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Published in: Clinical Orthopaedics and Related Research® 3/2013

01-03-2013 | Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

Compressive Osseointegration Into a Custom Acetabular Implant Masquerading as Tumor Recurrence: A Case Report

Authors: Adam J. Schwartz, MD, Christopher P. Beauchamp, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2013

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Abstract

Background

Compressive osseointegration is a durable method of method of achieving fixation in long-bone reconstruction, and radiographic findings are well described. The radiographic appearance of integration into the pelvis is poorly defined in the available literature.

Case Description

We describe a 50-year-old man with a localized chondrosarcoma of the pelvis treated with wide resection and reconstruction using a custom acetabular device that used compressive osseointegration for fixation. A linear area of sclerosis was identified at the patient’s 3-month followup surveillance film, which was concerning for tumor recurrence. We used PET-CT to document the absence of worrisome hypermetabolism and to support our suspicion that the abnormalities seen on a surveillance CT scan represented bony integration into the custom acetabular component rather than tumor recurrence.

Literature Review

The use of FDG-PET for staging and surveillance of chondrosarcoma is presently evolving. Several articles suggest it may be useful in differentiating low-grade chondrosarcoma from benign lesions.

Purposes and Clinical Relevance

We found PET-CT useful to differentiate the midterm radiographic appearance of the remodeling produced by compressive implant osseointegration from local recurrence.
Literature
1.
go back to reference Aoki J, Watanabe H, Shinozaki T, Tokunaga M, Inoue T, Endo K. FDG-PET in differential diagnosis and grading of chondrosarcomas. J Comput Assist Tomogr. 1999;23:603–608.PubMedCrossRef Aoki J, Watanabe H, Shinozaki T, Tokunaga M, Inoue T, Endo K. FDG-PET in differential diagnosis and grading of chondrosarcomas. J Comput Assist Tomogr. 1999;23:603–608.PubMedCrossRef
2.
go back to reference Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ. Early distal femoral endoprosthetic survival: cemented stems versus the Compress® implant. Int Orthop. 2006;30:465–472.PubMedCrossRef Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ. Early distal femoral endoprosthetic survival: cemented stems versus the Compress® implant. Int Orthop. 2006;30:465–472.PubMedCrossRef
3.
go back to reference Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–711; discussion 711–712. Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–711; discussion 711–712.
4.
go back to reference Bredella MA, Caputo GR, Steinbach LS. Value of FDG positron emission tomography in conjunction with MR imaging for evaluating therapy response in patients with musculoskeletal sarcomas. AJR Am J Roentgenol. 2002;179:1145–1150.PubMed Bredella MA, Caputo GR, Steinbach LS. Value of FDG positron emission tomography in conjunction with MR imaging for evaluating therapy response in patients with musculoskeletal sarcomas. AJR Am J Roentgenol. 2002;179:1145–1150.PubMed
5.
go back to reference Carl M, Kock K, Du J. MR imaging near metal with undersampled 3D radial UTE-MAVRIC sequences. Magn Reson Med. 2012 Feb 28 [Epub ahead of print]. Carl M, Kock K, Du J. MR imaging near metal with undersampled 3D radial UTE-MAVRIC sequences. Magn Reson Med. 2012 Feb 28 [Epub ahead of print].
6.
go back to reference De Wit M, Raabe A, Seegers B, Buchert R, Beck-Bornholdt HP, Alberti W, Hossfeld DK. Time benefit in the assessment of recurrences following fractionated radiotherapy in an experimental tumour system using positron-emission tomography with 18F-fluorodeoxyglucose. Int J Radiat Biol. 2004;80:529–539.PubMedCrossRef De Wit M, Raabe A, Seegers B, Buchert R, Beck-Bornholdt HP, Alberti W, Hossfeld DK. Time benefit in the assessment of recurrences following fractionated radiotherapy in an experimental tumour system using positron-emission tomography with 18F-fluorodeoxyglucose. Int J Radiat Biol. 2004;80:529–539.PubMedCrossRef
7.
go back to reference Farfalli GL, Boland PJ, Morris CD, Athanasian EA, Healey JH. Early equivalence of uncemented press-fit and Compress femoral fixation. Clin Orthop Relat Res. 2009;467:2792–2799.PubMedCrossRef Farfalli GL, Boland PJ, Morris CD, Athanasian EA, Healey JH. Early equivalence of uncemented press-fit and Compress femoral fixation. Clin Orthop Relat Res. 2009;467:2792–2799.PubMedCrossRef
8.
go back to reference Feldman F, Van Heertum R, Saxena C, Parisien M. 18FDG-PET applications for cartilage neoplasms. Skeletal Radiol. 2005;34:367–374.PubMedCrossRef Feldman F, Van Heertum R, Saxena C, Parisien M. 18FDG-PET applications for cartilage neoplasms. Skeletal Radiol. 2005;34:367–374.PubMedCrossRef
9.
go back to reference Franzius C, Daldrup-Link HE, Sciuk J, Rummeny EJ, Bielack S, Jürgens H, Schober O. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol. 2001;12:479–486.PubMedCrossRef Franzius C, Daldrup-Link HE, Sciuk J, Rummeny EJ, Bielack S, Jürgens H, Schober O. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol. 2001;12:479–486.PubMedCrossRef
10.
go back to reference Halaç M, Mut SS, Sönmezoglu K, Ylmaz MH, Ozer H, Uslu I. Avoidance of misinterpretation of an FDG positive sacral insufficiency fracture using PET/CT scans in a patient with endometrial cancer: a case report. Clin Nucl Med. 2007;32:779–781.PubMedCrossRef Halaç M, Mut SS, Sönmezoglu K, Ylmaz MH, Ozer H, Uslu I. Avoidance of misinterpretation of an FDG positive sacral insufficiency fracture using PET/CT scans in a patient with endometrial cancer: a case report. Clin Nucl Med. 2007;32:779–781.PubMedCrossRef
11.
go back to reference Hayter CL, Koff MF, Shah P, Koch KM, Miller TT, Potter HG. MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques. AJR Am J Roentgenol. 2011;197:W405–411.PubMedCrossRef Hayter CL, Koff MF, Shah P, Koch KM, Miller TT, Potter HG. MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques. AJR Am J Roentgenol. 2011;197:W405–411.PubMedCrossRef
12.
go back to reference Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress implants. Int Orthop. 2008;32:567–571.PubMedCrossRef Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress implants. Int Orthop. 2008;32:567–571.PubMedCrossRef
13.
go back to reference Makis W, Hickeson M, Lisbona R. Interesting image. Maffucci syndrome with extraosseous chondrosarcoma imaged with F-18 FDG PET-CT. Clin Nucl Med. 2010;35:29–31.PubMedCrossRef Makis W, Hickeson M, Lisbona R. Interesting image. Maffucci syndrome with extraosseous chondrosarcoma imaged with F-18 FDG PET-CT. Clin Nucl Med. 2010;35:29–31.PubMedCrossRef
14.
go back to reference Morris CD. Pelvic bone sarcomas: controversies and treatment options. J Natl Compr Canc Netw. 2010;8:731–737PubMed Morris CD. Pelvic bone sarcomas: controversies and treatment options. J Natl Compr Canc Netw. 2010;8:731–737PubMed
15.
go back to reference Purandare NC, Rangarajan V, Agarwal M, Sharma AR, Shah S, Arora A, Parasar DS. Integrated PET/CT in evaluating sarcomatous transformation in osteochondromas. Clin Nucl Med. 2009;34:350–354.PubMedCrossRef Purandare NC, Rangarajan V, Agarwal M, Sharma AR, Shah S, Arora A, Parasar DS. Integrated PET/CT in evaluating sarcomatous transformation in osteochondromas. Clin Nucl Med. 2009;34:350–354.PubMedCrossRef
16.
go back to reference Salavati A, Shah V, Wang ZJ, Yeh BM, Costouros NG, Coakley FV. F-18 FDG PET/CT findings in postradiation pelvic insufficiency fracture. Clin Imaging. 2011;35:139–142.PubMedCrossRef Salavati A, Shah V, Wang ZJ, Yeh BM, Costouros NG, Coakley FV. F-18 FDG PET/CT findings in postradiation pelvic insufficiency fracture. Clin Imaging. 2011;35:139–142.PubMedCrossRef
17.
go back to reference Schwartz AJ, Kiatisevi P, Eilber FC, Eilber FR, Eckardt JJ. The Friedman-Eilber resection arthroplasty of the pelvis. Clin Orthop Relat Res. 2009;467:2825–2830.PubMedCrossRef Schwartz AJ, Kiatisevi P, Eilber FC, Eilber FR, Eckardt JJ. The Friedman-Eilber resection arthroplasty of the pelvis. Clin Orthop Relat Res. 2009;467:2825–2830.PubMedCrossRef
18.
go back to reference Shin D, Shon O, Byun S, Choi JH, Chun KA, Cho IH. Differentiation between malignant and benign pathologic fractures with F-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Skeletal Radiol. 2008;37:415–421.PubMedCrossRef Shin D, Shon O, Byun S, Choi JH, Chun KA, Cho IH. Differentiation between malignant and benign pathologic fractures with F-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Skeletal Radiol. 2008;37:415–421.PubMedCrossRef
19.
go back to reference Shin KH, Rougraff BT, Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994;304:207–217.PubMed Shin KH, Rougraff BT, Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994;304:207–217.PubMed
20.
go back to reference Tyler WK, Healey JH, Morris CD, Boland PJ, O’Donnell RJ. Compress periprosthetic fractures: interface stability and ease of revision. Clin Orthop Relat Res. 2009;467:2800–2806.PubMedCrossRef Tyler WK, Healey JH, Morris CD, Boland PJ, O’Donnell RJ. Compress periprosthetic fractures: interface stability and ease of revision. Clin Orthop Relat Res. 2009;467:2800–2806.PubMedCrossRef
21.
go back to reference Unni KK, Inwards CY. Dahlin’s Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Baltimore, MD, USA: Lippincott Williams & Wilkins; 2009:89. Unni KK, Inwards CY. Dahlin’s Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Baltimore, MD, USA: Lippincott Williams & Wilkins; 2009:89.
Metadata
Title
Compressive Osseointegration Into a Custom Acetabular Implant Masquerading as Tumor Recurrence: A Case Report
Authors
Adam J. Schwartz, MD
Christopher P. Beauchamp, MD
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 3/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2482-5

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