Introduction: Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not. Methods: 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant–Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients. Results: Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°–60°) vs. 32° (20°–45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13–90) vs. 69.5 (40–79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA. Conclusion: SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery.

This study aimed to retrospectively analyze the follow-up results of cases in which the adjacent joint was preserved using a custom-made uncemented short-stem design (hollow stem) with optional external flanches in tumor endoprosthetic replacement due to bone sarcomas in 13 patients (with an average age of 9.6 years) between 2017 and 2023. Reconstructions were proximal femur (n = 6), intercalary femur (n = 4), intercalary tibia (n = 2), and proximal humerus (n = 1) tumor prostheses. The hollow body was used distally in 10 of the megaprotheses, proximally in 1, and both proximally and distally in 2 of them. The average distance from the joints was 6 cm in stems with flanches and 11.8 cm in stems without flanches. No aseptic loosening or deep infection was observed during an average follow-up of 34 months. Except for one case with a tibial intercalary prosthesis that needed a revision, all cases were well osteointegrated and all lower extremity cases could bear full weight without pain. In cases where the remaining bone stock after bone resection is insufficient for a standard stem implantation, reconstruction with a patient-specific short hollow-stem design appears to be a good alternative to protect healthy joints with high prosthesis survival and low revision rates in the short-term follow-up.

Background/Objectives: The World Health Organization’s (WHO) classification of tumors contains around 80 entities of soft tissue sarcomas (STSs). Currently, surgery is the standard treatment for patients with localized STS, but the adequacy of resection margins in soft tissue sarcomas (STSs) remains a topic of intense discussion. Methods: This single-center study retrospectively reviewed 203 patients with primary high-grade soft tissue sarcoma, including a follow-up period of at least 24 months. Patients with prior resection, secondary STS, metastasis at presentation, or those who required amputational surgery were excluded from the study. Patients were categorized based on their margin thickness: positive (n = 13, 6.4%), 0–1 mm (n = 67, 33.0%), 1–5 mm (n = 70, 34.5%), and >5 mm (n = 27, 13.3%). Results: A total of 64 out of 203 (31.5%) patients developed a local recurrence. The estimated 5-year local-recurrence-free survival (LRFS) was 11.5% (CI 4–25%) for positive margins, 58% (CI 51–64%) for margins 0–1 mm, 76% (CI 70–81%) for margins > 1–5 mm, and 93% (CI 88–98%) for margins > 5 mm. No local recurrences occurred in patients with margins > 5 mm and adjuvant radiotherapy. Margin status significantly influenced the development of distant metastasis and overall survival. Adjuvant radiotherapy improved both local control and overall survival. Conclusions: To minimize the risk of local recurrence (LR), a resection margin greater than 5 mm should be attained. When adjuvant radiotherapy is applied, the likelihood of LR decreases even more. In scenarios where preserving critical structures is essential, a resection margin of less than 5 mm can be acceptable for ensuring local control.

Zusammenfassung Hintergrund Tumorprothesen werden mit guten Langzeitergebnissen bei Kindern und Jugendlichen mit Knochentumoren implantiert und ermöglichen meist einen langfristigen Extremitätenerhalt. Ebenso finden 3‑D-gedruckte Individualimplantate zunehmend Anwendung. Fragestellung Mit diesem Beitrag wird eine Übersicht zu kindlichen und jugendlichen Knochentumoren und deren chirurgischer Behandlung gegeben. Aufgrund der Verteilungshäufigkeit der kindlichen und jugendlichen Knochentumoren mit einer Häufung im Bereich der unteren Extremität liegt der Schwerpunkt dieses Beitrags auf diesem Bereich. Methodik Es erfolgte die systematische Literaturrecherche bei PubMed sowie die Darstellung anhand der zentrumsinternen Erfahrungen. Ergebnisse Knochentumoren bei Kindern und Jugendlichen finden sich zumeist kniegelenknah. Die Verwendung von modularen Tumorprothesen stellt heutzutage die Therapie der Wahl dar, mit der in der Mehrzahl der Fälle ein langfristiger Extremitätenerhalt erreicht werden kann. Mittels Wachstumsprothesen kann bei jüngeren Kindern versucht werden, einer großen Beinlängendifferenz entgegenzuwirken. 3‑D-gedruckte Individualimplantate kommen zunehmend zum Einsatz. Generell haben Tumorprothesen eine höhere Komplikationsrate als primäre Endoprothesen. Die am häufigsten auftretenden Komplikationen und daraus folgende Revisionseingriffe im Langzeit-Follow-up sind periprothetische Infektionen, Prothesenverschleiß und aseptische Lockerungen.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.