Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis

3D-Printed Talus-Calcaneus Prosthesis in Treating Ewing's Sarcoma: A Case Report

BACKGROUND

Malignant tumors originating in the talus are rare and present significant challenges in reconstruction. Traditional treatments, such as below-knee amputation or tbiocalcaneal fusion, often result in significant loss of ankle function. After tumor resection, reconstruction of the talus and calcaneus is necessary to preserve ankle function. However, the intricate anatomical structure and unique location of the talus and calcaneus present significant challenges for prosthetic reconstruction.

CASE PRESENTATION

Here, we present the case of an 11-year-old adolescent patient diagnosed with Ewing's sarcoma of the talus, accompanied by suspected involvement of the calcaneus. Following a comprehensive evaluation, a 3D-printed talus-calcaneus prosthesis, which is composed of a ultrahigh-molecular weight polyethylene (UHMWPE) part and a titanium alloy part, was designed for talus and calcaneus reconstruction. In addition, a porous structure was designed to promote the integration of bone-prosthesis interface. The lesion was completely resected and the prosthesis was precisely installed. After 12 months follow-up, patients demonstrated favorable function results with the Musculoskeletal Tumor Society (MSTS) score was 27/30, and the American Orthopedic Foot and Ankle Society (AOFAS) score was 92/100. The range of motion for dorsiflexion, plantarflexion, inversion, and eversion of the right ankle joint was measured as 10° and 35°, 15°, and 10°, respectively. The postoperative radiograph showed a good position of the prosthesis. No narrowed joint space was observed. Tomosynthesis shimadzu metal artifact reduction technology (T-SMART) revealed that integration between bone and prosthesis was good.

CONCLUSION

In this case, we present a case of 3D-printed talus-calcaneal prosthesis reconstructing talus and calcaneus. Favorable postoperative function outcome and good integration of the interface were observed. Therefore, this case provides an alternative therapeutic option for the treatment invasive talus tumor accompanied by suspicious contamination of the calcaneus. Nevertheless, a larger cohort study and with longer follow-up is needed to evaluate the effectiveness and potential complications of this novel prosthesis.

3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy

BACKGROUND

The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing.

METHODS

We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded.

RESULTS

Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up.

CONCLUSION

The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery.

LEVEL OF EVIDENCE

Level IV, case series.

Total calcaneal allograft reconstruction of an Ewing's sarcoma in a child: Outcome and review of the literature

BACKGROUND

Ewing's sarcoma rarely presents in bones of the feet. Surgical management usually includes amputation. Limb sparing surgery is anecdotal.

CASE

We report the case of a 13-year-old boy with an Ewing sarcoma in his calcaneus who had a calcaneal reconstruction with total calcaneus allograft after induction chemotherapy.

CONCLUSIONS

At 42 months of follow-up our patient remains disease free and functionally intact. A review of the exceptional limb salvage procedure options for malignant calcaneus tumor was performed.

A radiological diagnostic approach to tumours and tumour-like lesions of the calcaneus

OBJECTIVE

The calcaneus is a rare location for the development of primary bone tumours. The purpose of the study is to review the imaging findings in a cohort of patients presenting with tumours and tumour-like lesions of the calcaneus and to develop a more structured approach to the diagnosis of calcaneal lesions.

METHODS

A retrospective study with a collection of 167 cases of calcaneal tumours and tumour-like lesions from our tertiary orthopaedic oncology institution over a period of 13 years. Cases were reviewed by two consultant musculoskeletal radiologists and the location of the lesion within the calcaneus and demographics of the patient were noted for each case. A diagnostic algorithm, which is based on patient age and tumour location, was then extrapolated.

RESULTS

Out of the 167 cases, we identified 24 different calcaneal pathologies which included both tumours and tumour-like lesions. The most common being simple bone cysts (18.3% of cases) and intra-osseous lipoma (15% of cases) sited in the diaphyseal equivalent of the calcaneus. A diagnostic algorithm was formulated, which describes the most common location of the different pathologies including both benign and malignant pathologies, subdivided by age.

CONCLUSION

Our algorithm should help the radiologist narrow down the differential diagnosis when evaluating calcaneal lesions.

ADVANCES IN KNOWLEDGE

This article provides a radiological approach to calcaneal lesions.