Oncologic pathologies

Abstract

Current musculoskeletal surgery is based on studies from the beginning of 1900 and the incorporation of metal implants (into the human body) that are subjected to corrosion when in contact with bodily fluids, thus reacting as a foreign body. In 1932, the development of Vitallium, an alloy of chromium and cobalt, first used in dental implants, opened the way to the employment of chromium-cobalt alloy syntheses in orthopaedics [1, 2]. The use of Vitallium in musculoskeletal oncology dates back to 1943, when a proximal femur endoprosthesis was implanted [3] after resection due to giant-cell tumour, with signs of evident integration at autopsy and radiography 1 year later. This led to the creation of new implants using different materials, such as steel, polyethylene, and others, both in the treatment of resections and in long bone defects [4]. However, amputation represented the main treatment option in patients affected by musculoskeletal neoplasias. The actual spread of prosthetic implants (still personalized) came thanks to the progress in radiology, pathology, chemotherapy, and radiotherapy, which allowed a better staging and assessment of the tumour's size, and a higher survival rate in patients with musculoskeletal tumours. In particular, adjuvant chemotherapy was used in the 1970s as additional therapy in surgery to reduce local relapses and treat any residual cancer cells with encouraging results in terms of survival rates [5, 6]. Moreover, thanks to the progress in integrated treatments, the number of candidate patients for prosthetic treatments and conserving surgery increased, and this was a major improvement compared to amputation. This context led to a growing effort towards the improvement of prosthetic systems and the birth of standard modular endoprostheses [7], first for the proximal and distal femur, for the proximal tibia, and for the proximal humerus [8–11]. With the development of more and more sophisticated prostheses for the reconstruction of bone defects after resection, a major contribution to the systematization of the treatment approach of musculoskeletal tumours was given by Prof. Campanacci and Prof. Enneking [12] who set the ground rules for staging, reconstruction, and integrated treatment of musculoskeletal tumours. In conclusion, musculoskeletal oncologic surgery was actually born about half a century ago and has evolved since then. In particular, the new material technologies, the development of adjuvant therapies, and the systematization of the approach have led us to the present context, where we are able to save most patients' limbs, thus increasing their quality of life, and the prognosis in case of musculoskeletal tumours [13].