Age is a known prognostic factor for many sarcoma subtypes, however in the literature there are limited data on the different risk profiles of different age groups for osteosarcoma survival. This study aims to provide an overview of survival in patients with high-grade osteosarcoma in different age groups and prognostic variables for survival and local control among the entire cohort. In this single center retrospective cohort study, 402 patients with skeletal high-grade osteosarcoma were diagnosed and treated with curative intent between 1978 and 2017 at the Leiden University Medical Center (LUMC). Prognostic factors for survival were analyzed using a Cox proportional hazard model. In this study poor overall survival (OS) and event-free survival (EFS) were associated with increasing age. Age groups, tumor size, poor histopathological response, distant metastasis (DM) at presentation and local recurrence (LR) were important independent prognostic factors influencing OS and EFS. Differences in outcome among different age groups can be partially explained by patient and treatment characteristics.

Local tissue and serum metal ions have been shown to be elevated in some metal-on-metal and metal-on-polyethylene joint replacements. Local elevations have been linked to adverse local tissue reactions in some patients, and systemic elevation has been less commonly implicated cardiac and neurologic issues. Using a prospective study design, we aimed to identify the changes in serum metal ion levels after hip or knee megaprosthesis reconstruction. Furthermore, we will evaluate the occurrence of adverse effects and complications, possibly linked to metal ion elevation. Fourteen consecutive patients receiving a Modular Universal Tumor Revision System megaprosthesis were enrolled. Blood samples were collected preoperatively and postoperatively to determine the serum ion concentrations of aluminum, chromium, cobalt, and silver. To evaluate the safety of the megaprostheses and the subsequently possible related (elevated) serum metal ion concentrations, all adverse effects and complications were registered until last outpatient clinic visit at the time of this study. Compared to the preoperative median serum concentrations, the postoperative median serum concentrations of chromium, silver, and cobalt increased 11-fold, 62-fold, and 64-fold, respectively. The median serum concentration of aluminum increased with 16%. Elevations were primarily noted in patients with knee prostheses. Eight patients had no adverse effects or complications during the period between preoperative and postoperative blood sampling. One adverse effect directly related to the serum metal ion concentrations, namely argyria, was observed. This study documents significantly elevated concentrations of the metal ions, but only one adverse effect directly related to the metal ion concentrations was observed. Future studies are needed to further assess the impact of elevated metal ion levels after megaprostheses, specifically knee implants, which are metal-on-metal.

Update: This article was updated on July 17, 2024 because of a previous error, which was discovered after the preliminary version of the article was posted online. The byline that had read “Richard E. Evenhuis, MD¹, Michiel A.J. van de Sande, MD, PhD^1,2, Marta Fiocco, PhD^2,3,4, Demien Broekhuis, MD¹, Michaël P.A. Bus, MD, PhD¹, and the LUMiC® Study Group*” now reads “Richard E. Evenhuis, MD¹, Michiel A.J. van de Sande, MD, PhD^1,2, Marta Fiocco, PhD^2,3,4, Edwin F. Dierselhuis, MD, PhD⁵, Demien Broekhuis, MD¹, Michaël P.A. Bus, MD, PhD¹, and the LUMiC® Study Group*”. The Department of Orthopaedic Surgery, Radboudumc, Nijmegen, The Netherlands, has been added as the affiliation for Edwin F. Dierselhuis, MD, PhD. Background: We previously reported promising early results for periacetabular tumor reconstructions using the LUMiC prosthesis. The current study evaluates mid-term complications, revision rates, cumulative incidence of implant revision, and risk factors for complications in a multicenter cohort. Methods: We assessed patients in whom a tumor defect after type P1b+2, P2, P2+3, or P1b+2+3 internal hemipelvectomy was reconstructed with a LUMiC prosthesis during the period of 2008 to 2022. Complications were reported according to the Henderson classification. Competing risks models were used to estimate the cumulative incidence of implant revision for mechanical and nonmechanical reasons, and reoperations for any complication. Cox models were used to study the effect of risk factors on dislocation and infection. Results: One hundred and sixty-six patients (median follow-up, 4.2 years [interquartile range, 2.6 to 7.6 years]) were included. A total of 114 (69%) were treated for a primary malignant tumor, 46 (28%) for metastatic carcinoma, 5 (3%) for a benign aggressive lesion, and 1 (1%) for another reason. One hundred and sixty-five reoperations were performed in 82 (49%) of the patients; 104 (63%) of the reoperations were within 6 months. Thirty-two (19%) of 166 implants were revised: 13 (8%) for mechanical reasons, mainly dislocation (n = 5, 3%), and 19 (11%) for nonmechanical reasons, mainly periprosthetic joint infection (PJI) (n = 15, 9%). The cumulative incidences of revision for mechanical reasons and PJI (Henderson 1 to 4) at 2, 5, and 10 years were 11% (95% confidence interval [CI], 7% to 17%), 18% (12% to 25%), and 24% (16% to 33%), respectively. Previous surgery at the same site was associated with an increased dislocation risk (cause-specific hazard ratio [HR_CS], 3.0 [95% CI, 1.5 to 6.4]; p < 0.01), and resections involving the P3 region were associated with an increased infection risk (HR_CS, 2.5 [95% CI, 1.4 to 4.7]; p < 0.01). Conclusions: Despite a substantial reoperation risk, the LUMiC prosthesis demonstrated its durability in the mid-term, with a low mechanical revision rate and most patients retaining their primary implant. Most complications occur in the first postoperative months. Patients with previous surgery at the same site had an increased dislocation risk and might benefit from more conservative rehabilitation and aftercare. Measures should be aimed at reducing the PJI risk, especially in resections involving the P3 region. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: The decreased perfusion of osteosarcoma in dynamic contrast-enhanced (DCE) MRI, reflecting a good histological response to neoadjuvant chemotherapy, has been described. Purpose: In this study, we aim to explore the potential of the relative wash-in rate as a prognostic factor for event-free survival (EFS). Methods: Skeletal high-grade osteosarcoma patients, treated in two tertiary referral centers between 2005 and 2022, were retrospectively included. The relative wash-in rate (rWIR) was determined with DCE-MRI before, after, or during the second cycle of chemotherapy (pre-resection). A previously determined cut-off was used to categorize patients, where rWIR < 2.3 was considered poor and rWIR ≥ 2.3 a good radiological response. EFS was defined as the time from resection to the first event: local recurrence, new metastases, or tumor-related death. EFS was estimated using Kaplan–Meier’s methodology. Multivariate Cox proportional hazard model was used to estimate the effect of histological response and rWIR on EFS, adjusted for traditional prognostic factors. Results: Eighty-two patients (median age: 17 years; IQR: 14–28) were included. The median follow-up duration was 11.8 years (95% CI: 11.0–12.7). During follow-up, 33 events occurred. Poor histological response was not significantly associated with EFS (HR: 1.8; 95% CI: 0.9–3.8), whereas a poor radiological response was associated with a worse EFS (HR: 2.4; 95% CI: 1.1–5.0). In a subpopulation without initial metastases, the binary assessment of rWIR approached statistical significance (HR: 2.3; 95% CI: 1.0–5.2), whereas its continuous evaluation demonstrated a significant association between higher rWIR and improved EFS (HR: 0.7; 95% CI: 0.5–0.9), underlining the effect of response to chemotherapy. The 2- and 5-year EFS for patients with a rWIR ≥ 2.3 were 85% and 75% versus 55% and 50% for patients with a rWIR < 2.3. Conclusion: The predicted poor chemo response with MRI (rWIR < 2.3) is associated with shorter EFS even when adjusted for known clinical covariates and shows similar results to histological response evaluation. rWIR is a potential tool for future response-based individualized healthcare in osteosarcoma patients before surgical resection.

Aims: Tumour defects of the proximal humerus can be reconstructed using hemiarthroplasty, reverse shoulder arthroplasty (RSA), or anatomical total shoulder arthroplasty (TSA). This study aimed to evaluate clinical and functional outcomes of reconstructions of proximal humeral tumour defects with MUTARS endoprostheses.Methods: A total of 165 reconstructions were included: 98 (59%) hemiarthroplasties, 61 (37%) RSAs, and six (4%) TSAs. Median age was 54 years (IQR 31 to 68). Median follow-up time was 5.9 years (IQR 2.83 to 10.50). Competing risks models were employed to estimate the cumulative incidence of revision (CIR) for mechanical reasons and infection with local recurrence and mortality as competing events. The range of motion was reported using descriptive statistics.Results: Axillary nerve preservation and deltoid muscle reattachment were observed in 89% and 96% of cases, respectively, without significant differences between implant types. Rotator cuff refixation was less frequent in RSA (78%) compared to hemiarthroplasty (91%). Overall, 26 implants (16%) were revised for mechanical complications (dislocation n = 11, loosening n = 2, periprosthetic fracture n = 3) and infection (n = 10). Patients with previous surgery at the same site had a higher revision risk due to instability (cause-specific hazard ratio 3.7; 95% CI 1.3 to 10.8). The CIRs for mechanical reasons (Henderson 1 to 3) in the entire population at two, five, and ten years were 7% (95% CI 3 to 11), 11% (95% CI 6 to 17), and 13% (95% CI 7 to 20), respectively. For periprosthetic joint infection (Henderson 4), the CIRs were 5% (95% CI 2 to 10), 7% (95% CI 3 to 12), and 7% (95% CI 3 to 12). Compared with hemiarthroplasty, RSA offered superior median anteflexion (73° (IQR 40 to 90) vs 30° (IQR 5 to 45)), abduction (70° (IQR 38 to 90) vs 30° (IQR 5 to 45)), and external rotation (15° (IQR 0 to 28) vs 5° (0 to 19)).Conclusion: MUTARS proximal humerus reconstruction outcomes are satisfying, particularly in terms of mechanical failure. RSA and hemiarthroplasty exhibit comparable revision risks, with previous surgery at same site as a prognostic factor for revision due to dislocation. RSA appears to provide the best functional outcome.Cite this article: Bone Jt Open 2025;6(6):715–723.

Primary osseous chest wall sarcomas are rare tumours with limited evidence guiding surgical management. This study aimed to evaluate oncological outcomes, complication rates, and prognostic factors associated with survival in a large, single-institution cohort. We retrospectively reviewed 100 patients who underwent chest wall resection for primary osseous sarcoma between 1994 and 2022. Outcomes included overall survival (OS), event-free survival (EFS), local recurrence (LR), distant metastasis (DM), and postoperative complications. The cumulative incidence of LR and DM were estimated using competing risk models. Prognostic factors were analysed with Cox regression. The cohort included 79 patients with chondrosarcoma, eight with osteosarcoma, and 13 with Ewing sarcoma. Negative margins (R0) were achieved in 79%. Reconstruction was performed in 68%, most commonly with mesh. Postoperative complications occurred in 19%. Five-year OS was 79% (70–87%) for the entire cohort, and by subtype: osteosarcoma 38% (4–71%), Ewing sarcoma 67% (41–94%), and chondrosarcoma 85% (77–94%). Recurrence patterns differed, osteosarcoma showed a high 5-year risk of DM (75% (40–100%)), chondrosarcoma predominantly exhibited LR (15% (7–23%)), and Ewing sarcoma both LR (15% (0–36%)) and DM (40% (11–69%)). Notably, grade 1 chondrosarcoma showed metastatic potential, emphasizing that the risk of distant metastasis should also be considered in these low-grade tumours, with a 5-year cumulative incidence of distant metastasis was 11% (95% CI: 0–27%). Tumour size and residual tumour (R1/2) were associated with worse outcomes. Radical resection (R0) remains the most important predictor of survival. 5-year survival differs substantially by subtype (chondrosarcoma 85%, Ewing sarcoma 67% and osteosarcoma 38%), while tumour size is associated with a less favourable prognosis. Individualized reconstructive strategies enable complex resections with acceptable morbidity (19% postoperative complications).