Role of incisional vacuum therapy in endoprosthetic bone reconstruction surgery / Papel da terapia a vácuo incisional em cirurgia de reconstrução óssea com endoprótese

ABSTRACT Reconstructive surgery with endoprostheses is the chosen method for treating bone malignancies. Postoperative infections are frequent complications, and their treatment involves prolonged hospital stays and antibiotic therapy. Among the advancements aimed at reducing the rate of postoperative infection, the use of incisional negative pressure therapy (iNPT) has shown promising results, with no reports in the literature regarding its use in patients with such conditions. Objective: To evaluate the effectiveness of iNPT in reducing postoperative complications in surgeries for resection of bone tumors associated with modular endoprosthesis reconstruction. Methods: Retrospective case series of 16 patients diagnosed with osteosarcoma, who underwent resection and reconstruction with endoprosthesis associated with iNPT during the postoperative period. Follow-up was performed for a period of six months, and the evaluated outcomes were the incidence of postoperative infection and complications of the surgical wound. Results: The use of iNPT for a postoperative period of seven days resulted in only three (18.7%) cases of postoperative infection. No cases of wound dehiscence, seroma formation, or hematoma at the surgical site were observed. Conclusion: The rate of surgical wound complications in our case series is lower than that reported in most of the literature, and iNPT appears to be an efficient way to reduce the rate of local complications in reconstructive surgeries with endoprosthesis after resection of bone malignancies. Level of Evidence III, Retrospective Study.

RESUMO A cirurgia reconstrutiva com endopróteses é o método escolhido no tratamento de malignidades ósseas. As infecções pós-operatórias são complicações frequentes, e seu tratamento envolve internações e antibioticoterapia prolongadas. Entre os avanços que visam reduzir a taxa de infecção pós-operatória, o uso da terapia com pressão negativa incisional (TPNi) vem mostrando resultados promissores, não havendo relatos na literatura de seu emprego em pacientes com tal quadro. Objetivo: Avaliar a eficácia da TPNi em reduzir complicações pós-operatórias em cirurgias de ressecção de tumores ósseos associadas à reconstrução com endopróteses modulares. Métodos: Série de casos retrospectiva de 16 pacientes diagnosticados com osteossarcoma, submetidos à ressecção e reconstrução com endoprótese associada à TPNi durante o pós-operatório. Foi realizado seguimento por um período de seis meses e os desfechos avaliados foram incidência de infecção pós-operatória e complicações da ferida operatória. Resultados: O uso da TPNi por um período pós-operatório de sete dias resultou em apenas três (18,7%) casos de infecção pós-operatória. Não foram observados casos em que ocorreu deiscência da ferida operatória, formação de seromas ou hematomas no sítio cirúrgico. Conclusão: A taxa de complicações de ferida operatória em nossa série de casos é menor que a da maior parte da literatura, e a TPNi parece ser uma forma eficiente de reduzir a taxa de complicações locais em cirurgias reconstrutivas com endoprótese após ressecção de malignidades ósseas. Nível de Evidência III, Estudo Retrospectivo.

Three-dimensional printing in orthopedics: where we stand and where we are heading / Impressão 3d na ortopedia: onde estamos e aonde podemos chegar

ABSTRACT Three-dimensional printing is a technology in expansion in the medical field. It also presents many applications in orthopedics. Our review article aims to describe 3D printing, types of 3D printers, and its use in the orthopedic field. 3D models can be created using tomography scans. Those models can then be manipulated, even simulating surgeries. It is possible to print biomodels, which will help us understand deformities and plan surgeries. Orthopedic surgeons must be updated in these disruptive technologies that may help their daily practice. Level of Evidence V, Expert opinion.

RESUMO A impressão 3D é uma tecnologia em expansão na medicina, possuindo diversas utilidades na ortopedia. O objetivo deste artigo de revisão é descrever o que é a impressão 3D, seus tipos e suas aplicações na ortopedia. Modelos em 3 dimensões podem ser criados a partir da tomografia computadorizada. Estes modelos podem ser manipulados em softwares específicos, onde inclusive cirurgias podem ser simuladas. Utilizando impressoras 3D podemos criar biomodelos que nos ajudam a compreender deformidades e planejar cirurgias. É importante que o ortopedista se mantenha atualizado nestas novas tecnologias disruptivas que podem auxiliar muito no seu dia a dia. Nível de Evidência V, Opinião do especialista.

Tumors of the patella: the experience of Institute of Orthopedics and Traumatology at University of São Paulo, Brazil

OBJECTIVE: To obtain epidemiological data from the tumors of the patella diagnosed and treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo (IOT-HC-FMUSP) between 1998 and 2015. METHODS: Series of cases with retrospective evaluation of patients diagnosed with tumors located in the patella. The data was obtained from the records and patients' charts at the Department of Pathology of IOT-HC-FMUSP. RESULTS: A total of 2220 medical records from patients with anatomopathological reports were included in the study. Only eight (0.3%) patients had patellar tumors. We found that six (75%) of these were benign, one (12.5%) was a pseudotumoral lesions and one (12.5%) was reported as malignant. Among benign tumors, the giant cell tumor (GCT) was the most frequently reported corresponding to 50% of the cases. Hemagioendothelioma was the only case of malignant tumor in this series. As for the pseudotumoral lesions, we found a brown tumor. CONCLUSION: From the data obtained retrospectively in a 17 year time frame, in a service that treats benign, malignant and pseudotumoral bone lesions, we conclude that our casuistry in patellar tumors is similar to that reported in scientific literature, where benign tumors are predominant in a 7:1 ratio over malignant tumors, being a rare location of appearance, with the GCT as the most common diagnosis . Level of Evidence IV, Case Series

Bioactive glass in cavitary bone defects: a comparative experimental study in rabbits

OBJECTIVES: To compare bioactive glass and autograft regarding their histomorphometric characteristics. METHODS: The authors conducted a prospective case-control experimental study on animals in order to compare the histomorphometric characteristics of bioactive glass versus autograft. Eight rabbits underwent surgery in which a cavitary defect was created in both proximal femurs. One side was filled with bioactive glass granules and the other, with autograft grafted from the contralateral side. The sides were randomized. Fourteen days after surgery, the animals were euthanized. RESULTS: Histologic analysis revealed that bone neoformation was equivalent among the two groups and the osteoblasts cell-count was higher in the femurs treated with bioactive glass. The osteocytes cell-count, however, was lower. The similarity in bone formation between both groups was consistent to literature findings. CONCLUSION: Bioactive glass is similar to autograft regarding bone neoformation in this animal model of cavitary bone defects. Level of Evidence III, Case-Control Study.

Gct: what happened after 10 years of curettage and cement? Retrospective study of 46 cases

Comparar o resultado funcional de pacientes tratados portumor de células gigantes (TCG) que evoluíram com e sem artrose, edeterminar se o desenvolvimento da artrose está relacionado à distânciaentre o tumor e o osso subcondral. Métodos: 46 pacientes tratadospor TCG entre 1975 e 1999 preencheram os critérios de inclusão. OTCG foi diagnosticado por biópsia percutânea e confirmado após aressecção em todos os casos. As classificações de Campanacci eKellgren, a distância do cimento para o osso subcondral e o escorede MSTS foram obtidos para todos os casos. Resultados: A distânciado cimento para o osso subcondral está associada ao maior risco dedesenvolver artrose, mas não houve diferença nos escores funcionaisde MSTS entre os pacientes com e sem artrose. Conclusão: A distânciaentre o cimento e o osso subcondral tem valor prognóstico comrelação ao aparecimento de artrose, mas isso não acarreta impactono resultado funcional. Nível de Evidência IV, Estudo Terapêutico...

To compare the functional outcome of patients with andwithout arthrosis, and to determine whether the development of arthrosisis related to the distance of the tumor from the subchondralbone. Methods: Forty six patients treated for Giant-cell tumor (GCT)between 1975 and 1999 met inclusion criteria. GCT was diagnosedby percutaneous biopsy and confirmed after resection, in allcases. Campanacci’s and Kellgren’s classification, the distance ofthe cement to the articular surface and MSTS score were obtainedthroughout the sample. Results: The distance of the cement to thesubchondral bone was associated with greater risk of developingarthrosis, but there was no difference in MSTS scores betweenpatients with or without arthrosis. Conclusion: We found that thedistance from the cement to the subchondral bone has a prognosticvalue regarding future arthrosis, but it does not impact on thefunctional outcome. Level of Evidence IV, Therapeutic Study...

Correlation between the expression of VEGF and survival in osteosarcoma

Apresentar uma série de 50 casos consecutivos de pacientescom osteossarcoma de extremidade não metastático, e tentarcorrelacionar a expressão da proteína VEGF na biópsia com o prognóstico– sobrevida global, sobrevida livre da doença e recorrêncialocal. Métodos: Cinquenta casos de osteossarcoma de extremidadenão metastático tratados entre 1986 e 2006 no Instituto de Ortopediae Traumatologia da Universidade de São Paulo São Paulo, Brasil,foram avaliados quanto à expressão de VEGF. Havia 19 pacientesfemininos e 31 masculinos. A média de idade foi 16 anos (intervalo,5-28 anos) e o seguimento médio foi de 60,6 meses (intervalo, 25-167 meses). As variáveis estudadas foram idade, gênero, localizaçãoanatômica, tipo de cirurgia, margens cirúrgicas, tamanho do tumor,necrose pós-quimioterapia, recorrência local, metástases pulmonarese morte. Resultados: Trinta e seis pacientes mostraram expressãode VEGF igual ou menor a 30% das células (baixo), e os 14 restantesmostraram expressão de VEGF acima de 30% (alto). Entre os 36pacientes com baixa expressão, nove desenvolveram metástasespulmonares e quatro morreram (11,1%). Entre os 14 pacientes comalta expressão de VEGF, seis desenvolveram metástases pulmonarese três morreram (21,4%). Conclusão: Não houve correlaçãosignificativa entre a expressão de VEGF com nenhuma das variáveisestudadas. Nível de Evidência IV, Estudo Terapêutico...

To present a series of 50 consecutive patients withnon-metastatic extremity osteosarcoma, and attempt to correlateexpression of the VEGF protein in biopsy tissue to their prognosisregarding overall survival, disease-free survival and local recurrence.Methods: Fifty cases of non-metastatic osteosarcoma ofthe extremities treated between 1986 and 2006 at Instituto deOrtopedia e Traumatologia da Universidade de São Paulo, SãoPaulo, Brasil, were evaluated regarding expression of the VEGFprotein. There were 19 females and 31 males. The mean age was16 years old (range 5-28 years old) and the mean follow-up was60.6 months (range 25-167 months). The variables studied wereage, gender, anatomic location, type of surgery, surgical margins,tumor size, post chemotherapy necrosis, local recurrence, pulmonarymetastasis and death. Results: Thirty-six patients showedVEGF expression on 30% or less cells (low), and the remaining14 cases had VEGF expression above 30% (high). Among the 36patients with low VEGF expression, nine developed pulmonarymetastasis and four died (11.1%). Among the 14 patients withhigh VEGF expression, six developed pulmonary metastasis andthree died (21.4%). Conclusion: There was no statistically significantcorrelation between the expression of VEGF and any of thevariables studied. Level of Evidence IV, Therapeutic Study...