Knee; is a hinged joint between the thigh bone (femur) and the tibia (tibia). The joint is divided into two parts, internal and external. The joint is protected from the front by a knee cap.
All bone surfaces within the joint are covered with articular cartilage. The load-bearing cartilage surfaces between femur and tibia are protected and supported by two flexible cartilaginous structures called meniscus. The meniscuses are shaped like a letter "C" and the edges of the bird's nest are in the middle of a high middle. This structure provides a structural fit of the flat tibia with the round femur, allows the riding load to be distributed over the entire joint surface, the incoming pulsation helps to stabilize the joint.
Bonds are the main structures that fix the knee joint. It is necessary not to confuse tendons with ligaments which are completely separate structures from each other. Bonds are fixed structures that stick to both bones, with limited resilience. Tendons are structures that stick to one side of the bone and continue to the other side of the base, which transmits the motion of the adele to the bone.
The side links are located on the inner and outer sides of the index and prevent the index from opening on both sides. Outside the lateral side of the knee, which prevents the opening of the outside of the knee, the posterior-outer corner of the knee and the tendon of the popliteus is called a posterolateral complex is called a supplement. Findings and treatments for the damage to this structure may be out of sight. The anterior cruciate ligament -ACL-tibia connects the femur directly to the midpoint. The function is to restrict the rotational movements of the index and prevent the forward movement of the tibia. The rear cross-link - prevents the rearward movement of the PCL.
During all these anatomical structures of the knee the muscles stretch and work together to direct movements such as running, walking. Muscles also support and maintain constipation. There are two main groups of muscles that manage the sequence. The quadriceps of the anterior thigh (quadriceps) stretches along the front face of the thigh from the navel bone, the tendon continues over the knee cap and sticks to the upper front of the tibia. Performs directory rectification-smoothing motion. At the same time, the knee cap balances the knee cap with separate heads that stick to the top, inside and outside of the cap. By restricting the rotation of the directory, ACL helps the PCL by restricting the backward movement of the tibian. Behind the thigh are two out of tibian, two of which have hamsring bands sticking in. Hamsrings help the ACL by restricting the rotational motion and the tibian's forward motion.
Knee Prostheses
Calcifications that do not respond to other treatment methods in the knee are treated with knee prosthesis. In terms of the prosthesis, the joint surfaces of the three bones that are knee joints are cut out and these surfaces are covered with metal and plastic parts.
Prosthetics are a good choice for patients who do not respond to knee arthroscopy and ligament surgery in limbs that do not respond to intra-knee injection and physical therapy, or who are refusing complaints after having previously undergone these operations. If there is no answer to the above alternative treatments and knee problems disrupt the patient's standard of living, a knee prosthesis may be needed. Nowadays, if the prosthesis life is thought to be 25-30 years longer, the concept of life standard has become more important instead of construction age. However, for people under 55 years of age, other treatment modalities should be tried until the end. Other treatment modalities between the ages of 55-65 may be advantageous. It can be easily applied over 65 years.
Four links in a normal string provide the linking and coordination of index bones. In arthritis, these ligaments can break down. In knee prosthesis applications, some of these connections are removed with the articular surfaces and replaced with new artificial surfaces. There are 2 ways to keep the parts in place. One of them is fixed with cement called polymethylene methacrylate. The other is specially prepared prosthesis which consists of the parts which are integrated with the bone in accordance with the development of the bone.
Today, the vast majority of knee prostheses are made in cement. The cemented prosthesis has excellent adaptation and can last 25-30 years. This period of the patient's weight, general health conditions, activity level can increase or decrease. The advantage of cement is that it is a biomechanical strength that adds to the solidity of a solid material, as it is a structure that connects the bones and the prosthesis. The material used today is extremely low in fracture.
In the 1980s, prostheses were manufactured which can be applied without a cement material to the bone. On the surfaces of these implants are biologically active substances that can provide new bone formation. Various screw systems have also been developed to detect the bones in the bones. Screws will be responsible for fixing the prosthesis until new bone development is achieved. Some models have proved to be as successful as cemented prostheses. However, the more smoothly they are, the more the formation of smaller fragments due to under-load in these prostheses and the faster the biologic response is developed. Longer term results for the use of these types of prostheses it is not available at all.
By the end of the 1980s, tibial component cemented hybrid prostheses were produced with no femoral component cement, and the results so far are good.
As a result, some knee prosthesis surgery is an effective treatment method for regulating the biomechanics of the knee.
Post-operative
Patients are allowed to walk on the day after the operation and sit on the toilet on the 2nd day. Patients usually spend 4-7 days. On the day when the patients are discharged, the patients are lying and getting up and the toilet is going. Rarely, the length of the bedtime can be extended.
Sutures are taken on average in 15 days and afterwards the bathroom is allowed. From the day following the patient operation, knee bending and muscle strengthening exercises begin. These exercises continue until the knee functions are fully recovered. Usually all knee functions return at 6 weeks. Patients may feel swelling of the knee and prosthesis for 3-6 months, but walking is usually comfortable after 1.5 months.
Prosthetic Life; The most common question is the age of prosthetic make-up and how long it is. Here are the personal characteristics of the patient; age, gender, weight and level of motion. The prosthesis life is 25-30 years, provided that the best prosthesis is used in good hands. A life-span is obtained that is completely painless and the knee flexion is over 90 degrees. For people who are over 100 pounds and have a very active life (exhausting sports, heavy work conditions, etc.), the prosthesis life can be expected to decrease by about 5 years.
When the prosthesis fills its life, it begins to ache and the complaints progress over time. This may be why the prosthesis is loosened and worn. In this case, wear and loose parts of the prosthesis are replaced. This is a much more difficult, expensive and technically difficult operation than a first prosthetic operation and requires a very advanced experience.
Factors affecting the life span of knee prosthesis are very important in operating room and post-operative care services as well as in good hands. The risk of vascular and nerve injury is almost nonexistent.
Anesthesia and narcosis
Pre-operative examination of the anesthesiologists of the patients and some blood tests, electro, lung graphs are absolutely done. Patients in need are examined for internal medicine, cardiology and other specialists.
Today, hip prosthesis operations are usually performed by "epidural anesthesia". In this case, a painless capillary tube is placed in a completely painless manner and the operation is performed by numbing the patient down from the patient. If the patient does not want to see the operating room environment, he can sleep in the same way as the night sleep during operation without narcosis. General anesthesia may be applied to patients who are not eligible for epidural anesthesia.
Post-Operative Pain Control
With the drugs made after operation from the thin capillary tube placed during epidural anesthesia, it is ensured that the patient does not feel pain after the operation. 3. From the day on, the patient's pain can only be controlled completely by oral medications. Rarely, in some patients injection therapy may be needed for a longer period of time.
Disease Alerted to Operational Alert
Possible early complications during and after the operation;
Infection; In good operating room conditions the infection rate in prosthetic operations is below 1%. There is a system that prevents the transmission of special microbes called "laminar air flow" when the operating room conditions are good. Infection rates in normal operating rooms are between 5-20%.
At the same time, helmet-shaped special surgical heads have begun to be used during prosthetic operations in advanced centers. These headings provide a completely germ-free covering of the operation team down the hill. (normally covered with germ-free underside of the team and supported by a mask and mask) Operation helmets prevent the airflow from the top down of the laminar air flow system from infecting the operation site from the sterile (non-germ) head and neck areas of the operation team. a small part of the splashing drops can hit the hundreds of micro-areas and lead the micros to re-operation.The helmet and germ-free head restraint system can be lifted at this risk.It also ensures that the operation tools remain germ-free even when the operation team touches the head.
If an infection occurs, it may be necessary to rinse the joint with an operation again. For advanced infections, removal of the operative prosthesis may be necessary. In this case, after 6-12 weeks of antibiotic use, re-prosthesis can be placed.
Antibiotics are given to the vasculature during anesthesia to prevent infection. The use of antibiotics continues after the operation. In addition, much attention is paid to the sterilization of the instruments used.
Deep vein thrombosis (blood clotting in collecting veins); This complication is below 5%. It usually begins to occur after the 3rd day, 6-10. days are the most visible. However, rarely, it can be seen months after the operation. About 5-10% of deep vein thromboses (5-10 u in 10 patients of all patients) can be life-threatening by clipping the pit and going to the lung or brain. Some of the patients have additional risk factors. These include the use of birth control pills in women, the fact that patients have had deep venous thrombosis, varicose veins, familial predisposition, etc.
To protect against deep vein thrombosis, blood thinners, postoperative antiembolic stockings, in-bed exercises and early leg lift reduce the risk of giving weight. If the patients have additional risk factors, these treatments are extended.
Technical mistakes; Prosthetic surgeries are technically very complicated operations. Because of this, the possibility of a technical error-related complication can be always and everywhere. The risks of complications due to technical errors in good hands are greatly reduced, and technical errors that affect the result are very rare.
Postoperative course;
After the patients are taken to the operating room, they are first asleep, and for the sterile environment the legs are wiped and the operating systems are set up after covering. This requires an average of 40 minutes. The normal duration of the operation in experienced hands is around 2 hours. After the operation, the patients are kept in the soaking room for 30 minutes to 1 hour and then taken to their rooms. Patients with internal problems or very elderly patients may need intensive care from time to time.
Patients are completely awake within 2 hours of being taken to their room. The pain can be completely controlled by painkillers. Patients have drains, elastic bandages, and anti-embolic socks worn in the bacon to drain the blood that accumulates inside the patient's line (there are differences in practice in clinics). After 3-4 hours, the patient is given a meal. The next day the patient is allowed to stay with a walker. Be sure to sit down for 5 minutes before going to the foot and be sure not to turn back, reaching the head and trying again after 1 hour.
You will stay for 5-7 days in hospital (with different applications). On the 2nd day a physiotherapist will come to you to start doing the exercises on the bed and connect a device that will move the index called CPM. This is an electric motor tool and you will increase the knee motion angle from 30 degrees by 2 hours using the control shown by your physiotherapist. After 2 hours, it will be interrupted for 2 hours and will start again. 2-3. at the end of the day your knee will be bent 90-100 degrees. Your drains will be pulled and dressed on the 2nd or 3rd day. As long as you are in hospital, ice will be applied to the index. The first 2 nights may be fever around 38, does not mean infection. The infectious symptoms start on day 3.
You can lie down or sit down by stretching your leg until the end of the 10th day after the operation, which returns you home. In the meantime you should continue to apply ice. You can sit with your feet for dinner and walk up and walk as many times as you want through your walker for your needs .. Never remove the bandage and the stocking in your knee during this period. This can cause bleeding and swelling in your knee. Do your exercises every day as you disagree. In the meantime, do not interrupt your blood-diluting medicine, and if you have pain, take your painkiller. Attention; your fever will rise above 38 degrees, in your knee, your leg pain-if your toes swell, call your doctor immediately.
The 15th day will be seen by your doctor and, if appropriate, your stitches are removed. After the suture is taken, physical therapy is started. Your physiotherapy will continue until the end of the third month, usually 3 days a week. Physical therapy should be performed by experienced physiotherapists like the operation. Conclusion high quality physical therapy is one of the most effective factors.
At the end of the 3rd week, you can leave your walker and go to a bastion. You should use the cane on your sturdy side. If you have two-sided operation, you can use it until the 6th week of the runner. You can completely release your cane in 6-12 weeks. If you feel safe, you can use a cane for a long time. After the 8th week you may be more active, you can drive but sporting activity is still prohibited. At the end of the fourth month your physiotherapist can slowly start sportive activities. The full spore turn is at the end of 6th.
Orthopedic Tumors
The organs in the body are made up of building blocks called tissue cells. Cells contain many different organs or tissues in the body and multiply themselves by division. All cells have life cycles that result in growth, development, aging, and then death. New cells replace dead cells. Normally the division of the cells and then the multiplication is in order and controlled. For any reason, this process leaves control, followed by uncontrolled division and development, which in turn removes the swelling called the tumor.
Limited benign tumor in the tibia bone. Large soft tissue mass outside of pelvic bone is malignant tumor
Tumors can be malignant at the benign part. Benign tumors do not have the danger of spreading to distant organs, ie they do not metastasize. Malignant tumors, on the other hand, carry a risk of metastasis, especially when the tumor progressively increases in distant organs.
Malignant bone tumor around the knee, pelvis in the same patient and metastasis in the lung.
What is Cancer?
Tumors are divided into benign (malignant) or malignant (malignant) tumors. Cancer is the name given to malignant tumors. It should be known that cancer is not a single disease and that there is no single form of treatment. There are over 200 different types of cancer, each of which is cited and treated with its own name. Unlike cancer, benign tumors do not spread to other parts of the body and do not threaten the life of the patient, but benign tumors may develop in the area where they are found, cause enlargement and damage to the area, or cause pressure on the surrounding tissues and cause complaints such as pain and swelling in the patient.
Cancer Types
1. Carcinomas
They form the vast majority of cancers and are usually derived from epithelial tissue that covers the surface of organs.
2.Sarkom on
They form about 5% of cancers that originate from connective tissue elements of the body, such as muscle, bone and fat tissue.
3. Leukemia and Lymphomas
It is derived from the bone marrow and lymph system.
4. Types of Cancer
Uncommon cancer types, such as brain tumors, constitute about 3% of all cancers.
Who is Cancer?
With children being younger and younger, cancer can occur in every age. But the development of cancer increases with age. Approximately 70% of cancer occur in persons aged 60 years or older. However, sarcomas differ slightly in this regard, particularly in sarcomas of bone origin, occurring in children and young adults, often between 10 and 25 years of age. Soft tissue sarcomas occur more frequently in patients over 40 years of age.
Common Types of Cancer
Among the common types of cancer are lung cancer, prostate cancer in man, breast cancer in woman, bowel, bladder and ovarian cancers in woman.
Cancer Treatment
1. Careful and Close Follow-Up
Some types of cancer grow very slowly and may not cause serious problems over the years. In this case, depending on the type of cancer, only close follow-up may be sufficient.
2. Surgical Treatment
The giant cell bone tumor with good-natured but aggressive character, located in the region near the knee, and the space created after bone removal have been sterilized with mechanical and chemical agents.
Removal of cancerous tissue by surgery. This is a particularly valuable method for cancers not spread to other organs. Bone and soft tissue sarcomas have four main types of surgical treatment; First treatment method; cancer tissue is removed from the body by scraping. This usually leads to the tumor returning to that area. The second method of treatment is; the cancerous tissue is removed from the region very close to the border of the intact tissue. Likewise, there is a risk of frequent recurrence of cancerous cell debris left behind in this method. > The third treatment method; cancerous tissues around the body by leaving some amount of healthy tissue to remove any cancerous tissue. Fourth treatment method; Cancerous tissue (arm or leg) is removed from the body by amputation, which is what we call amputation. Today, the majority of the cancer is treated by the third method called broad resection. This is very important for the patient not to repeat the disease. Pathologic examination that cancer can not be removed widely can be understood by the absence of tumor at the surgical margin.
Cartilage tumor located in the region near the shoulder but limited to the bony. The diseased bone was removed entirely and the space created in the bone was removed with a prosthesis.
3.Chemotherapy (Drug Therapy)
Chemotherapy is based on the principle of using drugs that kill cancer cells by intravenous or oral route. Thus, the drug reaches the cancerous tissue through the blood and aims to destroy the cancerous tissue. Chemotherapy causes some side effects at the same time, depending on the chemotherapy drug used, such as nausea, vomiting, fatigue, anemia, decreased resistance to the microbe of the body and frequent infectious diseases, such as sores in the mouth. Side effects of chemotherapy disappear at the end of treatment and are usually not permanent.
4.Hormone Treatment
It is based on the principle of changing the level of some hormones in the body. Some cancers need some hormones for growth and development. Their replacement controls the cancer cells (blockage). Other treatments include drugs that stimulate the immune system. Likewise, some antibodies and some vaccine types have been successfully used in the treatment of cancer.
5. Radiotherapy (Radiation Therapy)
This is based on the principle of killing cancer cells by high-energy x-rays, but it is possible that during radiotherapy it may also be damaged in normal tissues. For this reason, it is aimed to plan well the area to be radiotherapy and to protect as much as possible the healthy tissues in the environment. In the area where radiotherapy is applied, the findings such as edema (liquid accumulation), redness, hardness, and movement restriction can be found over time. Radiotherapy can lead to the development of secondary cancers, especially in children and young people in later years of life (usually 20 to 25 years).
sarcoma
Sarcoma is the general name of malignant tumors originating from bone and soft tissue. Generally, the types of cancer-forming cells followed by sarcoma are called tumors. For example, the malignant tumor of the cartilage cell is called chondrosarcoma, the malignant tumor of the fat cell is called liposarcoma.
Bone-derived sarcomas
Bone tumors are separated as benign, benign or malignant malignant tumors. Benign tumors are not cancer. Their bodies do not threaten life by spreading to other organs of the body from the bone. The body can control and prevent the development and spread of these tumors. These tumors are treated surgically. Although benign bone tumors may recur after surgery, they may be removed by a new operation. Malignant bone tumors are called bone cancers. These tumors go out from the bone they are in and spread to neighboring tissues and organs. The body is insufficient to limit this spread. The cells that make up the bone cancer spread to the distant organs, often to the lungs, through the blood vessels in the area where the tumor is located. These spreads are called metastases. Metastases arise especially in cases of delayed diagnosis and treatment, and they threaten the life of the patient.
Cancer caused by the bone itself is called primary bone cancer. These are cancers that form bone, cartilage, connective tissue and bone marrow. Primary bone cancers occur at a frequency of approximately 100,000. It is estimated that 500-600 new cases of bone cancer occur every year in our country. Bone tumors frequently show settlement in the pelvic bone and spinal cord more often than in the arm and leg bones. Bone cancers are more common in children and adolescents than in adults. Bone cancers are called sarcomas. Osteosarcoma is the bone cell of the cell group that produces cancer of the lungs, chondrosarcoma is the cartilage cell, and fibrosarcoma is the connective cell. Bone cancers include cancer types of unknown cell origin, such as Ewing's sarcoma.
Osteosarcoma is the most common type of bone cancer. They often occur in children and adolescents, ages 10-25. In males, they are twice as many as females. Usually during rapid growth periods, the growth in the bones shows settlement near the insertion where the cartilage is located. In about 70% of patients, the tumor is around the knee.
Ewing sarcoma is the second most common bone cancer we have encountered. This tumor is common in children and teenagers. The site is usually the middle part of the limbs and bones, called long bones. According to osteosarcoma, it keeps flat bones, ie pelvic bone and ribs more frequently. Chondrosarcomas arising from cartilage cells usually appear after 40 years of age. These tumors are often located in the pelvic and long bones.
Apart from these, there are very rare bone cancers such as fibrosarcoma, cordoma and adamantinoma. These tumors arise after 30 years of age.
Apart from primary bone cancers, there are bone cancers that do not originate in the bone but spread to the bone from other cancers. Secondary cancers are called metastases. The incidence of cancers is higher than the cancers themselves. In such a case, cancer is not referred to as bone cancer, but as cancer of the organ that spreads to the bone. For example, breast cancers such as bone metastasis, bone cancer cancers include lung cancer respectively, breast cancer in men, prostate cancers, thyroid and kidney cancers, stomach and intestine cancers.
Leukemia, lymphoma and myeloma, such as bone marrow and blood cells of the origin of the cancer shows settlement in the bones. However, these are different types of cancer and the treatments are quite different from bone cancers.
Soft tissue-derived sarcomas
Soft tissue sarcomas originating from connective tissue are malignant tumors. They appear later in life than bone cancers. Among the common soft tissue sarcomas are malignant fibrous histiocytoma, liposarcoma, synovial sarcoma, and rhabdomyosarcoma. However, soft tissue sarcomas come in too many types. Treatments are also different than bone cancers. Chemotherapy in soft tissue sarcomas is not often used but it is used in some tumor types. The main treatment is extensive surgical resection and radiotherapy. Soft tissue sarcomas, like bone sarcomas, can be low grade at high altitude. Those with low grades are those that grow very slowly and have a low risk of spreading to distant organs. However, high grade soft tissue sarcomas are tumors that grow rapidly and tend to spread to distant organs early. They often spread far-reaching blood to the lungs and, rarely, to the back of the abdomen and other organs.
symptoms
Symptoms of Bone Cancer
Bone cancers may not show symptoms at first and may show insidious progress. Findings and symptoms vary depending on the type of cancer and the size of the tumor. Symptoms occur early in tumors that progress rapidly, settle in superficial bones, and reach large sizes. The most common finding is pain. Pain initially responds to mild and painful conditions, while the tumor gradually grows and becomes more severe. In advanced bone cancers, pain is more intense in the nights and does not respond to ordinary painkillers, seriously affecting the daily life of the patient. A major finding is swelling, especially in superficial bone cancer. In deep-seated bone cancers, swelling occurs quite late. In bone cancer, the presence of swelling indicates that the tumor has spread out into the soft tissue through the bone.
Soft tissue swelling due to bone cancer around the knee.
Some bone cancers, especially cancers spread from other organs in the bones, are the first signs of confusion with fractures. Broken is a very weak impact, buckling sometimes occurs spontaneously. The reason for this is that the weakening of the bone by the cancer cells is becoming an egg shell. Particularly in bone cancers, the weakening of the bone and the prevention of fracture are very important for the success of the treatment.
A fracture in a benign but aggressive tumor around the knee. After the tumor has cleared, it is fixed with MRI compatible titanium plate + screw.
None of the signs and symptoms mentioned above are specific to bone cancers, but are common symptoms seen in simple traumas, fractures, benign bone tumors, bone erosion, bone inflammation, arthritis and many other bone diseases. For this reason, specialists in bone tumors should be consulted as soon as possible, especially in the case of bone pain, which does not respond to painkillers and which develops with swelling.
Diagnostic Methods
Diagnostic Methods in Bone Cancer
Because bone cancers are rare, diagnosis and treatment should be done by doctors who are experts in orthopedic oncology who have experience in these cancers and are experts in the subject.
In the first stage, the doctor will question the patient's complaints, important illnesses that have already passed, and family history, especially in terms of cancer. A full examination will then be performed, including the bone area where the patient's pain or swelling complaint is located, the adjacent bones and joints, the surrounding soft tissues, and finally the distant organs.
At the next stage, blood tests and x-rays are taken to assess the tumor's location, size and shape. Bone cancers are seen on the x-ray as large, irregular, bounded masses. If a bone tumor is detected in the patient, additional tests are performed to prevent a diagnostic error and to detect the degree of spread of the tumor. For this purpose, computerized tomography, magnetic resonance imaging (MRI) and radioactive bone scintigraphy are the most frequently used methods. Computerized tomography is a computer-aided imaging technique that is used to visualize highly detailed images of bony structures in very thin cross-sectional areas. Magnetic resonance imaging reveals the extent of tumor spread, as well as the mapping of the tumor, by presenting the images of soft tissues, vessels and nerve structures adjacent to the bone as well as the bone in a very detailed manner on many planes. Bone scintigraphy provides scanning of the entire body with bone-specific radioactive materials. Angiography is used to determine the limits of surgical treatment, especially by showing the proximity of the tumor to the main vessels, vessels feeding the tumor, especially when an operation plan is made.
Benign bone tumor in right hip; X-ray, MR and scintigraphy
Biopsy
The above-mentioned diagnostic methods may raise doubts about the presence of bone cancer in the patient. However, definite diagnosis is possible with biopsy, that is to take part for diagnostic purposes from the area where the cancer is thought to be in the bone, and it is possible to determine the type of the cell under microscope by taking the specific part of the received part under the microscope. Bone cancer is a very serious mistake, It may produce.
Kidney cancer bone metastasis; X-ray, MR, angiographic views. Lung tomography also shows lung spread
Treatment Methods
Treatment Methods in Bone Cancer
Significant progress has been made especially in the treatment of bone cancers in the last 15-20 years. Improvements in the field of chemotherapy, the use of computed tomography and magnetic resonance imaging, and the development of surgical techniques have both helped patients to survive cancer and protect their limbs. 20 years ago, the average survival rate for bone cancers was 20-30%, but nowadays this rate has increased to around 65-70%. In other words, we can treat two of the three patients who are diagnosed with bone cancer today. In the same way, we can safely remove the cancerous bone with limb-sparing surgery without the necessity of cutting the arm in about 90% of our patients with the development of surgical techniques, metal artificial prosthesis technology including artificial bone, bone like fillings and joints.
Surgical treatment, chemotherapy and radiotherapy (beam therapy) are the main methods in the treatment of bone cancers. Depending on the age of the patient, the type of activity and the spread of bone cancer, these methods are often used together.
Medicines that kill cancer cells with chemotherapy are administered either orally, intramuscularly or intravenously. Because these drugs affect particularly fast-growing and developing cells, healthy cells as well as cancer cells are also affected and side effects occur. Common side effects of chemotherapy are nausea and vomiting, fatigue, hair loss, mouth sores and resistance to infectious diseases. Side effects of chemotherapy disappear at the end of treatment. Successful chemotherapy means that more than 90% of the cancer cells are destroyed. This is a very important positive display for survival.
Radiation therapy (radiation therapy) is to render the cancerous area inactive by radiation. This method of treatment is effective in the treatment of tumors such as Ewing sarcoma, which is sensitive to radiotherapy, and cancer that is spread from other organs to bone. Radiotherapy is not effective in osteosarcoma or chondrosarcoma, and is rarely used except in some cases. Radiotherapy may cause some side effects, such as edema, stiffness, restricted movement, in the area where radiation is made. Secondary cancer development can also be the subject of many years, especially after radiation therapy in children.
The basic principle in the surgical treatment of bone cancers is that a healthy amount of healthy tissue is left on the cancerous bone in a large amount without any residual tumor. The gap formed at the site of the removed bone is filled with prosthetic joints made of metal compatible with the body, or cadaveric bone, sometimes bone implantation or bone lengthening operations performed by the patient himself or herself. Thus, the patient's organ is protected and an effective tumor treatment is made. At the same time as children in the age of growth, extraterrestrial prostheses are used.
Metastases
It may spread more frequently to other bones and other organs than to the lung. In patients diagnosed with bone cancer, lungs and other bones should be screened before treatment. The presence of metastases is a poor indicator and seriously reduces the chance of survival. Metastases should be removed by surgical methods when possible.
After Cancer Treatment
Bone cancers require regular checks after treatment. Until you are sure that the patients do not repeat the cancer for many years, they should continue. If cancer is recurred in the same way, it is possible to get caught early and treat it immediately. During the examinations, examination, blood tests, x-rays and computed tomography scan the distant organs, mainly the lung, and the cancerous area.
Any abnormal findings that are noticed by the patient other than the controls should be reported to the doctor immediately.
Finally, rehabilitation of the patient after treatment in bone cancers, psychiatric support of patients and their relatives is very important in terms of increasing the quality of life.
Common Tumors
Poor Benign Bone and Soft Tissue Tumors
Bone and soft tissue tumors and especially malignant tumors are rare tumors. Among these, osteosarcoma is the most common malignant bone tumor originating from bone cells. Osteosarcoma mostly occurs around the knee, in the hip region, and in the bones near the shoulder joint. It is often seen in young patients aged 15-25 years. Osteosarcoma is treated with chemotherapy and surgical treatment. In 90% of the patients, the disease can be treated without having to amputate (cut) the diseased arm or leg. Osteosarcoma most commonly metastasizes to the lungs (splashes, spreads). In early non-metastatic disease, 65-70% success is achieved.
Chondrosarcoma is the second most common malignant cartilage-derived tumor. It is older than osteosarcoma (after 40 years of age). Unlike osteosarcoma, it is a chemotherapy-resistant tumor, so it is often treated only with surgery. Chondrosarcoma is seen at 1 to 3 different grades. As the tumor progresses, the chances of success decrease.
Ewing sarcoma is a very aggressive and rapidly progressive tumor seen in young children. This tumor is different from the first two tumors because both chemotherapy and radiotherapy are sensitive, chemotherapy, radiotherapy and surgery are applied together. Ewing's sarcoma is a tumor in which we achieve 55-60% success in patients with early onset and good chemotherapy response.
Adamantinoma and cordoma, which are more rare, are resistant to other methods except surgical treatment but are slower tumors than the first three tumors.
Soft tissue sarcomas (cancers) are more common than bone cancers. These are connective tissue-derived tumors that can appear in any part of the body. Malignant fibrous histiocytosis (originating from the donor tissue) and synovial sarcoma are frequently seen in liposarcoma (originating from fat tissue). The treatment principles of soft tissue sarcomas are generally the same. Surgery and radiotherapy routinely used in almost every patient in these tumors. However, studies showing that chemotherapy is effective in the treatment of soft tissue tumors in recent years are increasing.
Patient Examples
Tibiada Osteoid Osteoma
In a 17-year-old male patient, tibias had severe pain that lasted for the last two years, especially at night. These complaints were followed and treated for 2 years by menisci, belly button, sciatica. Osteoid osteoma was detected in the follow-up examinations (bone scintigraphy and MRI) following the patient's referral. After advanced imaging and mapping, tumor tomography was fully removed with a 2 cm incision with assisted minimally invasive surgery. The patient was sent home 1 day later and began to attend school one week later.
Giant Cell Tumor in Proximal Tibia
A 44-year-old male patient suffered from painful swelling on the knee and on the outside. After the examinations and needle biopsy, a giant cell tumor was diagnosed. After the tumor was completely removed during surgery, advanced tumor cleansing was performed using the tumor bed high-speed motor, phenol and electrocautery. The resulting space was filled with bone cement and titanium plaque. At 3 months postoperatively, the patient's knee function was complete and painless.
Osteosarcoma around the knee
A 25-year-old male patient was admitted to our clinic with complaints of increased swelling in the lower part of the knee for about 2 months, especially at night. The patient's examination revealed advanced radiological findings and high-grade osteosarcoma after biopsy. Following preoperative chemotherapy, the tumor was removed by extensive surgical resection and the resulting space was removed with a tumor prosthesis. At the 5th year after surgery, the patient is alive and well and has a very good knee function.
Soft Tissue Sarcoma in Elbow Region
A 62-year-old man presented with complaints of increasing swelling and redness on the elbow. It was learned that the patient had had surgery at another center in the same area before, but the swollenness was repeated within a short time. Malignant fibrous histiocytosis was detected after examination of the lung and other organs without metastasis, and the patient was treated with extensive resection. Tissue transplant was done to treat the resulting tissue defect. Following wound healing, the tumor was treated with radiotherapy. It is seen that after surgery the function of the tumor in the other side of the patient's arm has been provided without recurrence of the tumor.
