Ortopedia Oncológica

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Oncologic reconstructive surgery of the talus with structural allograft: Case report
(International Journal of Surgery Case Reports, 2024) Ramírez Jaramillo Andrés Felipe; Coronado David Alejandro; Arroyave rivera Sergio Andres; Gómez Mier Luis Carlos; Soto Montoya Camilo
Introduction and importance: Introduction and importance: Bone tumors of the foot constitute 3 % of all bone tumors, within these, the location in the talus constitutes between 8 and 23 % of bone tumors. Within the oncological management of these lesions, preservation surgery has had a great boom in the last 10 years, however, the use of massive structural allograft is not a conventional surgery and there is little literature on its use, which is why we consider important to document clinical cases. Case presentation: we document 2 clinical cases of bone tumor in the talus that were surgically managed with tumor resection plus reconstruction with total and partial talus allograft. Clinical discussion: Bone tumors involving the talus are rare and management techniques have emphasized intralesional resection plus bone graft application. In the literature consulted, no report of reconstructive surgery was found with the use of total and partial structural talus allograft. Conclusions: The use of structural talar allografts, both partial and total, has shown good functional results in short-term follow-up (18 months), so we consider it important to continue long-term follow-up to evaluate the evolution of this surgical technique.
Pelvic Metastatic Disease: A Novel Technique for Reconstruction of the Posterior Acetabular Column
(Seth Leopold, 2024-10-11) Ramírez Jaramillo Andrés Felipe; Arroyave Rivera Sergio Andres; Franco Betancur Andrea; Gómez Mier Luis Carlos; Soto Montoya Camilo
Abstract Background: Pelvic metastases often lead to significant morbidity due to acetabular destruction. Conventional methods may lack adequate support for the posterior acetabular column. This study evaluates a novel technique involving a retrograde ischioacetabular Schanz nail combined with the modified Harrington technique for enhancing stability in total hip arthroplasty (THA) Surgical technique description: After intralesional resection of the acetabular metastatic lesion, we use an ischiatic counter incision to drill a Schanz pin along the posterior acetabular column. Then, we augment the osseous defect with polymethyl methacrylate and total hip arthroplasty, according to each patient compromise we add acetabular reinforcement rings or cages. Methods: We reviewed records of 10 patients with harrington type II-IV lesions treated with this technique at Instituto Nacional de Cancerología from 2017 to 2023 at the Musculoskeletal tumors unit in Instituto Nacional de Cancerología, Bogota, Colombia. Using data acquired from medical history, we identified pain using VAS score in a follow up to 9 months. Outcomes measured included pain control (Visual Analog Scale) and functionality (Karnofsky Performance Status). Follow-up data, including radiological assessments and surgical notes, were analyzed for complications and reconstruction effectiveness Result: Mean patient age was 59.2 years, with 70% female. Average survival was 18.9 months, with follow-up averaging 21.1 months. All patients showed improved pain control (100%), with six achieving full independence. No major complications or revisions were necessary. The longest survivor remains well at 7 years postoperatively Discussion: The technique provides enhanced stability and reduces the need for revision, offering significant pain relief and structural support. It is effective for both short- and long-term survival patients with pelvic metastases. Conclusion: The retrograde Schanz nail in the modified Harrington technique offers a reproducible and effective method for acetabular reconstruction in pelvic metastases, providing durable support and pain relief.
Desenlaces funcionales y oncológicos en pacientes con lesiones metastásicas únicas óseas llevados a metastasectomía
(Clinical Orthopaedics and Related Research (CORR), 2025) Narvaez Rodriguez, Gabriel
Introduction: Solitary bone metastases represent a major clinical challenge. Surgical metastasectomy remains a valid option in selected patients. This study evaluated the oncologic and functional outcomes following metastasectomy in a cancer referral center in Bogotá, Colombia. Methods: A retrospective observational study including patients with solitary bone metastases who underwent metastasectomy between January 2004 and March 2024. Demographic, clinical, and surgical data were collected. Postoperative functionality was assessed using the MSTS score. Local recurrence, disease progression, and survival were analyzed with a minimum follow-up of 12 months. Kaplan–Meier and log-rank tests were used when appropriate. Results: Thirty patients (73.3% female) were included, with a mean age of 60.4 ± 10.9 years. The most common primary tumors were renal (26.7%) and breast (16.7%). The predominant surgical technique was endoprosthetic reconstruction (50%). Postoperative complications occurred in 40% (12/30), mainly infections (41%). Among 13 patients with recorded functionality, the moderate MSTS category was most common (53.8%), with no significant associations found with the evaluated clinical or surgical variables (all p > 0.10). During follow-up, 19 patients (63%) developed metastatic progression, 2 (6.7%) developed local recurrence, and 11 (36.6%) remained progression-free. The overall survival rate at 12 months was 65%, with a median follow-up of 12 months. Conclusion: Metastasectomy in patients with solitary bone metastases is a safe and effective procedure, yielding good functional outcomes and acceptable rates of disease progression and mortality. Its inclusion in multidisciplinary management should be considered in appropriately selected patients.
Oncologic reconstruction of the proximal femur in children younger than 9 years using a proximal humerus allograft and a hip prosthesis: Report of two cases and description of the surgical technique
(Journal of Orthopaedic Surgery, 2025-11-26) Ivan Mauricio Rodriguez Macias; Juan Fernando Chaustre; Gabriel Narvaez Rodriguez; Luis Carlos Gomez; Andrea Franco; Camilo Soto Montoya
Introduction: Proximal femoral tumor resection poses a major challenge in orthopaedic oncology, particularly in very young pediatric patients (<9 years), where the need to preserve function and limb length collides with the limited availability of reconstructive options (3D-printed implants, endoprostheses, biological constructs such as vascularized fibular grafts, and allograft-prosthetic composites) or leads to amputation. Objective: To describe in detail the surgical technique for proximal femoral tumor resection and reconstruction using an allograft-prosthetic composite (APC) with a proximal humerus allograft plus a hip prosthesis, documenting its applicability and outcomes regarding function, allograft survival, and oncologic disease status in two pediatric cases treated at a national cancer referral center in Bogot´a, Colombia. Methods: We report two pediatric cases and detail the surgical technique used for proximal femoral reconstruction after tumor resection, based on an APC (proximal humerus allograft + hip prosthesis). Data were collected from medical records with radiological and functional follow-up. Results: In both patients, proximal femoral reconstruction using our technique yielded a stable construct with preservation of limb function (MSTS >72), documented graft incorporation at 3 months, local disease control, and only one recorded complication (contact dermatitis). Conclusion: Proximal femoral reconstruction using an APC with a proximal humerus allograft is a viable and safe surgical option in pediatric patients with Ewing sarcoma. In our experience, the technique was successfully applied in two patients, allowing limb preservation with a favorable course. Thus, it offers a functional and reliable option for limb salvage in selected cases.

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