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Rehabilitation plays a critical role in the functional recovery of pediatric patients following rotationplasty for lower extremity malignant bone tumors. However, due to the limited number of cases and the unique characteristics of the surgery, there is a paucity of studies that have longitudinally evaluated the effect of rehabilitation strategies on long-term functional recovery after rotationplasty. Therefore, the present study aimed to identify an effective rehabilitation approach for pediatric patients undergoing rotationplasty for malignant bone tumors of the lower limb. Additionally, the study aimed to assess the effect of rehabilitation on long-term functional recovery and quality of life. A total of 12 patients were included in the current study, with a mean age at surgery of 6.58±1.73 years (range, 4-10 years). These patients underwent rotationplasty for malignant bone tumors of the lower extremity at the Fourth Medical Center of the Chinese People's Liberation Army General Hospital (Beijing, China) between March 2014 and March 2019. After surgery, patients underwent a 6-month postoperative rehabilitation programme, either on an outpatient or inpatient basis, with exercise therapy as the key training modality. The follow-up outcomes at 3, 6 and 12 months and at 3 and 5 years were recorded and analyzed, ensuring a comprehensive evaluation of long-term progress. The results demonstrated a gradual enhancement in functional performance and quality of life. Within a year of surgery, the patients displayed significant improvements in both functional recovery and quality of life, and all indicators remained stable 1 year later compared with those at 1 year post-surgery. More specifically, patients showed restored muscle strength and walking ability to normal levels, with a significant increase in muscle strength to 5/5. In addition, the study revealed that the mean distance covered in the 6-min walk test was 403.08±12.52 meters, while a duration of 8.83±0.72 sec was recorded in the timed up and go test. All patients have been continuously monitored up to date. The follow-up period for all patients ranged from 60 to 120 months, with a mean of 89.83±17.55 months. Overall, the findings indicated that the early postoperative period was a critical period for functional recovery, and that early postoperative rehabilitation interventions resulted in significant improvements to the rate and quality of functional recovery over time, thus further improving quality of life.

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INTRODUCTION: Osteosarcomas of the jaw (OSJs) are rare tumors with distinct characteristics from osteosarcomas affecting other bones. This study aims to analyze the clinical, pathological, and therapeutic characteristics of OSJs. METHODS: A retrospective, descriptive cross-sectional study including patients diagnosed with OSJ registered at the "La Paz" University Hospital, Madrid, was performed. RESULTS: Data of eight patients with a diagnosis of OSJ were obtained during the study period of 22 years (2002-2024). The mean age of the patients was 41 years. The distribution was 1:1 between the maxilla and mandible. Painful inflammation was the most frequent clinical manifestation. Conventional osteoblastic osteosarcoma was the most predominant histological type. Survival rate at 5 years was 50%, which decreased to 25% at 10 years. CONCLUSIONS: OSJs differ from conventional osteosarcomas of long tubular bones. Surgery continues to be the mainstay of treatment. However, more studies are needed through which more standardized protocols can be proposed for adjuvant therapeutic management.

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Primary leiomyosarcoma of bone (LMSoB) is extremely rare, comprising only <0.7% of primary malignant bone tumors, and is therefore considered an ultra-rare tumor entity. There is currently no consensus as to whether therapeutic strategies should be based on the biological characteristics of soft tissue leiomyosarcoma or on primary tumor localization in the bone. The use of perioperative chemotherapy and its effectiveness in this rare tumor entity remains unclear. We aimed to evaluate the impact of different treatment approaches in a multicenter setting with a total of 35 patients included. The 5-year overall survival (OS) was 74%. Patients with localized disease undergoing surgery had a significantly higher 5-year OS compared to patients who did not undergo surgical treatment (82% vs. 0%, p = 0.0015). Axial tumor localization was associated with worse event-free survival (EFS) probability (p < 0.001) and OS (p = 0.0082). A high proportion of our patients developed secondary metastases. Furthermore, the perioperative chemotherapy protocols applied to our patients were not associated with an improved EFS or OS. Therefore, the benefit of perioperative chemotherapy in LMSoB needs to be further investigated, and the choice of agents still needs to be clarified.

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The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. Level of evidence: level 4.

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Malignant bone tumors are characterized by severe disability rate, mortality rate, and heavy recurrence rate owing to the complex pathogenesis and insidious disease progression, which seriously affect the terminal quality of patients' lives. Photothermal therapy (PTT) has emerged as an attractive adjunctive treatment offering prominent hyperthermal therapeutic effects to enhance the effectiveness of surgical treatment and avoid recurrence. Simultaneously, various advanced biomaterials with photothermal capacity are currently created to address malignant bone tumors, performing distinctive biological functions, including nanomaterials, bioceramics (BC), polymers, and hydrogels et al. Furthermore, PTT-related combination therapeutic strategies can provide more significant curative benefits by reducing drug toxicity, improving tumor-killing efficiency, stimulating anti-cancer immunity, and improving immune sensitivity relative to monotherapy, even in complex tumor microenvironments (TME). This review summarizes the current advanced biomaterials applicable in PTT and relevant combination therapies on malignant bone tumors for the first time. The multiple choices of advanced biomaterials, treatment methods, and new prospects for future research in treating malignant bone tumors with PTT are generalized to provide guidance. Malignant bone tumors seriously affect the terminal quality of patients' lives. Photothermal therapy (PTT) has emerged as an attractive adjunctive treatment enhancing the effectiveness of surgical treatment and avoiding recurrence. In this review, advanced biomaterials applicable in the PTT of malignant bone tumors and their distinctive biological functions are comprehensively summarized for the first time. Simultaneously, multiple PTT-related combination therapeutic strategies are classified to optimize practical clinical issues, contributing to the selection of biomaterials, therapeutic alternatives, and research perspectives for the adjuvant treatment of malignant bone tumors with PTT in the future.

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PURPOSE: Bone tumors around the elbow are rare, with frequently delayed diagnosis. The current study aimed to assess the functional and oncological outcomes of limb salvage surgery for primary benign aggressive or malignant bone tumors around the elbow. METHODS: We conducted a retrospective review of patients with primary aggressive benign and malignant bone tumors around the elbow treated with limb salvage surgery between 1995 and 2020 at a single musculoskeletal oncology center. The minimum follow-up period was 24 months. Functional results were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the last follow-up visit. Local recurrence, chest metastasis, and complications were recorded. RESULTS: This study included 30 patients, 19 males and 11 females, with a mean age of 25.4 ± 14.2 years. The tumor location was the distal humerus (n = 21), proximal radius (n = 5), and proximal ulna (n = 4). Reconstruction was done by elbow fusion using fibular graft (n = 10), mobile endoprosthesis (n = 9), excision arthroplasty (n = 7), and extracorporeal freezing and reimplantation (n = 4). The mean follow-up period was 36.2 ± 21.3 months. The median follow-up MSTS score was 27 [Interquartile range (IQR): 26-30]. Skeletally immature patients had a significantly higher MSTS score. The rate of postoperative complications was 26.7%. CONCLUSION: Limb salvage surgery with different reconstructive options for benign aggressive and malignant bone tumors around the elbow can achieve good functional and oncological outcomes. LEVEL OF EVIDENCE: Level IV.

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PURPOSE: This study aimed to conduct a large-scale population-based study to understand the epidemiological characteristics of Primary Malignant Bone Tumors (PMBTs) and determine the prognostic factors by concurrently using the classical statistical method and data mining methods. METHODS: Patients included in this study were extracted from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database: "Incidence-SEER Research Data, 18 Registries, Nov 2020 Sub". Patients with unclassified and incomplete information were excluded. This search algorithm resulted in a dataset comprising 6234 cases. Survival analyses were performed with Kaplan-Meier curves and the Log-rank test. Multivariate Cox regression analysis determined the independent prognostic factors of PMBT. A decision tree-based data mining technique was used in this study to confirm the prognostic factors. RESULTS: 5-years survival rate was 63.6% and 10-years survival rate was 55.3% in the patients with PMBT. Sex, age, median household income, histology, primary site, grade, stage, metastasis, and the total number of malignant tumors were determined as independent risk factors associated with overall survival (OS) in the multivariate COX regression analysis. The prognostic factors resulting in five terminal nodes in the decision tree (DT) included stage, age, and grade. The stage was the most important determining factor for vital status. The terminal node with the shortest number of surviving patients included 801 (72.3%) deaths in 1102 patients with distant stage, and hazard ratio was calculated as 5.4 (95% CI: 4.9-5.9; p < .001). These patients had a median survival of only 17 months. CONCLUSIONS: Rules extracted from DTs provide information about risk factors in specific patient groups and can be used by clinicians making decisions on individual patients. We recommend using DTs in combination with COX regression analysis to determine risk factors and the effect of these factors on survival.

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BACKGROUND: Rare primary malignant bone sarcomas (RPMBS) account for 5%-10% of primary high-grade bone tumors and represent a major treatment challenge. The outcome of patients with RPMBS enrolled in the EUROpean Bone Over 40 Sarcoma Study (EURO-B.O.S.S) is presented. METHODS: Inclusion criteria were as follows: age from 41 to 65 years and a diagnosis of high-grade spindle cell, pleomorphic, or vascular RPMBS. The chemotherapy regimen included doxorubicin 60 mg/m2 , ifosfamide 9 g/m2 , and cisplatin 90 mg/m2 ; postoperative methotrexate 8 g/m2 was added in case of a poor histologic response. Version 2.0 of the Common Terminology Criteria for Adverse Events, Kaplan-Meier curves, log-rank tests, and univariate Cox regression models were used. RESULTS: In total, 113 patients were evaluable for analysis. The median patient age was 52 years (range, 40-66 years), and 67 patients were men. Eighty-eight tumors were categorized as undifferentiated pleomorphic sarcomas (UPS), 20 were categorized as leiomyosarcomas, three were categorized as fibrosarcomas, and two were categorized as angiosarcomas. Eighty-three of 113 tumors were located in the extremities. Ninety-five of 113 patients presented with no evidence of metastases. After a median follow-up of 6.8 years (interquartile range [IQR], 3.5-9.8 years), the 5-year overall survival rate for patients with localized disease was 68.4% (IQR, 56.9%-77.5%), and it was 71.7% (IQR, 58.1%-81.6%) for patients with UPS and 54.9% (IQR, 29.5%-74.5%) for patients with leiomyosarcoma. Grade III-IV hematologic toxicity was reported in 81% patients; 23% had grade II-III neurotoxicity, and 37.5% had grade I-II nephrotoxicity. Five-year overall survival was significantly better for patients with localized disease, for patients who obtained surgical complete remission, and when the primary tumor was located in the extremities. CONCLUSIONS: The survival of patients who had RPMBS in the current series was similar to that of age-matched patients who had high-grade osteosarcoma treated according to the same protocol. An osteosarcoma-like chemotherapy may be proposed in patients who have RPMBS.

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RATIONALE AND OBJECTIVES: We investigated the diagnostic performance of dual-energy CT (DECT) virtual non-calcium (VNCa) and Rho/Z images for bone marrow infiltration of primary malignant bone tumors (PMBTs). MATERIALS AND METHODS: We retrospectively analyzed 65 patients with PMBT who underwent DECT and MRI within 2 weeks. DECT was used to evaluate the presence and extent of marrow involvement surrounding PMBTs using the SCT, VNCa, and Rho/Z images. MRI was used as the reference standard for measurements. CT values of normal and involved bone marrow areas were measured on VNCa images, and Zeff values were measured on Rho/Z images. The statistical methods used were the 2*C chi-square test, ANOVA test, paired samples t test, and diagnostic performance of the different variables were evaluated using receiver operating characteristic curves. RESULTS: VNCa and Rho/Z images showed higher accuracy (91%, 92% vs. 67%) and sensitivity (90%, 92% vs. 69%) than SCT images for diagnosing bone marrow infiltration in patients with PMBT. The maximum longitudinal diameter of tumor involvement measurements was statistically different between VNCa and SCT, Rho/Z and SCT, MRI, and SCT (all p < 0.05, p = 0.047, p = 0.049, and p = 0.023, respectively). The maximum transverse diameter was statistically significant between SCT and MRI, VNCa and MRI, Rho/Z and MRI (all p < 0.05, and p = 0.015, and p = 0.044, and p = 0.047, respectively). The HU or Zeff values based on the area of interest of VNCa and Rho/Z images differed significantly between the normal and infiltrated bone marrow area (p < 0.001). Receiver operating characteristic curve analysis revealed area under the curves of 0.995 and 0.988, respectively, with cut-off values of -31.57 HU and 7.8, and the sensitivity of both was 96.9%. CONCLUSION: DECT-VNCa and Rho/Z images have good diagnostic value when evaluating bone marrow infiltration in PMBTs.

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Objectives: To explore the effects of neoadjuvant chemotherapy combined with customized tumor-type total knee arthroplasty (TKA) on immune function and limb function in the treatment of malignant bone tumors around the knee joint. Methods: Sixty-one patients with malignant bone tumors around the knee joint treated in Sichuan Provincial Orthopedics Hospital from February 2018 to February 2020 were retrospectively enrolled and divided into two groups according to treatment methods. The differences in immune function indexes before and after treatment were compared between the two groups. And their postoperative complications were recorded. Results: Before treatment, no significant difference can be observed in the comparison, values between the two groups (P>0.05); After treatment, the levels in Group-A were higher than before treatment (P<0.05), but the levels were not different from those before treatment (P>0.05). In contrast, the levels in Group-B were higher than before treatment and higher than that in Group-A, while the level of CD8+ was lower than before treatment and lower than that in Group-A (P<0.05). At six months postoperatively, no significant difference was observed in the excellent and good rate of limb function between the two groups (P>0.05). There were no differences in the incidence of postoperative prosthesis complications and the incidence of adverse chemotherapy reactions between the two groups (P>0.05). Conclusion: Neoadjuvant chemotherapy combined with customized tumor-type TKA for knee malignant bone tumors is an excellent safety treatment for malignant bone tumors around the knee joint, boasting a variety of benefits, such as significantly ameliorating the immune function of patients and promoting the recovery of limb function, which is worthy of clinical application.

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BACKGROUND: It is well-known that exercise through sports and physical activity has beneficial effects on health. After lower extremity amputation, low rates of participation in sports activities have been shown. So far, there is only limited scientific long-term information concerning sports activity and feasible types of sports in patients with lower extremity amputations due to malignant tumors. This study sought to provide very long-term information about the following questions: (1) What sports activity levels can be achieved after lower extremity amputation due to a malignant tumor? (2) What are feasible types of sports? (3) Is the University of California Los Angeles (UCLA) Activity Score influenced by patient's age, the age at the time of surgery and the amount of prosthesis sockets used to date? HYPOTHESIS: Patients with lower extremity amputation due to a malignant tumor cannot regularly participate in moderate sports activities (UCLA Activity Score≥6) in the very long-term. MATERIALS AND METHODS: In a retrospective questionnaire survey, 21 former patients (seven females, 14 males; median age: 60.5years [range: 33-74]) who underwent an amputation of the lower extremity (14 transfemoral, four knee disarticulations, three transtibial) from 1961 to 1993 due to a malignant tumor were interviewed. The median follow-up was 41.1years (range: 23-55). The patients were interviewed about types of sports, frequencies and durations of sports sessions at the time of the last follow-up, as well as retrospectively. Sports activity levels were then assessed based on the UCLA Activity Score. Demographic background, data on amputation level, histological results, prosthetic devices and revision surgeries were collected. RESULTS: Seven patients (33%) were still regularly exercising at least moderate sports activities at the last follow-up, including one patient regularly participating in impact sports. The preoperative median UCLA Activity Score of 9 (range: 2-10) decreased to 5 (range: 2-10) at the last follow-up (p<0.001). Swimming (13 patients, seven on a regular basis), cycling (seven), downhill skiing (five) and hiking (four) were among the most common feasible types of sports. Increasing age had a negative influence on the UCLA Activity Score [95% CI (-0.034, -0.006); RB=-0.020; SD=0.0074; p=0.007]. CONCLUSION: After a major amputation in the lower extremity due to a malignant tumor, high activity levels by practicing types of sports such as downhill skiing, are achievable. In the very long-term, a regular participation in at least moderate activities, such as swimming, is possible. Programs for physical and sports activities, based on recommendations drawn from long-term experience, are necessary and should be individually tailored to amputees and their limitations. LEVEL OF EVIDENCE: IV.

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PURPOSE: Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children. METHODS: A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb's case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint. RESULTS: The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities. CONCLUSIONS: The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

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PURPOSE: The proximal femur is a common area for primary and also metastatic bone tumors. The objective of this study was to assess the long-term functional and oncological outcomes of patients with malignant primary or secondary tumors of the proximal femur, who underwent proximal femoral resection then reconstruction using bipolar modular tumor prosthesis. METHODS: Sixty patients with proximal femoral malignant tumors underwent resection and bipolar modular prosthesis between 2000 and 2016, were retrospectively reviewed. Based on diagnosis and presence or absence of pathological fracture, patients were divided into groups. The functional outcome of the patients was evaluated using the Musculoskeletal Tumor Society (MSTS) functional scoring system for the lower extremities. RESULTS: The mean age was 38 (9-80) years at the time of primary surgery. Pathological fracture was the presentation in 28 patients. The study included 44 patients with primary bone tumor and 16 patients with a secondary bone tumor. The mean MSTS functional score of the patients was 24.3 (range, 18-30) points with no significant difference in patients with primary or secondary tumors. The rate of complications in the present series was 45%. The most frequent complication was an infection in 10 patients (16.7%), followed by aseptic loosening in 7 patients (11.7%). Local recurrence of primary bone tumors occurred in three out of 44 patients (6.8%). CONCLUSION: Modular bipolar tumor prosthesis has a good long-term functional result in both primary and secondary tumors of the proximal femur, with no significant effect of age, presence or absence of pathological fracture or femoral resection length on the functional outcome. It was found that the only statistically significant variable regarding the risk of infection is previous surgeries. LEVEL OF EVIDENCE: Level IV, retrospective case series.

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Survivors of malignant bone tumors in childhood are at risk of long-term adverse health effects. We comprehensively reviewed cases of somatic diseases that required a hospital contact in survivors of osteosarcoma and Ewing sarcoma. In a population-based cohort study, 620 five-year survivors of osteosarcoma (n = 440) or Ewing sarcoma (n = 180), diagnosed before the age of 20 years in Denmark, Finland, Iceland, and Sweden during 1943-2008, were followed in the national hospital registers. Overall rates of hospital contacts for any somatic disease and for 12 main diagnostic groups and 120 specific disease categories were compared with those in a matched comparison cohort (n = 3049) randomly selected from the national population registers. The rate of hospital contact for any somatic disease was 80% higher in survivors of malignant bone tumors than in comparisons and remained elevated up to 30 years after diagnosis. The rate of hospital contacts was higher after Ewing sarcoma (rate ratio (RR) 2.24; 95% confidence interval (CI) 1.76-2.85) than after osteosarcoma (RR 1.67; 95% CI 1.41-1.98). Elevated rates were observed for 11 main diagnostic groups, including infections, second malignant neoplasms, and diseases of the skin, bones, and circulatory, digestive, endocrine, and urinary systems. Survivors of malignant bone tumors in childhood are at increased risk of somatic diseases many years after diagnosis. This comprehensive study contributes new insight into the risk of late effects in survivors of osteosarcoma and Ewing sarcoma, which is an essential basis for optimal patient counseling and follow-up care.

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We aimed to evaluate the functional outcome and endoprosthetic complications following the Bateman-type soft tissue reconstruction around proximal or total humeral replacements in patients undergoing resection of a primary malignant bone tumor. Between September 2001 and December 2018, a total of 102 patients underwent resection of a primary malignant bone tumor and subsequent reconstruction with a modular humeral megaprosthesis in our department. Fifteen (15%) of these patients underwent a Bateman-type soft tissue reconstruction and were included in this retrospective study. The median Musculoskeletal Tumor Society (MSTS) score was 21, the median Toronto Extremity Salvage Score (TESS) was 70, and the median American Shoulder and Elbow Surgeons (ASES) score was 72. Fifty-three percent (8/15) of all patients required a revision surgery after a median time of 6 months. There were 2 soft tissue failures, 3 infections and 3 tumor recurrences. The revision-free implant survivorship amounted to 53% (95% confidence interval (CI) 28-81) after 1 year and 47% (95% CI 22-73) at last follow-up. The Bateman-type reconstruction is a feasible option for soft tissue reconstruction but functional outcome is overall limited and the risk for revision surgery within the first postoperative year is high.

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BACKGROUND: Following proximal tibial resection and modular endoprosthetic reconstruction, extensor mechanism can be reconstructed with different techniques. This study compares direct reattachment (DR) with medical textile augmented reattachment (MTAR) methods in terms of functional results and radiological results. MATERIALS AND METHODS: Fifty-five patients (34 male, 21 female) operated between 1990 and 2015 with a minimum follow up of 24 months in a single center were evaluated retrospectively. The median age was 18 years (range: 9-64). The reconstruction was performed via MTAR (polypropylene mesh, Trevira) in 23 patients and DR in 32 patients. Incidence and degree of extension lag, degree of flexion and development of postoperative patella alta were evaluated at 3, 6 and 24 months. RESULTS: The mean follow up was 78.5 months. Extension lag incidence at 24 months was 71.9% in the DR group compared with 43.5% in the MTAR group (P < 0.05).Theextensionlagratiosat 24 months in DR was 0-5° in 8.7% (n = 2), 6-10° in 21.7% (n = 5), 11-15° in 17.4% (n = 4) and > 15° in 52.2% (n = 12), respectively. Extension lag ratios at 24 months in MTAR were 0-5° in 12.5% (n = 4), 6-10° in 6.3% (n = 2), 11-15° in 6.3% (n = 2) and > 15° in 6.3% (n = 2). The mean MSTS score in DR group was 20.7 compared with 23.2 in the MTAR group (P = 0.008). CONCLUSION: MTAR is associated with a lower incidence as well as a lower degree of extension lag. The flexion range and the incidence of patella alta are not statistically different between the groups. MSTS scores of MTAR group are significantly higher than DR group at 2-year follow up.

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BACKGROUND: It has been recognized that cancer is associated with a higher risk of suicide or accidental death. Earlier studies have evidenced that patients with malignant bone tumors usually experience psychological dysfunction and physical disability following surgery, which are shared risk factors between suicidal and accidental deaths. To our knowledge, there is no large population-based study on the risk of suicide or accidental death among patients with malignant bone tumors. QUESTIONS/PURPOSES: This study aimed to determine whether patients with primary malignant bone tumors are at a higher risk of suicide and accidental death than the general population and to identify the demographic and tumour-related characteristics and type of surgery associated with a higher risk of suicide and accidental death among these patients. METHODS: Overall, 50,817 patients diagnosed with primary malignant bone tumors between 1973 and 1975 were identified from the Surveillance, Epidemiology, and End Results database. The standardised mortality ratio (SMR) was calculated based on the general population's mortality data, gathered by the National Center for Health Statistics. The Cox regression model was developed to determine risk factors associated with a higher risk of suicide and accidental death. RESULTS: Patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general population in the United States (US) (SMR = 2.17; 95% confidence interval (CI) [1.80-2.62] and SMR = 1.73; 95% CI [1.54-1.95]). Compared with limb salvage, amputation significantly increased the risk of suicide (SMR = 3.99; 95% CI [2.52-6.34], hazard ratio (HR) = 2.32; 95% CI [1.31-4.09]; P < 0.01) but did not increase the risk of accidental death (SMR = 1.61; 95% CI [1.07-2.42], HR = 1.11; 95% CI [0.71-1.74]; P = 0.65). Higher suicide risk was observed among older patients whose age at diagnosis was more than 60 years (HR = 4.04; 95% CI [1.98-8.26]; P < 0.001), males (HR = 3.48; 95% CI [2.16-5.62]; P < 0.001), and whites (HR = 3.71; 95% CI [1.17-11.73]; P < 0.001). The risk of suicide and accidental death was highest in the first year after diagnosis (SMR = 2.95; 95% CI [1.86-4.69] and SMR = 2.02; 95% CI [1.48-2.74]). CONCLUSION: We first reported that patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general US population. Therefore, clinicians should pay more attention to the psychological status, physical function, and cognitive level of these survivors.

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BACKGROUND: (I) To determine whether patients with malignant bone tumors had a higher risk of dying from pneumonia compared with the general US population; (II) to identify the independent risk factor associated with fatal pneumonia among these patients. METHODS: We identified 18,583 patients diagnosed with primary malignant bone tumors between 1973 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios (SMRs) were calculated based on the mortality data of the general population gathered by the National Center for Health Statistics, which provided the risk of death from pneumonia among cancer patients relative to that of the general population. Given that other causes of death were considered as competing events, we also designed the Fine-Gray model to identify demographic and tumor-related characteristics associated with a higher risk of dying from pneumonia among these patients. RESULTS: Patients with primary malignant bone tumors had a higher risk of dying from pneumonia than the general population after adjusting the distribution difference of age, sex, and race among them (SMR =2.79; 95% CI: 2.17-3.59). The older age, Black and earlier period of diagnosis were found to be the independent prognostic factor for a higher risk of death from pneumonia for these patients. Additionally, amputation due to malignant bone tumors significantly increased the risk of death from pneumonia compared with non-surgery. The highest mortality rate of pneumonia was observed among patients with chordoma. Interaction tests demonstrated that amputation only increased the relative risk of fatal pneumonia among patients with osteosarcoma. Throughout the follow-up period, the mortality rate of fatal pneumonia was the highest within the first year after diagnosis, and the highest relative suicide risks persisted over time in patients with osteosarcoma. CONCLUSIONS: To mitigate the risk of fatal pneumonia among patients with bone tumors, we call for long-term clinical monitoring of the lung condition among these patients, especially for those after amputation for bone tumors.

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Background: Malignant bone tumors (MBT) are one of the causes of death in elderly patients. The purpose of our study is to establish a nomogram to predict the overall survival (OS) of elderly patients with MBT. Methods: The clinicopathological data of all elderly patients with MBT from 2004 to 2018 were downloaded from the SEER database. They were randomly assigned to the training set (70%) and validation set (30%). Univariate and multivariate Cox regression analysis was used to identify independent risk factors for elderly patients with MBT. A nomogram was built based on these risk factors to predict the 1-, 3-, and 5-year OS of elderly patients with MBT. Then, used the consistency index (C-index), calibration curve, and the area under the receiver operating curve (AUC) to evaluate the accuracy and discrimination of the prediction model was. Decision curve analysis (DCA) was used to assess the clinical potential application value of the nomogram. Based on the scores on the nomogram, patients were divided into high- and low-risk groups. The Kaplan-Meier (K-M) curve was used to test the difference in survival between the two patients. Results: A total of 1,641 patients were included, and they were randomly assigned to the training set (N = 1,156) and the validation set (N = 485). The univariate and multivariate analysis of the training set suggested that age, sex, race, primary site, histologic type, grade, stage, M stage, surgery, and tumor size were independent risk factors for elderly patients with MBT. The C-index of the training set and the validation set were 0.779 [0.759-0.799] and 0.801 [0.772-0.830], respectively. The AUC of the training and validation sets also showed similar results. The calibration curves of the training and validation sets indicated that the observed and predicted values were highly consistent. DCA suggested that the nomogram had potential clinical value compared with traditional TNM staging. Conclusion: We had established a new nomogram to predict the 1-, 3-, 5-year OS of elderly patients with MBT. This predictive model can help doctors and patients develop treatment plans and follow-up strategies.

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