Enhancing Osteoporosis Management: A Thorough Examination of Surgical Techniques and Their Effects on Patient Outcomes.

Managing osteoporotic fractures in older individuals is a difficult task in orthopedic surgery. It requires a careful approach that combines advanced diagnostic methods, customized surgical treatments, and comprehensive rehabilitation strategies. This article presents the results of an analysis carried out at the University Emergency Hospital, Bucharest. The analysis specifically examines the treatment of osteoporotic fractures using different osteosynthesis techniques. Although diagnostic tools like dual-energy X-ray absorptiometry (DXA) and Fracture Risk Assessment Tool (FRAX) have improved, a considerable number of fractures still happen in people who do not have obvious osteoporosis. This emphasizes the importance of using additional diagnostic measures such as high-resolution peripheral quantitative computed tomography (HR-pQCT) and quantitative computed tomography (QCT) to improve the accuracy of predictions. The study demonstrates the intricate nature of surgical decision-making and the significance of adjusting techniques to meet the specific needs of each patient. An instance of osteosynthesis failure resulting from the inappropriate choice of method highlighted the crucial significance of a thorough preoperative assessment. The discussion highlights the importance of early mobilization and rehabilitation in reducing the risks associated with prolonged immobilization and improving patient recovery. This paper strongly supports the use of evidence-based and patient-centered methods in the management of osteoporotic fractures. It emphasizes the importance of utilizing the most recent advancements in diagnostic and surgical technologies. Promising advancements in orthopedic medicine lie in the future, particularly in the integration of interdisciplinary research and personalized medicine. These advancements have the potential to enhance patient outcomes in this population that is at high risk.

Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective.

Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

An Examination of Personalized Approaches in the Management of Ankle Fractures: A Thorough Evaluation of Soft Tissue Factors, Treatment Methods, and Patient Adherence.

This study offers a thorough analysis of tibial pilon fractures, accounting for patient compliance, diverse treatment options, and soft tissue implications. The article discusses varied treatment pathways, ranging from single-stage interventions to two-stage methods for open fractures by presenting seven clinical cases. The emphasis is on the intricate interplay of trauma intensity, bone damage, and adjacent soft tissue in dictating treatment plans and patient outcomes. The challenges posed by non-compliant patients rejecting advised treatments are underscored, illuminating the inherent risks. Drawing from varied patient demographics, comorbidities, and fracture types, a comprehensive guide for clinicians emerges. The findings underscore the importance of a tailored, patient-centric approach, considering the multifaceted nature of ankle fractures, local soft tissue health, patient's overall well-being, and their adherence to the proposed treatment regimen.

Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation.

Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.

Local recurrence management of extremity soft tissue sarcoma.

Patients diagnosed with soft tissue sarcoma (STS) present a number of challenges for physicians, due to the vast array of subtypes and aggressive tumor biology. There is currently no agreed-upon management strategy for these tumors, which has led to the ongoing debate surrounding how frequently surveillance scans should be performed following surgery. However, advances in multidisciplinary care have improved patient outcomes over recent years. The early detection of local recurrence reflects a more aggressive tumor, even in association with the same histopathologic entity. Treating the local recurrence of extremity STS is a difficult clinical challenge. The goal should be to salvage limbs when possible, with treatments such as resection and irradiation, although amputation may be necessary in some cases. Regional therapies such as high-intensity, low-dose or interleukin-1 receptor antagonist treatment are appealing options for either definitive or adjuvant therapy, depending on the location of the disease's recurrence. The higher survival rate following late recurrence may be explained by variations in tumor biology. Since long-term survival is, in fact, inferior in patients with high-grade STS, this necessitates the implementation of an active surveillance approach.

The Role of Serum and Peritoneal Biomarkers in Predicting Sepsis and Septic Multiorgan Failure in Patients With Secondary Peritonitis.

Purpose Secondary peritonitis is still one of the most important causes of severe sepsis in the world; therefore, it is of utmost importance to identify biomarkers that could be employed for the purpose of selecting patients at high risk for developing life-threatening complications after emergency surgery. In view of this quest, our study seeks to reveal the possible role for serum and peritoneal concentrations of selected biomarkers, specifically presepsin, procalcitonin, monocyte chemoattractant protein-1 (MCP-1), high mobility group box 1 protein (HMGB-1) and interleukins (IL-6, -8, -10), in early prediction of sepsis and septic multiorgan failure for patients with secondary peritonitis. Methods We prospectively observed 32 selected patients with secondary peritonitis that underwent emergency surgery. Blood and peritoneal fluid samples were drawn at the time of surgery (T0), and after that, blood samples were taken at 24 (T1) and 48 (T2) hours postoperatively. Cytokines concentrations were determined using a sandwich enzyme-linked immunosorbent assay (ELISA), a non-competitive variant, both in peritoneal fluid and serum. For determining whole blood concentration of presepsin and procalcitonin, PATHFAST™ assays (Polymedco, Cortlandt, New York) were used, based on the principle of non-competitive chemiluminescent enzyme immune-assay (CLEIA). The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of University Emergency Hospital Bucharest (no. 40325/6 April 2023). Results We found significant elevations in the peritoneal concentrations of interleukins 6, 8, 10, HMGB-1, and MCP-1 in all patients with secondary peritonitis at the moment of surgery; however, no clear correlation could be made based on this data with patient evolution. With regards to blood concentrations of the aforementioned serum cytokines and presepsin, procalcitonin (as already established markers of sepsis), our results showed good predictive value of presepsin for developing sepsis and septic multiorgan failure from the first hours in this patient category. All other biomarkers, despite having higher concentrations than baseline, in particular at 24-48 hours after surgery, had unpredictable dynamics that couldn't be correlated with the severity of the disease. Conclusion Cytokine production is the mainstay in developing sepsis and septic multiorgan failure in patients with secondary peritonitis; therefore, studying the dynamics of said cytokines seems of interest in finding tools to predict the development of sepsis or sepsis-related mortality. However, at the time, there seemed to be no clear correlation between the values of these cytokines and the development of complications.

Restoring Anatomical Features in Primary Total Knee Arthroplasty.

Today, the number of people affected by gonarthrosis symptoms is increasing proportionally. Total knee arthroplasty (TKA) is a successful intervention that aims to reduce pain and restore knee function. However, studies have shown that active young patients still have limitations in performing activities such as skiing, golfing, surfing, and dancing. Over the last few years, total knee arthroplasty has undergone significant changes. Most of the modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological pattern with greater compliance in the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. Unfortunately, functional outcomes are compromised in approximately half of TKA patients. This loss may be caused by the abnormal kinematics and inherent instability of many contemporary implants. The proper alignment of the femoral component during TKA is a crucial step that influences postoperative results. The position of the femoral component in the axial plane is responsible for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The main goal when choosing a type of prosthesis is to achieve an adequate recovery that leads to an improvement in mobility and an increase in the efficiency of the quadriceps.

A Narrative Review of Patellar Resurfacing Versus Non-resurfacing in Total Knee Arthroplasty.

The number of individuals who experience the symptoms of gonarthrosis rises proportionally as life expectancy rises and the population becomes more active. The purpose of total knee arthroplasty (TKA) is to lessen pain and restore knee function, and it has a high success rate. The restoration of patellar tracking in addition to the proper alignment of the femoral and tibial components contributes to the success of the arthroplasty and the patient's happiness. Replacement of the knee is not an easy process. One of the major objectives of total knee replacement is to achieve the proper rotation of the femoral components. A critical step that affects postoperative outcomes in total knee arthroplasty is the correct alignment of the femoral component. The axial plane of the femoral component is to blame for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The patella is the largest sesamoid bone in the human body, and its major role is to enhance the quadriceps' moment arm, which allows the knee to expand. The distribution of patellofemoral compressive pressures during knee flexion and the centralization of the quadriceps muscles' multidirectional pull during extension are both critical functions of the patella. After primary knee arthroplasty, there are 8% more cases of anterior knee discomfort than there were before. Whether or not the patella was resurfaced, patients with primary TKA experience anterior knee discomfort. Patella baja is caused by excessive joint line elevation, which causes persistent overload and discomfort. The design of the TKR might have an impact on postoperative patellofemoral problems. After TKR, patellofemoral maltracking and patellar dislocation are often caused by surgical mistakes.

Melorheostosis: A Review of the Literature and a Case Report.

Background and Objectives: Melorheostosis, also referred to in the literature as Leri's disease, is an unusual mesenchymal dysplasia with the clinical appearance of benign sclerosing bone dysplasia; it frequently occurs in late adolescence. Any bone in the skeletal system can be affected by this disease, though the long bones of the lower extremities are the most common, at any age. Melorheostosis has a chronic evolution, and symptoms are usually absent in the early stages. The etiopathogenesis is still unknown, however, numerous theories have been proposed that could explain the appearance of this lesion formation. An association with other benign or malignant bone lesions is also possible, and associations with osteosarcoma, malignant fibrous histiocytoma, or Buschke-Ollendorff syndrome have also been reported. There have also been reported cases of the malignant transformation of a pre-existing melorheostosis lesion into malignant fibrous histiocytoma or osteosarcoma. The diagnosis of melorheostosis can be made only based on radiological images, but, due to its polymorphism, additional imaging investigations are often necessary and sometimes only a biopsy can establish a definite diagnosis. Because there are currently no guidelines for treatment based on scientific evidence, due to the low number of cases diagnosed worldwide, our objective was to highlight the early recognition and specific surgical treatments for better prognosis and outcomes. Materials and Methods: We conducted a review of the literature consisting of original papers, case reports, and case series and presented the clinical and paraclinical characteristics of melorheostosis. We aimed to synthesize the treatment methods available in the literature as well as determine possible future directions related to the treatment of melorheostosis. Furthermore, we presented the results of a case of femoral melorheostosis admitted to the orthopedics department of the University Emergency Hospital of Bucharest in a 46-year-old female patient with severe pain in the left thigh and limitation of joint mobility. Following the clinical examination, the patient complained of pain in the middle third of the left thigh in the antero-medial compartment; the pain appeared spontaneously and was aggravated during physical activity. The pain started about two years prior, but the patient experienced complete pain relief after the administration of non-steroidal anti-inflammatory drugs. In the last six months, the patient presented an increase in pain intensity without significant improvement following the administration of non-steroidal anti-inflammatory drugs. The patient's symptoms were mainly determined by the increase in the volume of the tumor and the mass effect on the adjacent tissues, especially on the vessels and the femoral nerve. The CT examination and bone scintigraphy showed a unique lesion in the middle third of the left femur and no oncological changes in the thoracic, abdominal, and pelvic regions; however, at the level of the femoral shaft, there was a localized cortical and pericortical bone lesion formation that surrounded approximately 180 degrees of the femoral shaft (anterior, medial, and lateral). It had a predominantly sclerotic structure but was associated with lytic areas with thickening of the bone cortex and areas of periosteal reaction. The next therapeutic gesture was to perform an incisional biopsy using a lateral approach at the level of the thigh. The histopathological result supported the diagnosis of melorheostosis. Additionally, immunohistochemical tests completed the data obtained after the microscopic examination through the classic histopathological technique The patient was discharged and included in a full medical recovery program for eight weeks in a specialized medical center, during which she also received analgesic treatment in maximum doses, but without improvement regarding her symptoms. Taking into account the chronic evolution of the pain, the complete lack of response to conservative treatment after eight weeks, and the lack of treatment guidelines in the case of melorheostosis, a surgical approach needed to be considered. The surgical option in this case, considering the circumferential location of the lesion at the level of the femoral diaphysis, was a radical resection. The surgical approach consisted of segmental resection to healthy bone tissue and reconstruction of the remaining defect with a modular tumoral prosthesis. At the 45-day postoperative control, the patient no longer complained of pain in the operated-on limb and was mobile with full support without gait difficulties. The follow-up period was one year, and the patient presented complete pain relief and a very good functional outcome. Results: In the case of asymptomatic patients, conservative treatment seems to be a good option with optimal results. However, for benign tumors, it remains unclear whether radical surgery is a viable option. Conclusions: Melorheostosis remains an incompletely understood disease, given the limited number of cases worldwide, and thus, there is a lack of clinical guidelines regarding specialized treatment.

Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections.

Periprosthetic joint infection (PJI) after arthroplasty is a major complication, which requires significant resources, resulting in high costs for the medical system. In recent years, significant progress has been made in the diagnosis and treatment of periprosthetic infections, the identification of the pathogen being the central element in the establishment of targeted antibiotic therapy. Next-generation sequencing (NGS) or metagenomic NGS (mNGS) represents a promising, fast alternative, with increased specificity and sensitivity compared to identification methods using conventional culture media, thus enabling an increased rate of identification of pathogenic microorganisms and antibiotic resistance genes (ARG). The purpose of this article was to highlight new molecular diagnostic methods for periprosthetic joint infections and their involvement in treatment efficiency. NGS technologies are cutting-edge techniques that may challenge the PJI diagnostic model.

Cerebral Tuberculosis in a Patient Following Treatment With Infliximab for Ankylosing Spondylitis: A Case Report.

Ankylosing spondylitis (AS) mainly belongs to the group of axial spondylitis. It is a chronic inflammatory disease that primarily affects the spine, but can also affect peripheral joints. It is characterized by inflammatory lower back pain and morning stiffness. Tuberculosis is still a cause of morbidity and mortality in developing countries. Management of patients with AS consists of patient education, spinal mobility exercises, non-steroidal anti-inflammatory drugs (NSAIDs), corticotherapy, and anti-tumor necrosis factor alpha (TNF-α) biological agents. Anti-TNF-α biological agents have changed the prognosis of patients with AS. They contain anti-TNF-α monoclonal antibodies (golimumab, infliximab, adalimumab, certolizumab) and the soluble TNF-α receptor (etanercept). Hip and knee involvement is common in patients with AS, as evidenced in radiographs as bone erosion and joint space narrowing. The patient may have severe pain, stiffness, and loss of mobility, and the treatment involves surgery for joint arthroplasty. We present the case of a 63-year-old patient with axial spondyloarthritis who was treated with infliximab and developed cerebral tuberculosis after three years of biological therapy. The purpose of the study is to determine the possibility of resuming biological therapy at the time of AS reactivation, given the long-term treatment and adverse reactions of cortisone therapy (aseptic necrosis of the femoral head).

Management of Lung Cancer Presenting with Solitary Bone Metastasis.

Lung neoplasm is the main cause of cancer-related mortality, and bone metastasis is among the most common secondary tumors. The vast majority of patients also present with multiple bone metastases, which makes systemic and adjuvant pain therapy preferable to surgery. The optimal approach for a resectable non-small-cell lung tumor that also presents a unique, resectable bone metastasis is not fully established. The number of papers addressing this subject is small, and most are case reports; nevertheless, survival rates seem to increase with radical surgery. The sequencing of local versus systemic treatment should always be discussed within the multidisciplinary team that will choose the best approach for each patient. As targeted systemic therapies become more accessible, radical surgery, together with existing reconstructive methods, will lead to an increase in life expectancy and a better quality of life.

Clavicular Malignancies: A Borderline Surgical Management.

Nearly 1% of all bone cancers are primary clavicular tumors and because of their rarity, treating clinicians are unfamiliar with their diagnosis, classification, treatment options, and prognosis. In terms of preserving function and avoiding complications, clavicle reconstruction seems logical; however, further studies are needed to support this measure. Reconstruction techniques are difficult taking into account the anatomical structures surrounding the clavicle. When chest wall defects are present, a multidisciplinary team, including an orthopedist and thoracic and plastic surgeons, is of paramount importance for optimal surgical management. Malignant clavicle tumors may include primary and secondary malignancies and neighboring tumors with clavicular invasion. Surgical resection of complex thoracic tumors invading the clavicles can result in larger defects, requiring chest wall reconstruction, which is a substantial challenge for surgeons. Correct diagnosis with proper preoperative planning is essential for limiting complications. Post-resection reconstruction of the partial or total claviculectomy is important for several reasons, including maintaining the biomechanics of the scapular girdle, protecting the vessels and nerves, reducing pain, and maintaining the anatomical appearance of the shoulder. The chest wall resection and reconstruction techniques can involve either partial or full chest wall thickness, influencing the choice of reconstructive technique and materials. In the present paper, we aimed to synthesize the anatomical and physiopathological aspects and the small number of therapeutic surgical options that are currently available for these patients.

Surgical management options for long-bone metastasis.

Bone metastases are difficult to treat surgically, necessitating a multidisciplinary approach that must be applied to each patient depending on the specifics of their case. The main indications for surgical treatment are a lack of response to chemotherapy, radiation therapy, hormone therapy, immunotherapy, and bisphosphonates which is defined by persistent pain or tumor progression; the risk of imminent pathological bone fracture; and surgical treatment for single bone metastases. An important aspect of choosing the right treatment for these patients is accurately estimating life expectancy. Improved chemotherapy, postoperative radiation therapy, and sustainable reconstructive modalities will increase the patient's life expectancy. The surgeon should select the best surgical strategy based on the primary tumor and its characteristics, the presence of single or multiple metastases, age, anatomical location, and the functional resources of the patient. Preventive osteosynthesis, osteosynthesis to stabilize a fracture, resections, and reconstructions are the main surgical options for bone metastases. Resection and reconstruction with a modular prosthesis remain the generally approved surgical option to restore functionality, increase the quality of life, and increase life expectancy. Preoperative embolization is necessary, especially in the case of metastases of renal or thyroid origin. This procedure is extremely important to avoid complications, with a major impact on survival rates.

Rheumatological Adverse Events Following Immunotherapy for Cancer.

Background and Objectives: The occurrence of rheumatological side effects in a patient after receiving immunotherapy for cancer is becoming increasingly common. Oncologists often fail to diagnose and refer affected patients to rheumatologists. This paper presents the various rheumatological adverse events that occur after immunotherapy in patients as well as their treatment and evolution. Materials and Methods: A total of 36 patients were monitored between November 2018 and March 2020. The oncologist monitoring the immunotherapy-treated patients identified the occurrence of musculoskeletal side effects. The grading of toxicities was performed by both the oncologist and the rheumatologist using common terminology criteria for adverse events (CTCAE). Rheumatological treatment was administered, and for some patients, immunotherapy was discontinued. Results: The clinical presentations of the patients varied. Mild side effects (grade 1-2) were reported in a higher proportion than severe side effects (grade 3-5). Therefore, thirty-one patients had mild-to-moderate side effects, and five patients had severe side effects. Adverse reactions occurred, on average, 10 weeks after the initiation of immunotherapy; this indicated that the severity of the toxicity was dose dependent. Patients were treated with NSAIDs or prednisone, depending on the severity of the side effects, and for patients with severe manifestations, immunotherapy was discontinued. The remission of rheumatic manifestations varied depending on the grade of the manifestations. Conclusions: The clinical, biological, and ultrasound presentations of the patients with adverse events followed by cancer treatments differed from classic rheumatological manifestations. Thorough examinations of these patients by both oncologists and rheumatologists are needed in order to correctly diagnose and treat rheumatological adverse events. Multiple studies that include a larger number of participants are needed in order to better understand the pathogenesis and clinical evolution of these patients under different treatment conditions.

Clinical Impact of the Administration of FOLFIRINOX Beyond Six Months in Advanced Pancreatic Adenocarcinoma: A Cohort Study.

Background Although a toxic regimen, FOLFIRINOX is one of the most efficient chemotherapy regimens in advanced pancreatic adenocarcinoma. There is no standard number of cycles in locally advanced or metastatic stages. Materials and method The present retrospective study reports the experience of a single center with this regimen administered until disease progression or unacceptable toxicity. The authors of this retrospective study analyzed the data on patients with this diagnosis treated in our clinic during 2017-2021. Forty-two patients were included in the study, 21 who received six courses or less and 21 who received more than six courses. Progression-free survival (PFS) and overall survival (OS) were analyzed according to this stratification. The oncological response was also reported according to dose reduction and treatment delay, irrespective of the number of courses administered. Results Median PFS was 7.5 months, and median OS was 13.6 months in the entire studied population. When patients were compared according to the number of courses received (under six vs. over six), there were obvious differences (PFS: 5.17 months vs. 11.2, p = 0.8, OS: 8 months vs. 17.3 months, p = 0.6). However, when stratifying survival by treatment delay and the presence or absence of dose reduction, better results were seen with lower doses (p<0.001) and treatment temporization (p=0.03). The general incidence of hematologic and neurologic toxicity was higher than the ones reported in the literature. Conclusion The study revealed that patients benefit from the administration of FOLFIRINOX for more than six months, but that the administration of full dose and the maintaining dose intensity does not necessarily favor the patient.

Failure Analysis of Retrieved Osteosynthesis Implants.

Failure of osteosynthesis implants is an intricate matter with challenging management that calls for efficient investigation and prevention. Using implant retrieval analysis combined with standard radiological examination, we evaluated the main causes for osteosynthesis implant breakdown and the relations among them for a series of cases. Twenty-one patients diagnosed with implant failure were assessed for this work. For metallurgical analysis, microscopy techniques such as scanning electron microscopy (SEM), stereomicroscopy, and optical microscopy were employed. The results showed that material structural deficiencies (nine patients) and faulty surgical techniques (eight patients) were the main causes for failure. An important number of patients presented with material structural deficiencies superimposed on an imperfect osteosynthesis technique (six patients). Consequently, the importance of failure retrieval analysis should not be overlooked, and in combination with other investigational techniques, must provide information for both implant manufacturing and design improvement, as well as osteosynthesis technique optimization.

Failed Attempt of Total Hip Arthroplasty in a Patient with Klippel-Trenaunay Syndrome: A Case Report.

CASE: A 41-year-old man with Klippel-Trenaunay syndrome presented with pain and limited range of motion in his left hip due to secondary hip osteoarthritis. After preoperative assessment, which also included tomography and conventional arteriography, total hip arthroplasty by direct anterior approach was attempted, but rapid blood loss occurred during surgery and the procedure had to be stopped. CONCLUSIONS: Total hip arthroplasty should be undertaken with great caution in a patient with Klippel-Trenaunay syndrome. Preoperative conventional arteriography alone may not reveal the true extent of vascular malformations, which may lead to catastrophic results.

Current review of surgical management options for extremity bone sarcomas.

Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy.All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation.The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty.Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres.Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment. Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048.