Learn Orthopedic Surgery, From the Source

Palliative Surgery

Chemotherapy For Bone Tumors

Endoprosthesis

reconstruction is a cornerstone technique in musculoskeletal oncology, allowing immediate restoration of skeletal continuity and early mobilization after wide tumor resection. Modern modular megaprostheses, made of titanium or cobalt-chromium alloys, are designed for durability, functional recovery, and ease of revision. They are primarily indicated for periarticular or diaphyseal bone loss following tumor excision, failed fixation, or pathological fractures. Cemented fixation ensures immediate stability, while press-fit and porous-coated designs promote biological integration. Despite excellent limb salvage rates (>90%), complications such as infection, aseptic loosening, and mechanical failure remain challenges. Advances including silver-coated implants, expandable pediatric prostheses, and improved soft-tissue reattachment techniques continue to enhance long-term outcomes and quality of life for oncology patients.

Synovial Sarcoma

Synovial sarcoma is a high-grade malignant soft tissue tumor primarily affecting the extremities of young adults. Diagnosis requires MRI, histopathology, and molecular confirmation of the SS18–SSX fusion gene. Treatment is multidisciplinary, centered on complete surgical excision with limb preservation when feasible, combined with perioperative radiotherapy and chemotherapy for large, deep, or high-risk lesions. Prognosis depends on tumor size, depth, margin status, and recurrence, with lung metastasis being the most common pattern of spread. Long-term surveillance is essential due to the potential for late metastatic relapse.

Pathologic Fracture Management

Pathological fractures occur in structurally weakened bone, most commonly due to metastatic disease, but also from primary tumors or metabolic bone disorders. Management begins with accurate diagnosis, staging, and biopsy planning before any surgical fixation. The femur, pelvis, and spine are typical sites, with lung, breast, thyroid, renal, and prostate cancers being leading causes. Predictive tools such as Harrington criteria, Mirel’s score, and CT-based structural rigidity analysis guide the need for prophylactic fixation.

Surgical Reconstruction Options

The BACTIP Protocol: A Pragmatic Imaging and Follow-up Guide for Incidental Cartilage Tumors of the Proximal Humerus and Knee

Patel A, Davies AM, Botchu R, James S. Article Title: A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee. Journal: Clinical Radiology, 2019. DOI: 10.1016/j.crad.2019.01.025.

Biologic Reconstruction in Orthopaedic Oncology: Are Autografts the Long-Term Solution?

Wallace MT, Williams RP Autograft and Biologic Living Bone Reconstructions in Orthopaedic Oncology JAAOS, 2026

Reconstruction Strategy in Pediatric Bone Sarcoma: Algorithm-Based Approach

Errani C, O’Meally AA, Tsukamoto S, et al. An algorithm for surgical treatment of children with bone sarcomas of the extremities SICOT-J, 2024 DOI: 10.1051/sicotj/2024033