of dalbavancin after a minimum of 1â year follow-up. RESULTS: Infection eradication was achieved in 69 (77.5%) and 66 (74.2%) patients of the DAL and SoC groups, respectively. Thirteen (14.6%) patients in the DAL group and 12 (13.5%) patients in the SoC group had an infection-related re-revision. The most prevalent microorganisms among the two groups were Staphylococcus epidermidis (32.3%), Staphylococcus aureus (13.8%) and Cutibacterium spp. (11.3%). There were significantly less Gram-positive bacteria (Pâ=â0.03) detected in patients who received dalbavancin (17.4%) treatment compared with those treated with SoC (48.0%) in culture-positive re-revisions. CONCLUSIONS: Dalbavancin treatment for Gram-positive PJIs resulted in a similar outcome to SoC, with excellent safety and low rate of adverse effects. Dalbavancin seems to be a promising antimicrobial against PJIs by reducing the risk of Gram-positive re-infections and allowing a less frequent dosage with potential outpatient IV treatment.
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Artrite Infecciosa , Infecções Relacionadas à Prótese , Antibacterianos/efeitos adversos , Artrite Infecciosa/tratamento farmacológico , Bactérias Gram-Positivas , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Teicoplanina/efeitos adversos , Teicoplanina/análogos & derivadosRESUMO
BACKGROUND: In recent years, total hip arthroplasty via the direct anterior approach (DAA) has become more common. Little is known on the influence of the surgical approach on the microbiological spectrum and resistance pattern in periprosthetic hip joint infections. The aim of the present study was to evaluate the microbiological spectrum and resistance pattern in periprosthetic hip joint infections comparing the direct anterior versus lateral approach in a matched-cohort analysis at a single institution. METHODS: Patients who underwent revision hip arthroplasty due to PJI following primary total hip arthroplasty with culture positive microbiology were analyzed. In all study patients, both the primary surgery and the revisions surgery were performed at the same institution. Only patients in whom primary surgery was performed via a direct anterior or lateral approach were included (n = 87). A matched cohort analysis was performed to compare the microbiological spectrum and resistance pattern in PJI following direct anterior (n = 36) versus lateral (n = 36) primary THA. RESULTS: We identified both a significantly different microbiological spectrum and resistance pattern in PJI comparing direct anterior versus lateral approach THA. Cutibacterium avidum was obtained more frequently in the anterior subgroup (22.2% vs. 2.8%, p = 0.028). In the subgroup of infections with Staphylococcus aureus (n = 12), methicillin resistance was detected in 3/5 cases in the direct anterior group versus 0/7 cases in the lateral group (p = 0.045). Overall, Staphylococcus epidermidis was the most common causative microorganism in both groups (direct anterior: 36.1%; lateral: 27.8%, p = 0.448). CONCLUSION: The present study indicates a potential influence of the localization of the skin incision in THA on the microbiological spectrum and resistance pattern in PJI. Cutibacterium avidum seemed to be a more common causative microorganism in PJI in patients who underwent direct anterior compared to lateral approach THA.
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Artroplastia de Quadril , Prótese de Quadril , Infecções Relacionadas à Prótese , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Articulação do Quadril , Prótese de Quadril/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVES: Accurate assessment of knee alignment and leg length discrepancy is currently measured manually from standing long-leg radiographs (LLR), a process that is both time consuming and poorly reproducible. The aim was to assess the performance of a commercial available AI software by comparing its outputs with manually performed measurements. MATERIALS AND METHODS: The AI was trained on over 15,000 radiographs to measure various clinical angles and lengths from LLRs. We performed a retrospective single-center analysis on 295 LLRs obtained between 2015 and 2020 from male and female patients over 18 years. AI and expert measurements were performed independently. Kellgren-Lawrence score and reading time were assessed. All measurements were compared and non-inferiority, mean-absolute-deviation (sMAD), and intra-class-correlation (ICC) were calculated. RESULTS: A total of 295 LLRs from 284 patients (mean age, 65 years (18; 90); 97 (34.2%) men) were analyzed. The AI model produces outputs on 98.0% of the LLRs. Manually annotations were considered as 100% accurate. For each measurement, its divergence was calculated, resulting in an overall accuracy of 89.2% when comparing the AI outputs to the manually measured. AI vs. mean observer revealed an sMAD between 0.39 and 2.19° for angles and 1.45-5.00 mm for lengths. AI showed good reliability in all lengths and angles (ICC ≥ 0.87). Non-inferiority comparing AI to the mean observer revealed an equivalence-index (γ) between 0.54 and 3.03° for angles and - 0.70-1.95 mm for lengths. On average, AI was 130 s faster than clinicians. CONCLUSION: Automated measurements of knee alignment and length measurements produced with an AI tool result in reproducible, accurate measures with a time savings compared to manually acquired measurements.
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Aprendizado Profundo , Idoso , Estudos Transversais , Feminino , Humanos , Extremidade Inferior , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
PURPOSE: The purpose of this study was to evaluate the reliability of a newly developed AI-algorithm for the evaluation of long leg radiographs (LLR) after total knee arthroplasties (TKA). METHODS: In the validation cohort 200 calibrated LLRs of eight different common unconstrained and constrained knee systems were analysed. Accuracy and reproducibility of the AI-algorithm were compared to manual reads regarding the hip-knee-ankle (HKA) as well as femoral (FCA) and tibial component (TCA) angles. In the evaluation cohort all institutional LLRs with TKAs in 2018 (n = 1312) were evaluated to assess the algorithms' ability of handling large data sets. Intraclass correlation (ICC) coefficient and mean absolute deviation (sMAD) were calculated to assess conformity between the AI software and manual reads. RESULTS: Validation cohort: The AI-software was reproducible on 96% and reliable on 92.1% of LLRs with an output and showed excellent reliability in all measured angles (ICC > 0.97) compared to manual measurements. Excellent results were found for primary unconstrained TKAs. In constrained TKAs landmark setting on the femoral and tibial component failed in 12.5% of LLRs (n = 9). Evaluation cohort: Mean measurements for all postoperative TKAs (n = 1240) were 0.2° varus ± 2.5° (HKA), 89.3° ± 1.9° (FCA), and 89.1° ± 1.6° (TCA). Mean measurements on preoperative revision TKAs (n = 74) were 1.6 varus ± 6.4° (HKA), 90.5° ± 3.1° (FCA), and 88.9° ± 4.1° (TCA). CONCLUSIONS: AI-powered applications are reliable for automated analysis of lower limb alignment on LLRs with TKAs. They are capable of handling large data sets and could, therefore, lead to more standardized and efficient postoperative quality controls. LEVEL OF EVIDENCE: Diagnostic Level III.
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Artroplastia do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/métodos , Inteligência Artificial , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Perna (Membro) , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: A positive microbiological result at reimplantation may lead to a failed 2-stage revision arthroplasty in the treatment of periprosthetic joint infections. Little is known about changes in microbiological spectrum and resistance pattern between culture positive first and second stage procedures in revision knee and hip arthroplasty. METHODS: Between January 2011 and December 2019, we performed 327 two-stage revision arthroplasties on 312 patients. There were 37 of 312 (11.9%) patients (20 hips/17 knees) who had a positive microbiological culture during the first and second stage procedure. We analyzed the microbiological spectrum, antimicrobial resistance pattern, and clinical outcome of culture positive first and second stage procedures as well as subsequent re-revisions. RESULTS: Re-revision was necessary in 40.5% (15/37) of patients with culture positive first and second stage procedure at a median follow-up of 3.5 years. We found microbiological changes in 83.8% (31/37) of patients between the first and second stage and in 88.9% (8/9) between the second stage and subsequent culture positive re-revision. Polymicrobial infections were found in 21.6% (8/37) of first and in 16.2% (6/37) of second stage procedures. In 27% (10/37) of patients, microorganisms persisted between the first and second stage procedure. The antimicrobial resistance pattern changed in 60% of persistent microorganisms between the first and second stage procedure. CONCLUSION: Changes in microbiological spectrum and resistance pattern are common between culture positive first and second stage procedures as well as subsequent re-revisions. This has to be considered in the antimicrobial treatment of periprosthetic joint infections.
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Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Articulação do Quadril , Humanos , Articulação do Joelho/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Addition of vitamin E to polyethylene is theorized to reduce the potential for oxidative wear in acetabular components. This paper presents a multicenter prospective cohort study that reports on outcomes from use of a Vitamin E-infused highly cross-linked polyethylene acetabular cup. METHODS: Patients were recruited across nine medical institutions. Clinical outcome measures recorded were the Harris Hip Score, visual analogue score for pain and satisfaction. Evidence of implant loosening or osteolysis was collected radiologically. Cup survival and reasons for revision in relevant cases were also recorded. Data collection was undertaken preoperatively, at 6-12 weeks, 6 months, 1 year, 2 years, and 5 years. A total of 675 patients were recruited, with 450 cases available at final review. Data regarding cup survival was available to 8 years and 9 months postoperatively. RESULTS: Improvements in both the Harris Hip Score and visual analogue score for pain and satisfaction were recorded at all time points, with these being maintained through the length of follow-up. In total, 89% of cups were implanted within the Lewinnek safe zone. A lucent line was identified in one case, with no evidence of acetabular osteolysis observed throughout the follow-up period. Cup survival was 98.9% at 8 years and 9 months. No revisions for aseptic loosening were observed. CONCLUSIONS: The use of a vitamin E-infused polyethylene acetabular cup demonstrates reassuring patient-reported outcomes, radiological measures, and cup survival at medium to long-term follow-up.
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Artroplastia de Quadril , Prótese de Quadril , Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Reoperação , Sobrevivência , Vitamina ERESUMO
BACKGROUND: The present study investigates the novel Synovasure periprosthetic joint infection (PJI) lateral flow test device for detection of alpha-defensin and attempts to determine its diagnostic accuracy for the intraoperative diagnosis of PJI and compares it to frozen section. METHODS: Forty consecutive patients, who underwent revision surgery, between September 2014 and September 2015 were included. The patients underwent 29 revision total knee arthroplasties and 11 revision total hip arthroplasties. Twelve patients had a confirmed PJI based on Musculoskeletal Infection Society criteria, and 28 patients were considered aseptic. RESULTS: The overall accuracy to detect PJI using the lateral flow assay was 85% (95% CI 70%-93%). The device has a positive predictive value of 80% (95% CI 44%-96%) and a negative predictive value of 87% (95% CI 68%-96%) and showed a sensitivity of 67% (95% CI 35%-89%) and specificity of 93% (95% CI 75%-99%). Frozen section had a lower sensitivity (58% [95% CI 29%-84%]) but a higher specificity (96% [95% CI 80%-100%]). Receiver operator curve analysis demonstrates an area under the curve of the Synovasure PJI Lateral Flow Test Kit and frozen section of 0.80 and 0.77, respectively. CONCLUSION: The present study suggests that the intraoperative lateral flow test is at least equivalent to intraoperative frozen section and is a useful tool to confirm the absence of PJI. Although the clinical results are promising, they are not as good as previous studies using alpha-defensin levels measured in a laboratory.
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Artrite Infecciosa/cirurgia , Biomarcadores/análise , Proteína C-Reativa/análise , Infecções Relacionadas à Prótese/cirurgia , Líquido Sinovial/química , alfa-Defensinas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Artroplastia do Joelho , Feminino , Secções Congeladas , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reoperação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: This diffusion tensor magnetic resonance imaging (DTI) study aimed to clarify the relationship of peripheral nerves and soft tissue tumors (STTs) in 3D to optimize subsequent treatment. METHODS: Twenty-six consecutive STT patients (histologically malignant, n=10; intermediate, n=3; and benign, n=13) underwent 3-Tesla MRI using an echoplanar DTI sequence. Deterministic tractography was performed. Fractional anisotropy (FA) values were measured within peritumoral and distant regions of interest. RESULTS: Tractography depicted the 3D course of the sciatic (n=12), femoral (n=2), tibial (n=7), fibular (n=2), median (n=1), musculocutaneous (n=1), and ulnar (n=1) nerves in a regular (n=8 of 18, 44.4%) or thinned (n=7 of 18, 38.9%) fashion. The lowest peritumoral FA values, abrupt thinning, and/or complete discontinuity of trajectories were found in 2 cases with histologically proven tumoral nerve infiltration. CONCLUSIONS: DTI clarifies the 3D topography between major peripheral nerves and STTs and may be helpful in the assessment of peripheral nerve infiltration by malignant tumors.
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Imagem de Tensor de Difusão/métodos , Imageamento Tridimensional/métodos , Nervos Periféricos/patologia , Neoplasias de Tecidos Moles/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/metabolismo , Estudos Prospectivos , Neoplasias de Tecidos Moles/metabolismo , Adulto JovemRESUMO
OBJECTIVES: To test the feasibility and accuracy of MR-guided soft tissue tumour biopsy at 3T, using the dynamic contrast-enhanced (DCE) information from staging MRI for intralesional targeting. METHODS: After obtaining written informed consent for this institutional review board-approved study, 53 patients with suspected soft tissue tumours prospectively underwent preoperative staging MRI at 3T, including DCE, and subsequent MR-guided core needle biopsy. In 44/53 cases, DCE was heterogeneous and was used for intralesional biopsy targeting. Surgical, whole-specimen histology was used as the gold standard in 43/44 patients and revealed 42 soft tissue tumours (24 men; 18 women; mean age, 52 years; range, 19 - 84). RESULTS: Final surgical histology revealed eight benign lesions, six tumours of intermediate dignity, and 28 malignancies. All malignancies had shown heterogeneous DCE. The diagnostic yield of the biopsies was 100% (42/42). Histological accuracy rates of biopsy were 100% in predicting the dignity (42/42; 95% CI [0.916 - 1.000]), 95.2% for the tissue-specific entity (40/42; 95% CI [0.847 - 0.987]), and 90.5% for the tumour grade (38/42; 95% CI [0.779 - 0.962]). CONCLUSIONS: Our preliminary study indicates that biopsy of soft tissue tumours can be performed accurately and safely with DCE targeted MR-guidance at 3T, using a combined staging/biopsy MRI protocol. KEY POINTS: ⢠MR-guided soft tissue tumour biopsy using DCE for intralesional targeting is feasible. ⢠Targeting by staging-MRI allows reliable planning of the biopsy approach. ⢠The method seems accurate and safe as a combined staging/biopsy procedure in outpatients. ⢠DCE-targeted biopsy seems useful in challenging large and heterogeneous tumours.
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Neoplasias de Tecidos Moles/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Meglumina/análogos & derivados , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organometálicos , Cuidados Pré-Operatórios , Estudos Prospectivos , Neoplasias de Tecidos Moles/cirurgia , Adulto JovemRESUMO
The prognosis after relapse of high-grade osteosarcoma is poor and complete resection of all tumors is essential for survival. A 6-year old was diagnosed with high-grade osteosarcoma and treated according to the COSS-96 protocol. Within 5 years from initial diagnosis, five osteosarcoma relapses occurred and every time it was possible to achieve complete surgical remission. Additional treatments included chemotherapy and dendritic cell-based cancer immune therapy. Since the end of therapy of the 5th relapse, he is alive for 11½ years. Our experience further supports that aggressive surgery can help to achieve long-term survival even in patients with multiple osteosarcoma relapses.
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Neoplasias Ósseas/terapia , Osteossarcoma/terapia , Prevenção Secundária/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Ósseas/patologia , Criança , Humanos , Masculino , Recidiva Local de Neoplasia , Osteossarcoma/patologiaRESUMO
PURPOSE: This study evaluated the feasibility of computed magnetic resonance imaging (MRI) volumetry in conventional osteosarcomas. Secondly, we investigated whether computed volumetry provides new prognostic indicators for histological response of osteosarcomas after neoadjuvant chemotherapy. METHODS: In a retrospective cohort study, data from the Vienna Bone Tumour Registry was used. MR images from 14 patients (male:female = 1.8, mean age 19 years) were analysed prior to and after neoadjuvant chemotherapy according to current therapy regimens. Histological response to chemotherapy was graded according to the Salzer-Kuntschik classification. Computed volumetry was performed for the intraosseous part, as well as the soft-tissue component and the tumour as a whole. RESULTS: In a setting of appropriate radiological equipment, the method has been considered to be well implementable into clinical routine. The mean tumour volume prior to chemotherapy was 321 (±351) ml. In good responders (n = 6), overall tumour volume decreased by 47% (p = 0.345), whereas poor responders (n = 8) showed a 19% decrease (p = 0.128). Neoadjuvant multidrug therapy remarkably changed the tumour composition. This is seen in a decrease of the mean ratio of soft-tissue to intraosseous tumour volume from 8.67 in poor responders and 1.15 in good responders to 1.26 and 0.45 (p = 0.065), respectively. Interestingly, the bony compartment of good responders showed a volume increase during neoadjuvant chemotherapy (p = 0.073). However, we did not find prognostic markers for histological tumour response to pre-operative chemotherapy. CONCLUSIONS: Separated volumetry of tumour segments revealed interesting insights into therapy-induced growth patterns. If verified in a larger study population, these results should be taken into account when planning ablative surgery.
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Neoplasias Ósseas/tratamento farmacológico , Imageamento por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Osteossarcoma/tratamento farmacológico , Adolescente , Adulto , Neoplasias Ósseas/patologia , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Osteossarcoma/patologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Giant cell tumor of bone (GCTB) is an aggressive primary osteolytic tumor. GCTB often involves the epiphysis, usually causing substantial pain and functional disability. Denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor κΒ ligand (RANKL), is an effective treatment option for patients with advanced GCTB. This analysis of data from an ongoing, open-label study describes denosumab's effects on pain and analgesic use in patients with GCTB. MATERIAL AND METHODS: Patients with unresectable disease (e.g. sacral or spinal GCTB, or multiple lesions including pulmonary metastases) were enrolled into Cohort 1 (N = 170), and patients with resectable disease whose planned surgery was associated with severe morbidity (e.g. joint resection, limb amputation, or hemipelvectomy) were enrolled into Cohort 2 (N = 101). Patients received denosumab (120 mg) subcutaneously every four weeks, with additional doses on study days 8 and 15. Patients assessed worst pain severity with the Brief Pain Inventory - Short Form (BPI-SF) at baseline, at each visit for the first six months, and every three months thereafter. RESULTS: Clinically relevant pain improvement was reported by 29% of patients in Cohort 1 and 35% in Cohort 2 during week 1 and by ≥ 50% of patients in each cohort at each study visit from months 2-30. Median time to clinically relevant improvement was 30 (95% CI 16, 57) days in Cohort 1 and 15 (95% CI 15, 29) days in Cohort 2. Results in patients with moderate/severe pain at baseline were similar. Fewer than 30% of patients in Cohort 1 and 10% in Cohort 2 experienced clinically relevant pain worsening at any visit through 27 months. Most patients had no/low analgesic use during the study. CONCLUSION: Most patients treated with denosumab experienced clinically relevant decreases in pain within two months.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Neoplasias Ósseas/complicações , Tumor de Células Gigantes do Osso/complicações , Dor/tratamento farmacológico , Ligante RANK/antagonistas & inibidores , Adolescente , Adulto , Estudos de Coortes , Denosumab , Esquema de Medicação , Feminino , Humanos , Injeções Subcutâneas , Masculino , Medição da Dor/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Little data is available about the incidence and especially the management of hip dislocation following the implantation of modular tumor prostheses of the proximal femur. In this retrospective single-centre study we assessed the incidence of hip dislocation following implantation of a proximal femoral modular prosthesis as well as the success of the subsequent surgical or non-surgical treatment in tumor patients. METHODS: Between 1982 and 2008, 166 tumor patients received a modular prosthesis of the proximal femur at our institution. The average age at the time of surgery was 50 ± 20 years (range, six to 84 years). An additional pelvic reconstruction was done in 14 patients. An artificial band for soft tissue reconstruction of the hip was used in 19 patients. The average time of follow-up was 46 ± 64 months (range, one to 277 months). RESULTS: The overall dislocation rate after proximal femoral replacement was 13% after a mean time of seven ± eight months (range, 0.3-33 months) after surgery. Between 1982 and 1986 the dislocation rate was 33% and declined to 9% in subsequent years (1987-2008). Patients who had received an additional pelvic reconstruction had a three fold higher dislocation rate (p <0.05). Patients with closed reduction had a 58% (eight of 12) re-dislocation rate compared to 11% (one of nine) for open reduction (p = 0.0357). CONCLUSIONS: Dislocation of a modular prosthesis of the proximal femur is a common complication, especially in cases with additional pelvic resection with extensive bone and soft-tissue defects. Open surgical management may be more effective in preventing re-dislocation than closed reduction and bracing alone.
Assuntos
Artroplastia de Quadril/efeitos adversos , Neoplasias Ósseas/cirurgia , Fêmur/cirurgia , Luxação do Quadril/epidemiologia , Luxação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Desenho de Prótese/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Condrossarcoma/cirurgia , Estudos de Coortes , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Luxação do Quadril/etiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteossarcoma/cirurgia , Radiografia , Estudos Retrospectivos , Sarcoma de Ewing/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Due to its good prognosis despite local recurrence, more and less invasive methods for surgical treatment of parosteal osteosarcoma (POS) have been described. Aim of this retrospective single-center study was to investigate differences in outcome after biological and prosthetic reconstruction. METHODS: A total of 28 patients with POS, 14 females, 14 males, mean age of 27 years (median, 24 years; range 15-59 years), mean follow-up of 130 months (median, 104 months; range, 9-383 months), underwent wide tumor resection and prosthetic reconstruction (12 patients, 42.9%), less extensive resection and biological reconstruction (11 patients, 39.3%), rotationplasty (three patients, 10.7%), or amputation (two patients, 7.1%). RESULTS: There were two cases of local recurrence in patients with biological reconstruction and three cases of pulmonary metastases, leading to death of disease in two. Ten-year disease-specific survival was 91.1%. There was no significant difference between prosthetic and biological reconstruction in terms of local recurrence, metastasis, or functional outcome (mean MSTS Score, 85%). There were significantly more revisions in prosthetic reconstructions. CONCLUSIONS: Given that the resection of the tumor has clear margins, both prosthetic and biological reconstruction show similar results; prostheses allow better local tumor control, however, require more revisions over time.
Assuntos
Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/terapia , Osteossarcoma/mortalidade , Osteossarcoma/terapia , Periósteo/patologia , Adolescente , Adulto , Amputação Cirúrgica/estatística & dados numéricos , Neoplasias Ósseas/patologia , Transplante Ósseo , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Osteossarcoma/patologia , Periósteo/cirurgia , Próteses e Implantes , Estudos Retrospectivos , Adulto JovemRESUMO
In a retrospective single-centre study 170 consecutive patients were included who received a Kotz modular prosthesis after resection of bone tumours of the proximal femur to evaluate the management of prosthetic infection. Infection occurred in 12 of 166 patients available for follow-up (six males; six females; mean age, 47 years; range, ten to 75 years) after a mean of 39 months (range, one to 166 months; infection rate, 7.2%). Mean follow-up was 54 months (range, four to 200 months). One patient died of septic shock. Two patients were treated by wound revision only. Treatment of infection in the remaining patients was one-stage revision in eight and hip disarticulation in one. Infection control by one-stage revision was achieved in five of eight patients; re-infection occurred in three patients and was successfully treated by further revision in all of them. The overall success rate for controlling infection was 83.3%.