ABSTRACT
PURPOSE: It is increasingly relevant to better define what constitutes an adequate surgical margin in an effort to improve reconstructive longevity and functional outcomes following osteosarcoma surgery. In addition, nonunion remains a challenging problem in some patients following allograft reconstruction. Bone morphogenetic protein-2 (BMP-2) could enhance osseous union, but has been historically avoided due to concerns that it may promote tumor recurrence. EXPERIMENTAL DESIGN: An orthotopic xenograft murine model was utilized to describe the natural temporal course of osteosarcoma growth. Tumors were treated either with surgery alone, surgery and single-agent chemotherapy, or surgery and dual-agent chemotherapy to assess the relationship between surgical margin and local recurrence. The effect of BMP-2 on local recurrence was similarly assessed. RESULTS: Osteosarcoma tumor growth was categorized into reproducible phases. Margins greater than 997 µm resulted in local control following surgery alone. Margins greater than 36 µm resulted in local control following surgery and single-agent chemotherapy. Margins greater than 12 µm resulted in local control following surgery and dual-agent chemotherapy. The application of exogenous BMP-2 does not confer an increased risk of local recurrence. CONCLUSIONS: This model reliably reproduces the clinical, radiographic, and surgical conditions encountered in human osteosarcoma. It successfully incorporates relevant chemotherapy, further paralleling the human experience. Surgical margins required to achieve local control in osteosarcoma can be reduced using single-agent chemotherapy and further decreased using dual-agent chemotherapy. The application of BMP-2 does not increase local recurrence in this model.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/pharmacology , Bone Morphogenetic Protein 2/pharmacology , Bone Neoplasms/pathology , Neoplasm Recurrence, Local/prevention & control , Osteosarcoma/pathology , Animals , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Morphogenetic Protein 2/physiology , Bone Neoplasms/therapy , Cell Line, Tumor , Female , Humans , Mice, SCID , Neoplasm Recurrence, Local/diagnosis , Osteosarcoma/therapy , ROC Curve , Xenograft Model Antitumor AssaysABSTRACT
Bulk allograft reconstruction plays an important role in limb-salvage reconstructive surgery but is complicated by nonunion in up to one-third of cases. Because allograft-host healing is mediated via creeping substitution, intimate bone contact is desirable. Intraoperative assessment and optimization of the allograft-host junction site using a conventional transverse osteotomy is challenging and may result in slight gapping. Speculatively, this may result in longer healing times and may contribute to the high rate of non-union. Minimizing the nonunion rate and time to union are of value. This article describes the telescopic mating technique, which allows for substantially greater bone contact across the allograft-host junction site.
Subject(s)
Bone Neoplasms/surgery , Bone Transplantation/methods , Plastic Surgery Procedures/methods , Radius/surgery , Tibia/surgery , Ulna/surgery , Child , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: Femoroacetabular impingement has become more widely recognized in the athletic patient population. The purpose of the present study was to review the clinical outcome after arthroscopic treatment of femoroacetabular impingement in a mixed population of high-level athletes. HYPOTHESIS: Arthroscopic treatment of femoroacetabular impingement results in significant improvement in clinical outcome and a high rate of return to play. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: High-level athletes who underwent arthroscopic treatment of femoroacetabular impingement (rim trimming, labral refixation or debridement, femoral osteochondroplasty) with a minimum of 1-year follow-up were retrospectively identified. All patients completed hip-specific outcome scores (Modified Harris Hip Score [MHHS] and Hip Outcome Score [HOS]) at baseline and most recent follow-up. RESULTS: Forty-seven patients with an average age of 22.8 ± 6.2 years met the study criteria with a mean follow-up of 27.0 ± 5.5 months. Thirty-three patients (70.2%) were available for follow-up. The level of competition was 27.7% varsity high school, 53.2% college, and 19.1% professional athletes. There were statistically significant improvements in the mean MHHS score (preoperative, 68.6 ± 12.8; postoperative, 88.5 ± 17.7; P = .002) as well as the HOS score (preoperative, 78.8 ± 11.3; postoperative, 91.4 ± 14.0; P = .03). There was a significant improvement in the alpha angle, with 76.4° ± 14.5° preoperatively and 51.4° ± 11.7° postoperatively (P = .0003). Seventy-nine percent of patients were able to return to play after hip arthroscopy at a mean of 9.4 ± 4.7 months (range, 4-26 months); of those patients, 92.3% were able to return to the same level of competition. At 2-year follow-up, 73% of patients were able to return to play. CONCLUSION: Arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes may result in a significant improvement in hip functional outcome: 78% of athletes were able to return to play at 1 year and 73% of athletes were able to play at 2-year follow-up.
