Osteosarcoma (OS) is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults. Despite advances in surgery and multi-agent chemotherapy, survival rates for metastatic or recurrent OS remain poor, highlighting the need for novel prognostic and therapeutic strategies. This review integrates histopathologic, molecular, and immune perspectives to provide a comprehensive understanding of OS biology in the context of precision medicine. We discuss classic morphologic and radiographic features alongside recent insights into the tumor microenvironment, including the role of tumor-infiltrating lymphocytes, tumor-associated macrophages, and immune checkpoint expression. Emerging molecular markers, such as gene expression–based immune risk signatures, circulating tumor DNA, and gasdermin D overexpression, are evaluated for their prognostic and therapeutic relevance. Key dysregulated pathways, including WNT/β-catenin and JAK/STAT, are examined in relation to metastasis, chemoresistance, and immune evasion, with emphasis on current targeted approaches under development. By bridging histopathology, immunogenomics, and translational research, this work outlines how integrated biomarker assessment can refine patient stratification and guide the implementation of individualized treatment strategies in OS.

Bone can be affected by different neoplastic conditions. Limb salvage surgery has become the preferred treatment strategy for most malignant tumors of the extremities. Advanced 3D printing technology has transformed the conventional view of oncological surgery. These types of implants are produced by electron beam melting (EBM) technology by sintering titanium powder in a scaffold shape designed following a project designed from HRCT and MRI. The aim of our study was to evaluate the outcomes and the mid-term follow-up of a population treated with 3D-printed custom-made prosthesis implantation in major oncological bone resection or after failure of primary implants. The primary outcome was the general patient satisfaction one year after surgery. The secondary outcomes were: mortality rate, treatment related complication rate, functional and clinical outcomes (KPS, ADL and IADL). Eight patients were included, five females and two males, with a mean age of 50.3 (±23.72) years at the surgery. The enrolled patients reported a mean satisfaction rate after surgery of 7.38 (±2) where 10 was the maximum value. There were no changes between pre- and postoperative mean KPS (81.43 +/−10.69). Mean preoperative ADL and IADL score was in both cases 4.86 (±1.07), while postoperative was 5 (±0.82), with a delta of 0.13 (p > 0.05). Custom-made prosthesis permits reconstructing bone defects caused by large tumor resection, especially in anatomically complex areas, restoring articular function.

(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of the most involved sites for metastases. Prosthetic replacement with modular megaprosthesis is one of the treatment choices, but there are several types of complications, such as problems with function and pain. The aim of our study is to assess functional outcomes and shoulder instability in the reconstruction of proximal humerus metastases. (2) Methods: This is a retrospective observational study. Twenty-eight patients, with proximal humerus metastases, admitted to the department of Orthopaedics and Traumatology of our University Hospital between 2014 and 2022 were recruited. Each patient underwent resection and prosthetic replacement surgery with modular megaprosthesis. Clinical evaluation was assessed through MSTS score, WOSI index, and DASH score. (3) Results: Twenty patients were included in the study. Fairly good results, especially regarding pain, function, and emotional acceptance, were obtained in all three tests: DASH, MSTS, and WOSI. Patients who reported shoulder instability actually have worse outcomes than those who report having stable shoulders. In addition, patients with a resection >10 cm have worse outcomes than those who had a resection of 10 cm. No significant differences were found between the deltopectoral approach group and the lateral approach group. (4) Conclusions: Reconstructive surgery with megaprosthesis of the proximal humerus in patients with metastases can be considered a treatment option, especially in patients with pathological fractures or injuries with a high risk of fracture and good life expectancy. This study shows how this type of surgery affects instability, but in terms of functionality, pain, and patient satisfaction, it gives satisfactory results.

Background: Total hip and knee arthroplasty are common procedures for end-stage osteoarthritis, with rehabilitation playing a central role in functional recovery. Conventional face-to-face programs are often limited by accessibility, costs, and logistical barriers. Digital telerehabilitation has been increasingly investigated as an alternative. This review aims to summarize current evidence on its effectiveness, patient-reported outcomes, satisfaction, and economic impact. Materials and Methods: A narrative review was conducted using Medline, Web of Science, and Scopus up to April 2025. Randomized controlled trials and longitudinal studies evaluating telerehabilitation after total hip or knee arthroplasty were included. Data were extracted on functional performance, pain, autonomy, quality of life, patient satisfaction, and cost-effectiveness. Results: Across multiple RCTs, telerehabilitation produced functional outcomes generally comparable to conventional rehabilitation, with some studies reporting superior short-term improvements. For example, in a retrospective trial, Timed Up and Go improved by −8.0 ± 2.6 s in the digital group versus −4.9 ± 2.5 s with standard care (p < 0.01). Tablet-assisted programs reduced Five Times Sit-to-Stand times to 11.7 s at 6 months compared with 14.7 s in controls (p = 0.05). In hip arthroplasty, digital rehabilitation resulted in higher active flexion (97.4° vs. 89.9°, p = 0.018) and abduction (51.7° vs. 43.8°, p = 0.024). Quality-of-life measures, such as EQ-5D VAS, also showed improvements (82.9 ± 4.3 vs. 68.7 ± 4.6 at 6 months). Some studies reported higher patient satisfaction, for instance, a VR-based RCT found GPE at day 15 of 4.76 ± 0.43 in the intervention group versus 3.96 ± 0.65 in controls (p < 0.001). Conclusions: Telerehabilitation after hip and knee arthroplasty appears to produce short-term functional and patient-reported outcomes comparable to conventional rehabilitation in selected populations. Evidence of superiority is limited and heterogeneous, and long-term effectiveness, equity, and cost-effectiveness remain uncertain. Heterogeneity in protocols and digital literacy barriers highlight the need for standardized guidelines and further independent validation.

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty.

Background: Post-radiation fractures are a significant complication of cancer treatment, often being challenging to manage and impacting patients’ quality of life. This study systematically reviews the literature on fractures in irradiated bones, focusing on risk factors, treatment modalities, and prevention strategies. Factors increasing fracture risk include exposure to high doses of radiation of at least 50 Gy, female gender, menopausal age, and periosteal stripping. Additionally further risk factors are the size of the original tumor and osteoporosis. Methods: A search of PubMed yielded 541 articles, with 4 were ultimately included in the review. These retrospective studies focused on patients undergoing Combined Limb-Sparing Surgery and Radiation Therapy for soft tissue sarcoma. Results: Results show post-radiation fractures affect approximately 4% of patients, with the femur being the most frequently affected site. Intramedullary nailing emerges as the gold standard treatment, with prosthetic replacement or megaprostheses used in the metaepiphyseal region and as salvage procedures. Non-union and infection remain formidable complications. Conclusions: This study highlights the importance of prophylactic nailing in fracture prevention and the efficacy of free vascularized fibular flaps to achieve bone union during revision surgeries. Limited case availability and patient follow-up hinder comprehensive studies, impacting treatment outcomes.