Surgical management of villonodular-pigmented synovitis of knee: decisional algorithm

Pigmented villonodular synovitis (PVNS) of knee is an uncommon disease defined as benign despite presenting local aggressiveness and high propensity to recurrence. Etiology is still not completely understood. It seems to be a chronic inflammation process involving synovial membranes characterized by hemosiderin deposition which leads to pain, limitation of range of motion and, if not treated, bone erosion and osteoarthritis of knee. The gold standard for treatment is surgical excision; other adjuvant or alternative therapies are described, too. We present a case series of PVNS of the knee treated with surgical excision at our institution. Functionality was assessed using the Muscoloskeletal Tumor Society (MSTS) Score for lower limbs and Oxford Knee Score (OKS). Statistical analysis were performed. At the latest follow-up, our patients' mean MSTS score was 26.4 (30-18): 27.4 for those treated with posterior approach and 26.1 for the anterior ones. Only 5% of patients suffered local complications and 15% had a local recurrence of the disease. Adequate pre-operative study and careful surgical excision, that should be tailored to each patient are the key to obtain a low recurrence rate

Il ruolo della chirurgia nel trattamento dei cordomi del sacro

Il cordoma è un tumore maligno di natura mesenchimale e rappresenta la patologia neoplastica maligna primitiva della colonna più frequente. La sua localizzazione più comune è il rachidee sacro-coccigeo (50%). Macroscopicamente il cordoma si presenta come una massa grigiastra translucida a crescita lenta e indolente. La diffusione metastatica è rara e coinvolge circa il 7-14% dei pazienti. Il trattamento dei cordomi rappresenta tutt’oggi una sfida e necessita sempre di un approccio multidisciplinare (ortopedico, radioterapista, oncologo..). Lo sviluppo di nuove tecniche radioterapiche, come l’uso degli adroni, protoni o ioni di carbonio, si è affermato sempre di più nel corso del tempo, garantendo buoni risultati in termine di controllo locale della malattia e anche nella gestione del dolore. Il trattamento chirurgico tramite asportazione en bloc, nonostante l’elevato rischio di sequele neurologiche e di infezione della ferita, rappresenta tutt’ora l’opzione di maggior successo in termini oncologici. Questa tesi descrive uno studio retrospettivo multicentrico (Chirurgia Vertebrale dell’Istituto Ortopedico Rizzoli e Ortopedia II dell’Ospedale di Cisanello) sui pazienti trattati chirurgicamente per Cordoma del Sacro da gennaio 2017 a febbraio 2023. Viene inoltre descritta una nuova tecnica chirurgica robot-assistita grazie alla collaborazione con l’UO di Chirurgia Generale Universitaria dell’Ospedale di Cisanell

Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management

Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and—as much as possible—upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages