Hand and foot osteosarcoma represents ~1% of all diagnosed cases of osteosarcoma. The rarity of osteosarcoma of the hand and foot leads to frequent misdiagnosis, delayed diagnosis or incorrect treatments, which can lead to fatal consequences. Typically, salvaging the affected limb is the treatment of choice, and with the use of chemotherapy, 60-65% of patients with osteosarcoma can be treated without amputation. Due to its rarity, misdiagnosis and treatment delays are common, yet detailed reviews and analyses of such cases are limited. The present retrospective cohort study aimed to review and analyze cases of osteosarcoma located in the hand and foot. From January 2007 to January 2019, 11 patients were treated at the Masaryk Memorial Cancer Institute Sarcoma Center (Brno, Czechia), 5 cases affected the hand and 6 affected the foot. A total of 6 male patients and 5 female patients, with a mean age of 30.9±16.74 years, were diagnosed with hand or foot osteosarcoma. The mean follow-up period was 90.36±66.14 months. The mean tumor size detected during diagnosis was 4.29±1.81 cm. Osteoblastic osteosarcoma was the most common histopathological type, accounting for 4 cases (33.4%). A majority of the osteosarcomas were identified as high grade (81.8%). A total of 5 patients experienced misdiagnoses following their initial biopsy, with 2 patients initially receiving treatment outside the Masaryk Memorial Cancer Institute Sarcoma Center. The most frequently encountered misdiagnosis was giant-cell tumor of the bone. A total of 3 patients underwent limb amputation and 2 patients developed lung metastasis and succumbed to the disease. The disease-free survival period and overall survival rate were calculated using Kaplan-Meier survival analysis. The mean disease-free survival period was 82.83±60.05 months, while the overall survival rate was 72%, with a mean survival time of 90.36±56.73 months. In summary, an examination of a case series involving 11 patients diagnosed with osteosarcoma of the hand and foot was conducted. The treatment approach, clinical characteristics and patient outcomes were described. A total of four case studies of patients with osteosarcoma in the hand or foot were presented. Misdiagnosis of this disease may result in the inappropriate treatment being administered to patients, therefore, the correct and rapid diagnosis of disease is necessary for effective treatment of hand and foot osteosarcomas.
- Publikační typ
- časopisecké články MeSH
PURPOSE: Revision total hip arthroplasty (rTHA) is an increasingly common procedure due to the growing number of primary total hip arthroplasties (THAs) performed worldwide. This study evaluates the long-term implant survival, functional outcomes, and radiographic performance of cemented femoral stem (Beznoska s.r.o., Kladno, Czechia) in rTHA. METHODS: A retrospective analysis was conducted on 183 patients who underwent rTHA with cemented stem between March 2012 and December 2023. The mean follow-up duration was 71.26(± 39.31) months. Implant survival was analyzed using Kaplan-Meier survival estimates, and failure modes were assessed. Radiographic changes were classified using the Gruen Zones system. Functional outcomes were evaluated using the Harris Hip Score (HHS). Cox proportional hazard models were applied to identify prognostic factors influencing implant survival. RESULTS: The five-year implant survival rate was 98.1%, declining to 83.9% at twelve years. The overall failure rate was 3.83%, with periprosthetic infection (4 cases) being the most common cause, followed by aseptic loosening (2 cases). Radiographic changes were observed in 24.03% of cases, predominantly in Gruen Zones 2, 6, and 1. Functional outcomes were favorable, with a mean HHS of 81.28(± 5.74), comparable to outcomes reported for uncemented revision stems. Age, stem diameter, and stem length did not significantly impact implant survival. CONCLUSION: The cemented stem demonstrated favourable long-term survival, with high implant retention rates. Functional outcomes indicated overall satisfactory performance. Radiographic evaluation revealed localized changes around the implant, predominantly in Gruen Zones 2, 6, and 1. Implant failure was relatively rare, with periprosthetic infection being the most common cause.
- MeSH
- cementování MeSH
- dospělí MeSH
- Kaplanův-Meierův odhad MeSH
- kostní cementy MeSH
- kyčelní kloub diagnostické zobrazování chirurgie MeSH
- kyčelní protézy * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody přístrojové vybavení škodlivé účinky MeSH
- protézy - design MeSH
- radiografie MeSH
- reoperace * MeSH
- retrospektivní studie MeSH
- selhání protézy * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The aim of this study was to investigate the long-term effects of computer-assisted CiTM navigation on clinical, radiological, and functional results versus conventional total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2005 and July 2011, a total of 85 patients (36 males, 49 females; mean age: 66.2±5.2 years; range, 59 to 84 years) who underwent P.F.C. SigmaTM knee system implantation using computer-assisted CiTM navigation system (BrainLAB®, DePuy International, Leeds, UK) and completed a minimum follow-up of eight years were included in the study. In the control group, a total of 100 patients (40 males, 60 females; mean age: 68.3±3.9 years; range, 60 to 79 years) who completed a minimum follow-up of eight years were randomly selected from a dataset of implanted P.F.C. SigmaTM knee systems in the same period using Specialist® 2 instrumentation without navigation. An implant survival analysis was used to compare implant survivorship between the groups throughout 12 years. The Knee Society Score (KSS) and range of motion (ROM) were assessed. Based on long-format X-ray images, the implant position in the frontal and sagittal planes was evaluated. RESULTS: The ratio for navigation to control group survival is approximately 1.01 at 12 years. The clinical outcomes showed no significant difference between the groups (knee scores, p=0.707 and functional scores, p=0.485). In the measured angles analysis, we observed a consistent pattern in both groups. In the control group, there was a trend toward implanting the tibial component with slight varus alignment (p=0.038) and a higher posterior slope (p<0.001). On average, the operation was prolonged by 13 min in the navigated group (p<0.001). CONCLUSION: In conclusion, our study results demonstrate that while kinematic navigation in TKA improves the precision of implant alignment, it does not provide significant benefits in terms of long-term implant survival or functional outcomes compared to conventional TKA methods. The use of the computer-assisted CiTM navigation system is associated with prolonged operation duration, although no technical complications related to the navigation device's software can be observed. Therefore, although navigation offers theoretical advantages in component positioning, its use may be more justifiable in cases with challenging alignment requirements rather than as a routine practice.
- MeSH
- artróza kolenních kloubů * chirurgie patofyziologie diagnostické zobrazování MeSH
- časové faktory MeSH
- chirurgie s pomocí počítače * škodlivé účinky metody přístrojové vybavení MeSH
- kolenní kloub * chirurgie diagnostické zobrazování patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- obnova funkce MeSH
- protézy kolene MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene * metody přístrojové vybavení škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Rhizarthrosis is accompanied by decreased mobility, poor grip, and progressive pain. Surgical treatment, which involves various techniques, is the only definitive solution sparing the joint. First carpometacarpal (CMC) joint arthroplasty helps reduce the discomfort associated with rhizarthrosis and restores joint function. From 2020 to the end of March 2024, 35 arthroplasties of the first CMC joint have been performed. In this study, the implant survival was recorded at a five-year follow-up. Evaluation of functional outcomes was conducted using preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH), visual analogue scale (VAS), and Kapandji scores. Two types of implants were used, and their postoperative DASH and Kapandji scores were compared. The one-year implant survival was 0.97, and the three-year implant survival was 0.86. Range of motion showed significant improvement in patients after the first CMC arthroplasty. The VAS score, which assesses pain, and the DASH score, used to subjectively assess upper extremity disability, showed similar postoperative improvement. There is no significant difference in postoperative outcomes (DASH score and Kapandji score) between the "standard" and "dual mobility" implant types when evaluating postoperative outcomes. One intraoperative and two postoperative complications were observed in this study. First CMC joint arthroplasty effectively relieves pain, improves range of motion, and enhances functional outcomes in patients with rhizarthrosis. Both implant types demonstrated similar postoperative results in terms of DASH and Kapandji scores. While the study observed a few complications, the overall results support the efficacy of first CMC joint arthroplasty as a reliable treatment option for restoring joint function and reducing pain.
- Publikační typ
- časopisecké články MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Implantace totální kloubní náhrady je jednou z nejúspěšnějších a nejúčinnějších ortopedických operací v posledním století. V tomto projektu chceme monitorovat a porovnávat zátěž těžkými kovy v cirkulaci, zejména Ti, Co, Cr, Ni, u pacientů po implantaci kloubní náhrady ve srovnání s populací České republiky bez implantátů jakéhokoliv kovu. Korelace dynamiky hojení a tolerance kovového materiálu bude hodnocena s klinickou symptomatologií, funkčními parametry s ohledem na vývoj a průběh komplikací po implantaci endoprotéz, včetně reimplantace. Procesy spojené s aktivací imunitního systému, včetně reakcí přecitlivělosti, budou simulovány na modelu in vitro za použití imunitního systému individuálního pacienta. Pokus o nalezení prediktivních markerů spojených se špatnou prognózou po implantaci v periferní krvi by mohl vést k včasnému zjištění komplikací. Povrch explantovaných náhrad bude hodnocen z hlediska opotřebení, koroze, defektů kovu.; Total-joint arthroplasty is one of the most successful and effective orthopedic operations performed during the last century. In the present project, we intend to monitor and compare heavy metal load in circulation, especially Ti, Co, Cr, Ni, in patients after implantation of joint replacement compared to the Czech Republic without implants of any metal. The correlation of the healing process dynamics and the tolerance of the metal material will be evaluated with clinical symptomatology, functional parameters with respect to the development and course of complications after implantation of the endoprostheses, including reimplantation. Processes associated with the activation of the immune system, including hypersensitivity reactions, will be simulated on an in vitro model using individual patient immune systems. Attempting to find predictive markers associated with poor prognosis after implantation in peripheral blood could lead to early detection of complications. The metal surface of the explanted substitutes will be evaluated in terms of wear, corrosion, metal defects.
- Klíčová slova
- implantace, hypersenzitivita, implantation, hypersensitivity, kov, metal, imunitní systém, Osteoartróza, totální kloubní náhrada, osteoblasty, osteoarthrosis, total joint arthroplasty, immmune system, osteoblasts, reimplantace, reimplantation,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Nickel(Ni)-containing materials have been widely used in a wide range of medical applications, including orthopaedics. Despite their excellent properties, there is still a problem with the release of nickel ions into the patient's body, which can cause changes in the behaviour of surrounding cells and tissues. This study aims to evaluate the effects of Ni on bone cells with an emphasis on the determination of Ni localization in cellular compartments in time. For these purposes, one of the most suitable models for studying the effects induced by metal implants was used-the patient's osteoarthritic cells. Thanks to this it was possible to simulate the pathophysiological conditions in the patient's body, as well as to evaluate the response of the cells which come into direct contact with the material after the implantation of the joint replacement. The largest differences in cell viability, proliferation and cell cycle changes occurred between Ni 0.5 mM and 1 mM concentrations. Time-dependent localization of Ni in cells showed that there is a continuous transport of Ni ions between the nucleus and the cytoplasm, as well as between the cell and the environment. Moreover, osteoarthritic osteoblasts showed faster changes in concentration and ability to accumulate more Ni, especially in the nucleus, than physiological osteoblasts. The differences in Ni accumulation process explains the higher sensitivity of patient osteoblasts to Ni and may be crucial in further studies of implant-derived cytotoxic effects.
- MeSH
- buněčný cyklus účinky léků MeSH
- ionty metabolismus MeSH
- kultivované buňky MeSH
- lidé MeSH
- nikl * metabolismus MeSH
- osteoartróza * metabolismus patologie MeSH
- osteoblasty * metabolismus účinky léků MeSH
- proliferace buněk * účinky léků MeSH
- viabilita buněk * účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- kortikální kost chirurgie MeSH
- kyretáž * metody MeSH
- lidé MeSH
- nádory kostí * chirurgie patologie sekundární MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Myxofibrosarcoma presents an infiltrating growth pattern that results in a high tendency for local recurrence. Clear margin resection is challenging because of microscopic infiltration. The purpose of the present study was to analyze the overall and disease-free survival rates of patients with myxofibrosarcoma and the prognostic factors that determine both survival and disease recurrence. Among the 111 patients included in our study, the 5-year overall survival rate was 65.5%. An age of more than 65 years (hazard ratio [HR] 1.9 [95% confidence interval (CI) 1.4-5.6]; p < 0.001), a tumor size of more than 5 cm (HR 2.8 [95% CI 0.9-8.1]; p = 0.049) and the G3 tumor grade (HR 14.1 [95% CI 2.1-105.0]; p < 0.001) negatively affected overall survival. The 5-year recurrence-free survival rate was 49.4%. R1/R2-type resection (HR 2.4 [95% CI 1.0-5.6]; p = 0.048) had a detrimental effect on tumor recurrence. Clear margins had a positive impact on recurrence-free survival, but did not significantly affect overall patient survival, suggesting that other factors may play a more significant role in determining patient outcomes. A surgical margin of 2 mm was not sufficient to significantly influence the incidence of recurrence. Consequently, a wider surgical margin may be necessary to reduce the risk of myxofibrosarcoma recurrence.
- MeSH
- dospělí MeSH
- fibrosarkom * chirurgie patologie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru * patologie MeSH
- míra přežití MeSH
- přežití bez známek nemoci MeSH
- prognóza MeSH
- resekční okraje * MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND OBJECTIVES: Curettage is the removal of a tumor from the bone while preserving the surrounding healthy cortical bone, and is associated with higher rates of local recurrence. To lower these rates, curettage should be combined with local adjuvants, although their use is associated with damage to nearby healthy bone. OBJECTIVE: The purpose of this analysis is to determine the effect of local adjuvants on cortical porcine bone by using micro-computed tomography (micro-CT) along with histological and mechanical examination. METHODS: Local adjuvants were applied to porcine specimens under defined conditions. To assess changes in bone mineral density (BMD), a micro-CT scan was used. The pixel gray values of the volume of interest (VOI) were evaluated per specimen and converted to BMD values. The Vickers hardness test was employed to assess bone hardness (HV). The depth of necrosis was measured histologically using hematoxylin and eosin-stained tissue sections. RESULTS: A noticeable change in BMD was observed on the argon beam coagulation (ABC) sample. Comparable hardness values were measured on samples following electrocautery and ABC, and lowering of bone hardness was obtained in the case of liquid nitrogen. Extensive induced depth of necrosis was registered in the specimen treated with liquid nitrogen. CONCLUSION: This study determined the effect of local adjuvants on cortical bone by using micro-CT along with histological and mechanical examination. Phenolization and liquid nitrogen application caused a decrease in bone hardness. The bone density was affected in the range of single-digit percentage values. Liquid nitrogen induced extensive depth of necrosis with a wide variance of values.
- MeSH
- kortikální kost * patologie diagnostické zobrazování chirurgie účinky léků MeSH
- kostní denzita * účinky léků MeSH
- kyretáž * metody MeSH
- nádory kostí * chirurgie patologie MeSH
- prasata MeSH
- rentgenová mikrotomografie * MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Total knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent. METHODS: A standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia. RESULTS: The equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 με in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 με, MBT only in less than 64% of the volume. CONCLUSION: The effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.
