• The Journal of the Korean bone and joint tumor society
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• v.3 no.2
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• pp.119-126
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• 1997

From 1980 to 1997, we experienced 3 skip metastasis in femur out of 19 osteosarcoma patients. After diagnostic incisional biopsy and chemotherapy, hip disarticulations for all patients were performed. Still the mechanism of skip metastasis is unclear, but there have been two suggestions including medullary extension through an intraosseous embolism of tumor cells, or trans articular extension along the planes of fascia, capsule, ligaments, and venous channels around joints. The mechanisms of skip metastasis in our cases were not clear, but it was considered as an initial preliminary stage of metachronous osteosarcoma. If there are evidences of skip metastasis, it is strongly recommended to disarticulate proximal to the skip lesion rather than to amputate transmedullary.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.8-17
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• 1996

The purpose of this study is a comparative evaluation of range motion, especially extension deficit between the group of total patellectomy and that of intact patella, after reconstruction of the patellar tendon in the prosthetic replacement of a proximal tibia. Between 1990 and 1994, 15 patients who had a primary malignancy on proximal tibia were operated on. All patients were evaluated clinically and radiographically. Two patients were excluded because one had a deep infection treated with arthrodesis of the knee and the other was a composite allograft. The mean follow-up of the 13 patients was 27 months(15-47), including 10 osteosarcomas, 1 chondrosarcoma, 1 malignant fibrous histiocytoma and 1 malignant giant cell tumor. Eleven patients had a resection of the proximal tibia and 2 had an extracapsular total knee resection with distal femur. Reconstruction of the defect was done in 8 cases with a custom-made Link Endo-Model Total Rotation Knee Joint Prosthesis, and in 5 with How Medica Modular Resection System (HMRS). We used two methods to reconstruct the ligamentum patellae. Fixation of the patellar tendon to the prosthesis only with suturing and/or stapling(group SS) was done in 7. Transposition of gastrocnemius muscle to enhance fixation and to cover the prosthesis(group TG) was done in 6. Regardless of fixation methods, total patellectomy was done in 5 either to lengthen the patellar tendon or to make primary skin closure easier or for both. In 8 cases, patella was left intact or resurfaced with polyethylene prosthesis. Active extension was measured while the patient was in a sitting position. There is no statistically meaningful difference in terms of extension deficit (Wilcoxon rank test, p=0.8800) between patellectomy group and intact patella group, and between group of fixation only with suturing and that of gastrocnemius transposition. Two cases of extension deficit over 30 degree were seen in group SS and in the group of intact patella. Conclusively, total patellectomy could be an option without increasing the risk of extension deficit when primary skin closure is difficult or patellar tendon is a little bit short to be fixed. There is no rating in the Enneking system of functional evaluation that this finding into consideration.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.1-8
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• 1997

Osteosarcoma is the most common primary bony malignancy and its survivorship has been progressed markedly through refined chemotherapy and surgery. But still there are many non-responders and analysis of prognostic factors may be helpful for them. Two hundred and sixty-six patients were enlisted between Mar, 1985 and Sep. 1994. Among them our inclusion criteria were: 1)primary, nonmetastatic classical osteosarcoma 2)extremity in location 3)no prior treatment at other institute and completed neoadjuvant chemotherapy and surgery according to our protocol. One hundred and eleven cases were eligible. Analyzed factors were:age, sex, location, tumor size, and pathologic response. Statistical methods were log-rank test for univariate and Cox's test for multivariate analysis. Male to female ratio was 69:42 with an average age of 17.2 years. Locations of tumor were distal femur 59, proximal tibia 29, and proximal humerus 8. Tumor size were measured by its maximal diameter and 48 cases were above 10cm and 47 cases were below 10cm. For pathologic response, 57 cases showed more than 90% and 54 cases were less than that. Limb salvage procedure was 101 cases and amputation was 10 cases and their local recurrence rate were 3.6%. Average follow-up period was 24(9-78.2) months and their final status was CDF 86, AWD 8, NED 5, and DOD 12 cases. In univariate study: type of operation(p=0.005), tumor size(p=0.005), and pathologic response(p=0.02) were significant variables. Pathologic response(p=0.03) and type of operation(p=0.01) were meaningful prognostic factors on multivariate analysis. But the latter result was interpreted as a bias, so pathologic response remained as a sole meaningful prognostic factor. More aggressive chemotherapy will be needed to improve the survival.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.2
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• pp.89-93
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• 2014

Clear cell chondrosarcoma is a very rare malignant bone tumor that shows a strong predilection for the epiphysis or metaphysis of long bones. Many studies have reported that the proximal end of the femur is the most commonly affected site, followed by the proximal end of the humerus. Histopathologically, tumor cells of this type have centrally located round nucleoli with clear cytoplasm and a distinct cytoplasmic membrane. Generally, clear cell chondrosarcomas is not confused with conventional chondrosarcomas. However, when it involves the diaphysis in long bones, diagnosis can be hindered, as only three reports of this exist in the literature. We report herein an unusual case of clear cell chondrosarcoma of the tibial diaphysis in a 42-year-old male.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.11
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• pp.337-346
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• 1996

Debonding of cement-femoral stem interface has been suggested as a initial focus of loosening mechanism in many previous studies of cemented total hip replacement. The purpose of this study was to investigate the effect of debonding of cement-femoral stem interface to the bone-cement interface by using three-dimensional non-liner finite element analysis. Three cases of partial debonded, full debonded, full bonded cement-bone interface were modelled with partial bonding of distal 70mm from the tip of femoral stem. Each situation was studied under loading stimulating one-leg stanced gait of 68kg patient. The results showed that under partial and full debonded cement-stem interface condition the peak von Mises stress(3.1 MPa) were observed at the cement of bone-cement interface just under the calcar of proximal medial of femur, and sudden high peak stresses(3.5MPa) were developed at the distal tip of femoral stem at the lateral bone-cement interface in all 3 cases of bonding. The stresses were transfered very little to the cement of upper lateral bone-cement interface in partial and full debonded cases. Thus, once partial or full debonded cement-femoral stem interface occured, 3 times higher stress concentration were developed on the cement of proximal medial bone-cement interface than full bonded interface, and these could cause loosening of cemented total hip replacement. Clinically, preservation of more rigid cement-femoral stem interface may be important factor to prevent loosening of femoral stem.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.1
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• pp.25-32
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• 2008

Purpose: This study was performed to evaluate the efficiency of Hydroxyapatite ($Bongros^{(R)}$-HA) what use for bone defect after operative treatment of benign bone tumor. Materials and Methods: Hydroxyapatite, was used to treat bone defect after operative treatment of benign bone tumor from September, 2006 to December, 2007. A total of 17 benign bone tumor cases (10 males and 7 females) with mean age of 28.5 was observed studied. The diagnoses were fibrous dysplasia in 8 cases, solitary bone cyst in 5 cases, and giant cell tumor in 4 cases. In categorization by location of tumor, there were 6 cases of proximal femur, 3 cases of proximal femur, 3 cases of proximal tibia, 4 cases of proximal humerus, and 1 case of hip bone. Autogenous bone was used with Hydroxyapatite in 4 cases, and only Hydroxyapatite used in 13 cases. Periods of Follow-up were from 3 months to 15 months, and mean period were 7.5 months. Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Results: More than 98% bone uptake was observed after mean 4.5 months, and more than 98% bone formation was observed after mean 6.2 months. Lesser bone defect size showed faster bone formation and it was statistically significant result (P=0.012). But other comparative studies on other factors such as sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complications in periods of follow-up. Conclusion: Hydroxyapatite is considered as one of useful method of bone defect after operative treatment of benign bone tumor.

• Journal of the Korean Society of Radiology
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• v.11 no.1
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• pp.43-48
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• 2017

Measurement of bone marrow measurements may occur if bone marrow examination performed with bone marrow examination (bone marrow examination) and bone density (bone scan) are performed together recently. Thus, it was examined in clinical aspects that $^{99m}Tc-MDP$ compounds were affected by bone mineral density measurements. The average age of the participants in the experiment was $35.17{\pm}9.45$ and the patient fractures of the lumbar vertebrae that could affect the metabolic disease and bone density measurements affecting the metabolic disease of the 17 subjects. 6 patients with normal bone mineral density T-scores>-1.0 in 12 patients were analyzed before and after the administration of $^{99m}Tc-MDP$. In the lumbar spine, the average of $0.975{\pm}0.084g/cm^2$ and $0.966{\pm}0.078g/cm^2$ were increased by $0.009g/cm^2$. respectively In the right proximal femur, mean values were $0.909{\pm}0.078g/cm^2$ and $0.913{\pm}0.086g/cm^2$. In the right proximal thigh, mean values were $0.909{\pm}0.078g/cm^2$ and $0.913{\pm}0.08 g/cm^2$, respectively, which decreased by $0.004g/cm^2$. In the left side proximal femur, mean $0.887{\pm}0.099g/cm^2$ and $0.881{\pm}0.103g/cm^2$, respectively, increased by $0.007g/cm^2$. Therefore, the BMD changes in the lumbar region were larger than that in the proximal thigh. In addition, $^{99m}Tc-MDP$ did not affect the BMD. And a bone scan test using a technetium-labeled compound emitting a gamma-ray energy of 140 keV did not significantly affect bone density measurements. However, if the nuclear medical examination and the osteoporosis test are to be performed together, the examination should be carried out at intervals considering the exposures of the patient.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.175-182
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• 2005

Purpose: Bone tumor occurred in femur frequently involve proximal intertrochanteric region or distal metaphyseal region. Sometimes, the pathologic fracture can happen according to the size of tumor due to the substantial biomechanical stresses. Therefore, the prognosis can be improved biomechanically by the angled blade plate considering the anatomic configuration after the excision of tumor. Materials and Methods: Between October 1991 and April 2005, there were a total of 16 patients(17 cases) who were treated by the excision of tumor and internal fixation with the angled blade plate for bone tumor occurred in femur. After the excision of tumor, we filled the cavity by bone graft in 11 cases and bone cement in 6 cases. The internal fixation was used by angled blade plate in all cases. Result: The average follow-up time was 55.5 months(6-144 months) in 16 patients(17 cases). No metal failure occurred after the operation. Reoperation was performed in 4 cases due to tumor recurrence, and the internal fixation was firm until that. Conclusion: The angled blade plate can prevent the fracture until grafted bone incorporated to host bone, and protect fragile connection between cement and host bone.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.111-117
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• 2005

Purpose: We evaluate the results of treatment of pathologic femur fractures secondary to bone tumors in children. Materials and Methods: Between January 1995 and June 2004, 18 patients(20 cases) were evaluated. Their mean age of the first episode of fracture was 10.2 years and mean follow-up period is 42.5 months. Primary bone tumors, the location of fracture, time to union and complications were evauated. Results: Fractures occurred at proximal portion in 14 cases, shaft 3 cases and distal portion 3 cases. The bone tumors causing pathologic fracture were fibrous dysplasia(9 c ases), simple bone cyst(4 cases), aneurysmal bone cyst(4 cases), nonossifying fibroma(2 cases) and eosinophilic granuloma(1 case). In the treatment for fractures, cast was in 11 cases, internal fixation 8 cases and external fixation in 1 case. In the treatment for tumors, observation was in 11 cases, curettage & bone graft in 8 cases and resection in 1 case. In polyostotic fibrous dysplasia, all cases were treated by cast initially but deformity developed in all cases. Fracture prevention and deformity correction were obtained with intramedullary nailing. Conclusion: Adequate choice of treatment of bone tumor and fracture will result in good prognosis.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.32-38
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• 1997

PURPOSE : For the reconstruction of large bone defect after tumor resection, it is possible to reuse the bone involved by tumor with some treatment to it. Several bone-reusing methods have been reported such as autoclaving, low-heat treatment(pasteurization) and intraoperative radiotherapy. We have used extracorporeally radiated autogenous bone graft for reconstruction after tumor resection, and analyzed the periods for junctional union, functional results and complications to know the indications of this method. METHODS : From Dec. 1993 to Sept. 1995, nine patients had taken autogenous bone graft with extracorporeal irradiation. Eight cases were osteosarcoma and 1 giant cell tumor. The graft sites were 5 in femur, 3 proximal tibia and 1 femur and tibia. Stage 3 was 1 case(GCT), Stage IIB 3 and Stage IIIB 5. After wide resection, surrounding soft tissue and intramedullary and extramedullary portion of the tumor were removed. Radiation was done in 5000cGy to the resected bone. Ender nails and bone cement were inserted and filled into the medulla to prevent fracture. RESULTS : Average follow-up period was 12.3(4 to 21) months. Average junctional union period in simple X-ray was 6.5 months in 4 cases. Average functional score following Enneking's criteria was 19(12-27). Complications were as follows ; condylar fractures and femur neck fracture in 4 cases, subluxation of the knee joint 3 and infection 1. Although local recurrence was detected in 1 case, the site of recurrence was not in the radiated bone but surrounding soft tissue. At final follow-up, no recurrence was found in one case(GCT), CDF 2, AWD 2, DOD 3, and died of chemotherapy related sepsis 1. CONCLUSIONS : Extracorporeally radiated bone autograft is considered to be a method for reconstruction of the large bone defect made by tumor resection, especially in the reconstruction around the joint.