F H Sim

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (387)1059.32 Total impact

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    ABSTRACT: Objective: To describe the radiographic, CT, and MRI appearance of synovial chondromatosis of the spine. Materials and methods: Radiology and pathology databases were searched for cases of spinal synovial chondromatosis from 1984 through 2013, yielding 29 patients (16 males, 13 females). The average age was 45 years. Twenty-eight patients had imaging studies available for review including seven radiographs, two myelograms, 13 CT, and 23 MRI exams. Results: Cases were located in the cervical spine (16), thoracic spine (6), lumbar spine (6), and sacrum (1). Twenty-two cases (79 %) had an epidural component. Eighteen (64 %) had a neural foraminal component. Sixteen (57 %) had a paraspinal component. The mass abutted a facet joint in 96 % of cases. Nearly all (96 %) showed a normal facet joint without internal erosive changes. Most (79 %) showed evidence of chronic extrinsic bony erosion, usually involving the surface of the facet. Only 44 % had calcifications as a dominant finding. Most patients (88 %) had evidence of neural compression. On T1-weighted MRI, 80 % showed intermediate or a combination of intermediate and dark signal. On T2-weighted images, 89 % showed heterogeneous signal with discrete areas of dark signal. The majority (83 %) showed a peripheral pattern of enhancement, usually peripheral nodular. Conclusions: Synovial chondromatosis should be considered in the differential diagnosis when evaluating an epidural and/or paraspinal mass near a facet joint, especially when there is evidence of chronic extrinsic bone erosion, dark signal or nodules on T1 and/or T2, and nonenhancing fluid or myxoid signal centrally with thin or nodular peripheral enhancement.
    Skeletal Radiology 09/2015; DOI:10.1007/s00256-015-2248-8 · 1.51 Impact Factor
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    ABSTRACT: Background: In order to achieve an oncological margin during limb salvage surgery for tumors of the distal femur, part or the entire knee joint is frequently sacrificed. Endoprosthetics make limb salvage possible through restoration of a functional extremity. Currently there remains a paucity of data concerning their long-term outcomes and associated risk factors for failure. Methods: We identified 152 patients who underwent an endoprosthetic reconstruction for an oncological process of the distal femur between 1972 and 2013. The mean follow-up was 10years. Mean age and body mass index (BMI) were 39years and 25.8 respectively. The most common pathology was osteosarcoma (n=78, 48%). Outcomes were compared to a control group of 20,643 patients undergoing total knee arthroplasty (TKA) for degenerative joint disease (DJD) during the same time period. Results: The mean five-, 10-, 15-, 20-, and 25-year revision-free survival for an endoprosthesis was 76%, 63%, 51%, 36%, and 28%. Compared to the five-, 10-, 15-, 20-, and 25-year survival of 95%, 90%, 82%, 74%, and 67% for control TKAs (p<0.0001 at all-time points). Overall limb survival was 93%, with 11 patients undergoing amputation. There was no difference in implant survival comparing modular and custom endoprostheses. Conclusion: The results of this study show that given the complexity of these operations, the rate of revision surgery following endoprosthetic replacement is high. Nevertheless, the use of these modular reconstructions leads to a high rate of limb salvage (93%) over a 25-year period at our institution. Level of evidence: Level III.
    The Knee 09/2015; DOI:10.1016/j.knee.2015.08.010 · 1.94 Impact Factor
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    ABSTRACT: Purpose: In order to achieve an oncological margin during limb salvage surgery for tumours around the hip, part or the entire hip joint is frequently sacrificed. Hip arthroplasty restores a functional extremity and achieves limb salvage. Currently there is a paucity of data concerning the late complications, long-term survival, and the risks of re-revision following aseptic revision of a total hip arthroplasty (THA) performed following an oncological resection. Methods: We identified 78 patients who underwent aseptic revision of a THA which was performed for an oncological process involving the hip from 1972 to 2006. All patients had a minimum 5 years of follow-up with a mean of 13 years. Outcomes were compared to 1,378 patients undergoing aseptic revision of a THA that was performed for a diagnosis of osteoarthritis. Results: The mean 5-, 10-, 15-, and 20-year re-revision-free survival for an oncologic process of the hip was 100%, 85%, 69%, and 57%. Within this cohort, younger patients were at an increased risk of revision surgery. There was no difference in survivorship of the revision implant at any of the aforementioned time points between the oncologic and osteoarthritis cohorts. Patients with an oncologic diagnosis had a higher rate of dislocations, component wear, and loosening compared to the osteoarthritis group. Conclusion: Late complications following revision surgery of THA performed for an oncologic resection are common. The results of this study provide information for counselling patients on implant survivorship and complications following aseptic revision THA after index surgery for an oncologic indication.
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 09/2015; 25(5). DOI:10.5301/hipint.5000280 · 0.76 Impact Factor
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    ABSTRACT: Major amputations are indicated for curative treatment of some tumors of the pelvis. Previous literature suggests that patients with a hemipelvectomy amputation are more efficient walking with crutches than using a prosthesis. The purpose of this study was to evaluate whether modern prosthetic use after hemipelvectomy may be a viable option for patients than in the past. Case control trial. We identified five patients who underwent hemipelvectomy amputation and fit with high-level prosthetic components. Patients were evaluated using a timed up and go, 5-m walk, 400-m walk, and stair climb tests to evaluate functional performance with a prosthesis and without. Short Form-36 scores were collected as well. These results were compared to matched controls. There was a trend for faster locomotion using crutches over wearing a prosthesis in the timed up and go, and 5-m and 400-m walk; no difference was seen in stair climbing. Short Form-36 scores showed decreased physical component score, but equal mental component score compared to the general population. Our results show that in addition to advances in surgical techniques, prosthetic rehabilitation and management are beginning to optimize functional mobility with the prosthesis. Patients who use a modern prosthesis following hemipelvectomy demonstrated good clinical function with and without their prosthesis. Although health status scores were decreased in the physical component, mental component scores were equal to healthy controls. © The International Society for Prosthetics and Orthotics 2015.
    Prosthetics & Orthotics International 04/2015; DOI:10.1177/0309364615574164 · 1.04 Impact Factor
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    ABSTRACT: Prosthetic rehabilitation after pelvic-level amputation (hemipelvectomy/hip disarticulation) is difficult, and because of this, many patients are never fit with a prosthetic limb. The objectives of the study were to evaluate the characteristics of successful prosthetic users and to determine what factors are associated with successful prosthetic fitting and use. The authors identified 43 patients who underwent hip disarticulation/hemipelvectomy between 2000 and 2010 and were candidates for prosthetic fitting at the authors' institution. The medical records of these patients were then reviewed for pertinent demographic and medical characteristics to identify the profile of successful prosthetic users. Of 43 patients, 18 (43%) successfully used a prosthetic limb. The only preoperative factor associated with unsuccessful prosthetic fitting was coronary artery disease. Specifically, age, body mass index, other medical comorbidities, and demographic characteristics were not associated with successful or unsuccessful prosthetic fitting. Successful users wore their prosthesis an average of 5.8 hrs/day, and most ambulated with one or both hands free. Successful prosthetic rehabilitation after hemipelvectomy and hip disarticulation is possible. Increased body mass index, advanced age, depression, and other comorbidities should not discourage prosthetic rehabilitation. Most patients that undergo prosthetic rehabilitation enjoy long periods of survival and wear their prosthesis for most of the day.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 04/2015; Publish Ahead of Print(12). DOI:10.1097/PHM.0000000000000292 · 2.20 Impact Factor
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    ABSTRACT: Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing. We asked whether a running subcuticular, vertical mattress, or skin staple closure technique enables the most robust wound perfusion after TKA as measured by laser-assisted indocyanine green angiography (LA-ICGA) in patients without specific risk factors for wound healing complications. Forty-five patients undergoing primary TKA without comorbidities known to impact wound healing and perfusion were prospectively randomized to receive superficial skin closure with one of the following techniques: (1) running subcuticular (3-0 monofilament); (2) vertical mattress (2-0 nylon); or (3) skin staples. Twenty procedures were performed by RTT, 15 by RJS, and 10 by FHS. All surgeons used an anterior skin incision over the medial third of the patella in combination with a median parapatellar arthrotomy. Perfusion was assessed with a LA-ICGA device and software system immediately after closure to quantify fluorescence. Twenty-seven points were assessed immediately after closure in the operating room in each patient (nine along the incision and nine pairs medial and lateral to the incision). Mean incision perfusion was determined from the nine points along the incision with higher values indicating greater blood flow. Mean perfusion impairment was determined by calculating the difference between the nine pairs of surrounding skin and the nine points along the incision with smaller values indicating less perfusion impairment. These parameters were compared with analysis of variance (ANOVA) and subsequent pairwise comparisons with an unadjusted analysis as well as a multivariate analysis that adjusted for age, sex, and body mass index. Patients were followed for a mean of 7 months after surgery (range, 3-12 months) for possible incision-related complications. No patents were lost to followup. Running subcuticular closure demonstrated the best overall perfusion. Mean incision perfusion in fluorescent units with SD was as follows: running subcuticular, 64 (16); vertical mattress, 32 (18); and staples, 19 (7) (ANOVA p < 0.001). The running subcuticular closure demonstrated the least impairment of perfusion among the closures compared. Mean perfusion impairment was as follows: running subcuticular, 21 (12); vertical mattress, 37 (24); and staples, 69 (27) (ANOVA p < 0.001). All Tukey-adjusted pairwise comparisons from both metrics likewise favored the subcuticular closure (p < 0.001) both before and after adjusting for age, sex, and body mass index. One patient in the vertical mattress cohort experienced a surgical site infection; no other wound-related complications were observed in this study. The method of closure can influence skin and soft tissue perfusion after TKA. Running subcuticular closure enables the most physiologic robust blood flow, which may improve wound healing. However, the clinical importance of these findings remains uncertain, because patients in this study were selected because they lacked risk factors for wound healing complications. Studies with this modality in specific patient populations at higher risk for wound complications will be necessary to quantify the clinical advantage of using running subcuticular closure. Level I, therapeutic study.
    Clinical Orthopaedics and Related Research 03/2015; DOI:10.1007/s11999-015-4209-x · 2.77 Impact Factor
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    ABSTRACT: After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations. The purpose of this study was to examine the revision-free survival using he Capanna technique for limb salvage for pediatric lower limb salvage. We attempted to answer the following questions: (1) What was the overall limb salvage rate along with incidence of reoperation and complications? (2) How did pediatric and adolescent patients functionally perform after this technique? (3) What was the incidence of late complications including infection and fracture? (4) What was the incidence of limb length discrepancy? Eighteen pediatric patients who underwent lower extremity limb salvage with the use of cadaveric allograft and intramedullary free fibular transfer (Capanna technique) were identified. There were nine boys males and nine girls with a mean age of 11 years (range, 5-18 years) and mean followup of 8 years (range, 2-15 years), respectively. All patients had at least 2 years followup. Three patients have not been seen in followup during the past 5-years; however, all had made it to their 5-year clinical followup. The patients' medical records were reviewed for clinical and functional outcomes as well as postoperative complications. Time to union was recorded through an evaluation of radiographs. Mankin functional outcome and Musculoskeletal Tumor Society (MSTS) rating scale were recorded for each patient. The overall limb salvage rate was 94%. Fourteen patients underwent an additional surgical procedure. Six patients underwent additional procedure(s) to treat a symptomatic nonunion. Seventeen of the patients had a good or excellent Mankin score with a mean MSTS rating of 93% at last followup. Six of the patients underwent a limb length modification procedure. Use of large allografts in conjunction with intramedullary vascularized free fibulas appears to be a reliable method for the reconstruction of large bony tumors of the lower extremity in this population, although we did not directly compare this with allografts alone in our study. The use of locked plates may improve union times. The proportion of patients achieving limb preservation was high and complication rates are acceptable. Level IV, therapeutic study.
    Clinical Orthopaedics and Related Research 02/2015; DOI:10.1007/s11999-015-4204-2 · 2.77 Impact Factor
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    ABSTRACT: Multiple myeloma is a malignancy of monoclonal plasma cells (plasma cells are of B-lymphocyte lineage of the hematopoietic system). It is the second most prevalent blood malignancy after non-Hodgkin's lymphoma. It accounts for approximately 1 % of all malignancies and 2 % of all cancer deaths. Bony involvement is very common; the incidence of pelvic and periacetabular involvement in MM is reported to be around 6 %. Lytic lesions comprise a hallmark of multiple myeloma, which may be complicated with pathologic fractures in a substantial percentage of patients. Pelvic and periacetabular bony involvement of multiple myeloma is associated with some unique characteristics regarding the biomechanics of this specific anatomical region, the morbidity, the overall survival, and prognosis, which all reflect to impairment of quality of life. In this paper, we review the special features of multiple myeloma lesions around the pelvis and acetabulum and present an algorithm of management with the use of current surgical techniques.
    European Journal of Orthopaedic Surgery & Traumatology 10/2014; 25(4). DOI:10.1007/s00590-014-1555-4 · 0.18 Impact Factor
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    ABSTRACT: Background: Aneurysmal bone cysts (ABCs) are a benign aggressive tumor that occurs rarely in the pelvis in the pediatric population. Pelvic ABCs may involve the triradiate cartilage and/or the acetabulum, which increases the technical difficulty of surgical treatment and has potential implications on the growth and development of the hip joint. This study examines the clinical presentation, rate of surgical complications, and recurrence rate, as well as, long-term clinical and functional outcomes of children with pelvic ABCs treated at a single institution by a single treatment modality.
    Journal of Children s Orthopaedics 05/2014; 8(3). DOI:10.1007/s11832-014-0588-x
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    ABSTRACT: The objectives of this study were to describe the authors' experience with the timeline for prosthetic fitting after rotationplasty of the knee and to determine factors that may be associated with earlier prosthetic fitting. The authors conducted a retrospective observational study of 12 patients who underwent rotationplasty of the knee and received prosthetic care at this institution. All patients had oncologic causes for surgery. The median age at amputation was 10 yrs. The overall survival rate was 92%. Five patients received a preliminary bypass prosthesis. All 12 patients were successfully fitted with a definitive prosthesis. Three patients were fitted within 90 days; two of these three patients did not require chemotherapy. The median time for definitive prosthetic fitting in the ten patients requiring chemotherapy was 230.5 days (range, 85-425 days). Nine patients had documentation supporting a return to sport/premorbid physical recreational activities. In the authors' experience, chemotherapy was associated with delayed definitive prosthetic fitting. Typically, the patients who required rotationplasty for cancer completed fitting with a definitive prosthesis in 6 mos. The findings of this study validate previous reports and confirm that most rotationplasty patients have excellent outcomes with return to premorbid physical activities.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 01/2014; 93(4). DOI:10.1097/PHM.0000000000000044 · 2.20 Impact Factor
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    Alex Senchenkov · Franklin H Sim ·
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    ABSTRACT: Limb salvage procedures in previously operated, radiated, and vessel-depleted fields rely heavily on the use of microvascular tissue transfer. This report illustrates the feasibility of the use of ovarian vessels for the revascularization of a free flap. We have achieved success with the use of rectus abdominis muscle free flap for coverage of exposed vascular reconstruction in the 75-year-old soft tissue sarcoma patient with twice chemoradiated femoral and hypogastric defect, preventing external hemipelvectomy. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.
    Microsurgery 02/2013; 33(2):148-51. DOI:10.1002/micr.22056 · 2.42 Impact Factor
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    ABSTRACT: The goals of pelvic tumor treatment are first, to obtain clear margins and prevent tumor recurrence, and second, to preserve limb function whenever possible. Treatment of tumors around the pelvis remains a difficult problem. Challenges include both tumor resection and pelvic reconstruction. We have made significant advances in both treatment and reconstructive efforts over the last decade with advances in imaging techniques and prosthetic design. Nevertheless, reconstruction after pelvic tumor resection must be individualized for each patient. One must consider age, functional status, and the extent of the tumor before deciding on the best reconstruction option. The aim of this paper is to outline the available reconstructive techniques and to discuss our current preferred strategy for reconstruction of the pelvis after tumor resection.
    02/2013; 2(2). DOI:10.1007/s40137-013-0041-y
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    ABSTRACT: Malignant tumors of the proximal part of the fibula are rare. We sought to analyze the presenting characteristics, postoperative complications, and local recurrences of malignant tumors in the proximal part of the fibula in a large series of patients. We identified 112 histologically confirmed malignant tumors of the proximal part of the fibula from the time period between 1910 and 2007. The sex ratio was nearly equal (fifty-four male, fifty-eight female). The average age of the patients was 27.6 years, and the average follow-up period was 5.7 years. Osteosarcoma (44%) was the most common diagnosis. Pain (86%), palpable mass (51%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. One hundred and three (92%) of 112 underwent curative surgical treatment. The two most common procedures were amputation in fifty (45%) of 112 patients and Malawer type-II resection in twenty-four (21%) of 112 patients. Deliberative sacrifice of the peroneal nerve was performed in seventy-four patients (66%). Postoperative complications occurred in fourteen (12.5%) of 112 patients, including wound issues (ten of 112), peroneal nerve palsy despite nerve preservation (two of twenty-nine), and posterior tibial artery thrombosis (two of 112). No long-term knee instability was seen in the fifty-three patients who underwent resection with lateral collateral ligament reconstruction. Fifty-six patients (50%) developed distant metastases and twelve (11%) had local recurrences. Osteosarcomas are the most common malignant tumor of the proximal fibula. Complication rates are modest and long-term knee instability was not seen in patients undergoing reconstruction of the lateral collateral ligament. Local recurrence following resection is not uncommon and metastatic dissemination is the main cause of death. This series represents the largest collection of such tumors for which there is extended follow-up and data on surgical complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 11/2012; 94(22):e1651-8. DOI:10.2106/JBJS.K.00953 · 5.28 Impact Factor
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    ABSTRACT: We present the first published case of Coxiella burnetii prosthetic joint infection. Diagnosis was established with PCR and culture of periprosthetic tissue and synovial fluid (and serology). A novel PCR assay is described herein. Q fever should be considered in patients with prosthetic joint infection without an identified pathogen.
    Journal of clinical microbiology 10/2012; 53(1). DOI:10.1128/JCM.02352-12 · 3.99 Impact Factor
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    ABSTRACT: Pelvic radiation has been commonly used to treat gastrointestinal, genitourinary, or hematopoietic malignancies. Conventional THA in these patients reportedly have high rates of fixation failure. Although secure short-term fixation reportedly occurs with trabecular metal implants following pelvic radiation, it is unclear whether the fixation is durable. We determined the survival of trabecular metal acetabular components in patients having THA following pelvic radiation and assessed function and radiographic loosening. We retrospectively reviewed 29 patients with prior pelvic radiation who had 34 arthroplasties using trabecular metal acetabular components from 1998 and 2005. The mean pelvic radiation dose was 6300 cGy. We collected the following data: patient demographics, surgery and implant information, clinical and radiographic followup, and tumor and radiotherapy related details. We obtained Harris hip scores (HHS) on all patients. Ten patients died of disease prior to 5 years and two patients were excluded, leaving 17 patients (22 hips) with a minimum of 5 years of clinical (mean, 78 months; median, 71; range, 57-116) and radiographic (mean, 73; median, 65; range, 51-116) followup. All implants were in place in the surviving patients. The mean HHS improved from 36 preoperatively to 80 at latest followup. There were no reoperations for any reason, and we observed no implant loosening or migration at final followup in surviving or deceased patients. Tantalum trabecular metal acetabular components restored function and provided durable reconstruction in patients undergoing THA following prior pelvic radiation. We observed no clinical or radiographic failures at a minimum 5-year followup. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 05/2012; 470(11):3041-7. DOI:10.1007/s11999-012-2382-8 · 2.77 Impact Factor
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    ABSTRACT: Phosphaturic mesenchymal tumor of mixed connective tissue type is a rare, histologically distinctive mesenchymal neoplasm associated with tumor-induced osteomalacia resulting from production of the phosphaturic hormone fibroblast growth factor 23. Because of its rarity, specific genetic alterations that contribute to the pathogenesis of these tumors have yet to be elucidated. Herein, we report the abnormal karyotypes from 2 cases of confirmed phosphaturic mesenchymal tumor of mixed connective tissue type. G-banded analysis demonstrated the first tumor to have a karyotype of 46,Y,t(X;3;14)(q13;p25;q21)[15]/46XY[5], and the second tumor to have a karyotype of 46, XY,add(2)(q31),add(4)(q31.1)[2]/92,slx2[3]/46,sl,der(2)t(2;4)(q14.2;p14),der(4)t(2;4)(q14.2;p14),add(4)(q31.1)[10]/46,sdl,add(13)(q34)[4]/92,sdl2x2[1]. These represent what is, to our knowledge, the first examples of abnormal karyotypes obtained from phosphaturic mesenchymal tumor of mixed connective tissue type.
    Human pathology 04/2012; 43(8):1334-8. DOI:10.1016/j.humpath.2011.11.020 · 2.77 Impact Factor
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    Courtney E. Sherman · Mary I. O’Connor · Franklin H. Sim ·
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    ABSTRACT: BackgroundMalignant pelvic tumors frequently pose challenges to surgeons owing to complex pelvic anatomy and local extension. External hemipelvectomy frequently allows adequate margins but is associated with substantial morbidity and reduced function. Limb salvage is an alternative approach when adequate margins can be achieved, but long-term function and survival are unclear. Questions/purposesWe therefore determined the long-term survival; development of late local recurrence and metastases; function; and need for further reconstructive procedures for patients undergoing limb salvage for treatment of malignant pelvic tumors. Patients and MethodsWe retrospectively reviewed 60 patients treated with pelvic limb salvage before 1989. We reviewed medical records and sent questionnaires incorporating Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage scores to the 38 patients who had no evidence of disease in 1989; 15 patients responded. Minimum followup was 23years (median, 30years; range, 23–38years). ResultsOverall survival rate of the 60 patients was 45%: 100% Stage IA, 75% Stage IB, 31% Stage IIB, and 0% Stage III were alive. Late local recurrence developed only in patients with chondrosarcoma (three of 24). Two patients developed late distant bone metastases. Function declined: the MSTS score of the 15 patients who completed a questionnaire decreased 23%. Two patients had further reconstructive procedures. ConclusionsAt 23- to 38-year followup, we believe pelvic limb salvage is a reasonable treatment if satisfactory margins can be achieved. If a patient with pelvic sarcoma is free of disease 5years after sarcoma resection, the subsequent risk of death from sarcoma appears to be low. Late local recurrence remains a risk in patients with pelvic chondrosarcoma. Patient-reported function of the salvaged limb declined with long-term followup. Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2012; 470(3):712-727. DOI:10.1007/s11999-011-1968-x · 2.77 Impact Factor
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    ABSTRACT: Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail. After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium. We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months). Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation. Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2012; 470(2):594-601. DOI:10.1007/s11999-011-2117-2 · 2.77 Impact Factor
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    ABSTRACT: Multicentric osteosarcoma (M-OGS) is characterized by multicentricity of osseous osteosarcomas, either synchronous or metachronous, without visceral involvement. The study's purpose was to clinicopathologically and radiographically analyze 56 cases of M-OGS (22 synchronous and 34 metachronous). The distal femur was the most common site. Histologically, all tumors were high grade. Of 22 patients with synchronous M-OGS, 16 had 3 or more simultaneous tumors; the axial skeleton was involved in 14 (64%) of 22 cases. In metachronous M-OGS, the second malignancy occurred after a median of 22 months. Treatment was surgery, chemotherapy, radiotherapy, or a combination of these. Patients with metachronous osteosarcoma had a median survival longer than did patients with synchronous tumors. Overall, 8 long-term survivors were treated by aggressive surgery with wide margins (plus chemotherapy and/or radiotherapy). M-OGS combines multiple skeletal locations of high-grade conventional osteosarcomas and has a poor prognosis. Aggressive surgery may result in improved long-term survival, particularly in patients with metachronous disease.
    American Journal of Clinical Pathology 11/2011; 136(5):799-807. DOI:10.1309/AJCP0V0OATKCNAZP · 2.51 Impact Factor

Publication Stats

9k Citations
1,059.32 Total Impact Points


  • 1974-2014
    • Mayo Clinic - Rochester
      • • Division of Orthopaedic Surgery
      • • Department of Orthopedics
      Рочестер, Minnesota, United States
  • 2009
    • Semmelweis University, Budapest
      • Department of Orthopaedics
      Budapest, Budapest fovaros, Hungary
  • 2008
    • Johns Hopkins University
      • Department of Orthopaedic Surgery
      Baltimore, MD, United States
  • 2007
    • Thomas Jefferson University
      • Department of Orthopaedic Surgery
      Philadelphia, Pennsylvania, United States
  • 2006
    • Mayo Foundation for Medical Education and Research
      Rochester, Michigan, United States
  • 2005
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2004
    • Rothman Institute
      Philadelphia, Pennsylvania, United States
    • China Medical University Hospital
      臺中市, Taiwan, Taiwan
  • 2003
    • Alexandria University
      Al Iskandarīyah, Alexandria, Egypt
  • 2002
    • State University of New York Upstate Medical University
      • Department of Orthopedic Surgery
      Syracuse, NY, United States
  • 1998
    • Chang Gung Memorial Hospital
      • Department of Orthopaedic Surgery
      Taipei, Taipei, Taiwan
  • 1996-1997
    • State University of New York
      New York City, New York, United States
  • 1994
    • Jacksonville College
      Jacksonville, Florida, United States
  • 1982
    • University of Minnesota Rochester
      Rochester, Minnesota, United States