Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.

Patients commonly present to orthopaedic surgeons with suspicious and low-energy mechanisms of injury for long-bone fractures. Most tumor-related pathologic fractures in patients older than 40 years are due to metastatic disease. Although rare, the treating surgeon should always consider the possibility of a primary bone tumor. Obtaining a tissue sample is a required early step in the surgical process following the principles of biopsy tract selection. An adequate tissue biopsy is also necessary for the diagnosis of a primary source of metastatic disease if otherwise unknown. These patients often require adjuncts to surgery, including bisphosphonate treatment, anticoagulation, radiation therapy, chemotherapy, and follow-up with multiple medical specialists for continuing care. The surgical treatment plan is based on the location of the fracture, and various options are available depending on whether the metastatic disease is present in the diaphysis, metaphysis, or epiphysis of long bones. The orthopaedic surgeon should have a working knowledge of proper identification and treatment principles of metastatic disease in long bones to properly assist in patient care delivery.

Evaluation and management of suspected pathologic fractures, secondary to metastatic disease, require a comprehensive understanding of the underlying disease process and a multidisciplinary treatment approach. Recognition of a pathologic fracture can be challenging, and the diagnosis today remains often missed, but is necessary for appropriate care. The incidence of cancer in the United States is on the rise, and with advances in medical and surgical care the prevalence of cancer is increasing as well. This will result in a similar trend of increased incidence and prevalence of metastatic disease requiring treatment from orthopaedic surgeons. The proximal femur is the most common location for metastatic lesions in the appendicular skeleton, and as such sees a disproportionate number of pathologic fractures. This site of injury is particularly challenging to manage due to the transmission of high forces through this region during ambulation. A combination of adjunct therapies and surgical intervention will maximize the outcomes for these patients. Obtaining a tissue diagnosis, especially in the setting of a solitary bone lesion, is a crucial and required early step in this process.