Four decades ago, specialized chemotherapy regimens turned osteosarcoma, once considered a uniformly fatal disease, into a disease in which a majority of patients survive. Though significant survival gains were made from the 1960s to the 1980s, further outcome improvements appear to have plateaued. This study aims to comprehensively review all significant, published data regarding osteosarcoma and outcome in the modern medical era in order to gauge treatment progress. Our results indicate that published survival improved dramatically from 1960s to 1980s and then leveled, or in some measures decreased. Recurrence rates decreased in the 1970s and then leveled. In contrast, published limb salvage rates have increased significantly every recent decade until the present. Though significant gains have been made in the past, no improvement in published osteosarcoma survival has been seen since 1980, highlighting the importance of a new strategy in the systemic management of this still very lethal condition.

Background: Infection complicates traditional joint reconstruction prostheses in up to 7% of cases, with even higher rates in oncologic cases. Questions / Purposes: The authors ask if prosthetic infection in bone tumor patients is associated with any epidemiologic, treatment, or outcome variables that could influence management of these difficult conditions. Patients and Methods: Authors retrospectively reviewed 329 consecutive bone tumor (malignant and benign) patients treated with hip or knee tumor resection and subsequent joint reconstruction, comparing infected and non-infected cases. Patients were followed for a mean of 34 months.Results: Of lower extremity tumor reconstructions, 13.1% developed periprosthetic infection, with the knee significantly more involved than the hip (20.5% vs 6.1%). The most common organism cultured was Staphylococcus aureus (33%). The diagnosis of sarcoma was associated with a higher infection rate, and infections were associated with a two-fold increase in number of total surgeries. Adjuvant radiation alone and chemotherapy alone (but not in combination) was associated with statistically increased infection rates. Debridement with fixed implant retention achieved a 70% infection remission rate, as opposed to 62% with two-staged treatment, and 100% with amputation. The implants tended to survive longer than the patients.Conclusions: Infection complicates lower extremity prosthetic joint reconstructions in tumor patients more frequently than in non-tumor arthroplasty cases, with eradication rates lower than that of non-tumor patients. Periprosthetic infection correlates with radiation and chemotherapy administration, as well as an overall increase in revision surgery. Single stage debridement procedures result in infection remission rates comparable to two-stage reconstructions.Level of Evidence  Level III, Retrospective comparative study.

IntroductionArterial lines are important for monitoring critically ill patients. They are placed most commonly in either femoral or radial sites, though there is little evidence to guide site preference.MethodsThis is an ambispective, observational, cohort study to determine variance in failure rates between femoral and radial arterial lines. This study took place from 2012 to 2016 and included all arterial lines placed in adult patients at a single institution. Causes of line failure were defined as inaccuracy, blockage, site issue, or accidental removal. The primary outcome was line failure by location. Secondary outcomes included time to failure and cause of failure.ResultsWe evaluated 272 arterial lines over both arms of the study. Fifty-eight lines eventually failed (21.32%). Femoral lines failed less often in both retrospective (5.36% vs 30.71%) and prospective (5.41% vs. 25.64%) arms. The absolute risk reduction of line failure in the femoral site was 20.2% (95% confidence interval [3.7 – 36.2%]). Failures occurred sooner in radial sites compared to femoral. Infection was not a significant cause of removal in our femoral cohort.ConclusionFemoral arterial lines fail much less often then radial arterial lines. If placed preferentially in the femoral artery, one line failure would be prevented for every fourth line.