The predominant sites of viable and nonviable tumor were determined in the primary lesions of 50 patients with osteosarcoma after initial treatment with preoperative chemotherapy. The degree of tumor destruction was classified as good, fair, and poor and a map of the sites revealing viable and nonviable tumor was constructed. The study revealed several preferential sites where viable tumor was likely to persist: soft tissues, cortex, subcortex, ligaments, and areas in contact with cartilage (growth plate and/or articular cartilage). Localized areas of hemorrhage and necrosis, designated "lacunae," were noted within the tumor. They were frequently surrounded by bundles of viable tumor and appeared to correlate with open surgical biopsies. Factors responsible for this phenomenon and the persistence of viable tumor are discussed. The findings have important implications in the design of surgical treatment and in the use of needle biopsies to determine the effects of preoperative treatment.
Despite the high rate of neurological complications, possibly related to excessive limb lengthening or inadequate soft-tissue release, total hip replacement can be considered a feasible option for patients with Legg-Calvé-Perthes disease. Careful preoperative planning is advisable in order to overcome the technical pitfalls related to the abnormal proximal femoral and acetabular anatomy of these patients.
Highly porous titanium cups showed trustworthy results at eight years, reducing the rate of aseptic loosening. Longer follow-ups, ion analyses, and pre-clinical in vivo studies would be helpful to better define the reliability of these devices and their advantages.
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