Background We evaluated the outcome and the survival rate of Limb salvage surgeries (LSSs) in osteosarcoma around knee by using megaprosthesis, ECI autograft, and modified arthrodesis of the knee with metallic plus bone cement (MAMC). Methods We reviewed 35 cases of osteosarcoma around the knee that was treated by megaprosthesis, ECI autograft and MAMC from 2012 to 2017. The survival, local recurrence, metastases, complications and functional MSTS score were evaluated for each operation technique. Kaplan-Meier was used to describe the survival rate for each technique. Result Megaprostheses group had an excellent MSTS score (78.7%), the ECI group (72.3%) and MAMC group (68.4%). Local recurrence occurred in the megaprothesis group (0%), the ECI group (9.1%) and MAMC group (20%). Infection occurred in 3 cases of ECI (13.6%) while only 2 (40%) cases in MAMC group and 1 case (12.5%) in the megaprostheses group. Aseptic loosening occurred in the megaprostheses group 1 case (12.5%) and MAMC 1 case (20%). Metastases occurred in 18.2% of the ECI group compared to 25% of the megaprostheses group and 40% of the MAMC group. The megaprosthesis group had an overall survival rate of 90.9 months, whilst the ECI group is on 94.6 months and the MAMC group was 47.2 months. Conclusion Megaprosthesis showed good-excellent functional outcome and survival rate. ECI that is an option in LSS has good functional outcome as well. Knee arthrodesis with MAMC it is still an option to perform LSS even in the advanced local stage of the disease.

HighlightsThis is an advanced case of aggressive GCT of calcaneus.It is not only a rare case but also an interesting diagnosis and surgical management.Limb salvage surgery which consists of wide excision-total calcaneoctomy, followed by reconstruction with femoral head allograft and soft tissue coverage with sural flap is a good option.

The survival rate was lower in patients with higher Evan grading, metastasis, or local recurrence.

HighlightsNo recurrence of osteofibrous dysplasia at 84 week following a wide extraperiosteal excision.The combination of autologous BM-MSCs, HA granules and BMP-2 successfully created new bone tissue.The newly formed bone tissue filled in the gap of critical-sized bone defect and was able to improve the patient’s quality of life significantly.No neoplastic, immunologic or other side-effects were noted at 84 weeks after autologous MSC transplantation.

AbstrakLatar belakang: Scaffold (biomaterial) adalah rangka yang digunakan dalam transplantasi sel punca mesenkimal. Sebelum digunakan perlu dilakukan uji biokompatibilitas secara in vitro melalui pengujian toksisitas langsung dan tak langsung MTT assay [3-(4,5-dimethylthiazol-2-yl AbstractBackground: Scaffold (biomaterial) biocompatibility test should be performed in vitro prior to in vivo stem cell application in animal or clinical trial. These test consists of direct and indirect toxicity test (MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]). Those tests were used to identify cell morphological changes, cell-substrate adhesion impairment, and reduction in cell proliferation activity.

Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. The objective of this study is to describe cases of parosteal osteosarcoma as well as a variety of treatment options amenable to such entity. Six cases of parosteal osteosarcoma were identified based on histopathological reports in a tertiary referral hospital in Jakarta, Indonesia between January 2001 and December 2019. The mean age was 29.8 years old; four of them (66.7%) were male. Distal end of femur was the most commonly involved bone (five cases, 83.3%). The patients were treated with wide excision followed by several different reconstruction methods: replacement with endoprosthesis, extracorporeal irradiation, knee arthrodesis, or prophylactic fixation. One of our patients presented with dedifferentiated component, and therefore was treated by limb ablation. While two cases died of pulmonary metastasis, other patients reported fair to excellent functional outcome.

There was no association between type of surgery and tumour recurrence, metastasis, or outcome. Curettage with adjuvant therapy was more commonly performed for stage 1 and 2 tumours, whereas wide resection was more for stage 3 tumours. Metastasis was associated with stage 3 tumour and mortality but not recurrence.

IntroductionIn most cases, osteosarcoma occurs in the metaphysis of long bones such as femur, tibia, or humerus. Meanwhile, osteosarcoma of the talus is extremely rare.Presentation of caseWe presented a case of a thirty-eight-year-old male patient with osteosarcoma of the talus treatedwith limb salvage surgery. That procedure consists of wide excision as extra-articular resection“ totaltalectomy” followed by challenging reconstruction of the defect using fibular graft and followed by internal fixation and arthrodesis. We did an extraarticular resection of the talus, which consists of total talectomy and excision of the distal tibia and fibula. An ipsilateralnon vascularized fibular graft as harvested and placed in a horizontal plane to bridge the distal tibia and fibula to the navicular. The graft was fixated using 7.5mm cannulated headless screw and was followed by arthrodesis across the distal tibia and fibula to the calcaneus.DiscussionOptions for surgical treatment for osteosarcoma of the talus islimb salvage surgery. Extraarticular resection “total talectomy” and reconstruction using fibular bone grafttechnique creates a good functional outcome and no signs of local recurrence were found during one-yearfollow-upConclusionExtraarticular resection and reconstruction using fibular bone graftis a good technique for management of osteosarcoma of the talus.