Ricardo Gehrke Becker

➢ Substantial disparities exist between Latin America and high-income countries in research capacity, and artificial intelligence (AI) has emerged as a powerful tool to accelerate scientific development and reduce this gap. ➢ Orthopaedic research in Latin America faces persistent barriers, including limited funding, lack of trained investigators, and insufficient data infrastructure, that restrict innovation and international collaboration. ➢ By automating complex and time-consuming tasks, AI can lower research costs, improve efficiency, and enhance project quality across all stages, from data analysis to manuscript preparation. ➢ The growing adoption of AI in the region is already strengthening academic productivity, fostering collaboration, and supporting Latin America’s transition to a more equitable and innovative research environment.

Background: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter randomized clinical trial comparing a 1-day with a 5-day postoperative intravenous antibiotic regimen after lower extremity bone tumor resection and endoprosthetic reconstruction. The trial found no difference in surgical site infections between groups, but a markedly increased risk for antibiotic-related complications in the 5-day group. The study was published in January 2022. The objective of this study was to assess the effect of these findings on the clinical practice of musculoskeletal oncologists. Methods: We developed an anonymous survey exploring changes in clinical practice after the publication of the PARITY trial and electronically distributed the survey to practicing musculoskeletal oncologists through REDCap in March 2024. Data were analyzed descriptively, and changes in practice from before to after the publication of the PARITY study were analyzed through the Pearson chi-square test. Results: We obtained 101 responses from surgeons across six continents. Nearly all respondents (94 of 101, 93%) were aware of the PARITY trial results. Forty respondents (40%) reported a meaningful change in clinical practice after PARITY, most frequently a reduction of antibiotic administration in >75% of patients. After PARITY, the proportion of respondents who reported limiting antibiotics to 24 hours increased from 25% to 51% ( P < 0.001), and the proportion prescribing oral antibiotics after discharge from the hospital declined from 23% to 16% ( P < 0.001). Among those who did not change their practice, personal experience/professional opinion was the most frequently cited reason. Adherence to institutional standards was cited as an additional barrier. Conclusions: Many respondents reported meaningful change in their clinical practice after the publication of the PARITY trial, most notably limiting perioperative antibiotics to 24 hours. The complexities influencing the personal decision to adopt a notable change in clinical practice in response to new evidence warrant additional study. Level of Evidence: IV

Soft-tissue sarcomas (STSs) are rare malignancies predominantly found in the extremities. Surgery and radiation are standard treatments, but post-operative pulmonary surveillance, involving clinical visits and thoracic imaging, is crucial due to a high recurrence rate, most commonly to the lungs. Current pulmonary surveillance guidelines lack robust evidence. The Surveillance AFter Extremity Tumor SurgerY (SAFETY) randomized controlled trial is designed to determine the impact of pulmonary surveillance frequency (every three versus six months) and chest imaging modality (CXR versus CT) on patient-important outcomes. The pilot phase assessed feasibility of patient enrolment, protocol adherence, and data quality, as well as aggregate outcomes at two years of follow-up. 100 patients were enrolled from 300 screened patients across 17 international sites. Minor protocol deviations were common. Follow-up, data completeness and data quality met the progression criteria of 85%. Of the 100 patients, 15 died, 21 had metastases, seven had local recurrence and 30 experienced at least one serious adverse event. This SAFETY trial study established feasibility of enrolment and data quality, and confirmed the need to emphasize protocol adherence in sarcoma care. The results of this trial are expected to provide crucial evidence to standardize STS pulmonary surveillance practices, ultimately improving patient management and expectations.

The proximal femur represents the most frequent site in the appendicular skeleton for metastatic bone disease (MBD) to occur, with a high risk for pathologic fracture. While surgical stabilization is typically used to manage fractures, reconstruction approaches are gaining popularity due to improved survival. Previous studies have focused on clinical outcomes, but patient-centered outcomes remain underexplored. This study aims to develop a patient-centered primary outcome for the Proximal FEmur Reconstruction or Internal Fixation fOR Metastases (PERFORM) Randomized Controlled Trial, employing a mixed-methods approach. First, a focus group with advanced cancer patients and caregivers identified relevant outcomes. Next, a discrete choice experiment (DCE) assessed the importance of these outcomes among stakeholders, including surgeons, patients and caregivers. The most important components for the primary outcome were identified: mortality within twelve months, physical function assessed at four months using the PROMIS^® Global Physical Function score, and the number of days at home within twelve months. The DCE further confirmed that survival and physical function were most prioritized. The PERFORM trial’s primary outcome, developed through extensive stakeholder engagement, will guide the evaluation of surgical approaches for MBD of the proximal femur and has the potential to influence patient-centered practice.

Objective: To analyze the evolution of patient/tumor characteristics and treatments for GCTB in the knee in Brazil over 30 years and assess changes in local recurrence rates.

Objectives: To assess patient and tumor characteristics and treatment outcomes, focusing on local recurrence rates based on treatment type.

Objectives: to identify oncological-orthopedic studies published in Acta Ortopédica Brasileira over three decades; to classify them according to the type and level of evidence (LE); to observe the inter-rater agreement in the classification of studies; to analyze the studies retrospectively, according to levels of evidence; and to outline the evolution of the evidence in the study period. Methods: Descriptive analyses were performed with absolute and relative frequencies of studies published between 1993 and 2022. Inter-rater agreement was analyzed by percentage of agreement and Kappa statistic (95%CI). The interpretation of the magnitude of the agreement was performed according to Landis & Koch. The association between classifications and publication period was analyzed using Fisher’s exact test. The analyses were performed using the R program (significance of 5%). Results: 69/1349 papers were selected; there was a significant association between type of study, statistical methodology, and LE with publication period (p < 0.05); inter-rater agreement regarding LE was 92.8%. Conclusions: Oncological-orthopedic studies accounted for 5.1% of all published papers. Regarding the LE, 80% were NE IV and V studies, despite the evolution observed between the first and last decade (decrease in LE V studies and increase in LE II, III and IV). Level of Evidence III, Retrospective Comparative Study.

On the right and left sides of the thyroid, the parathyroid glands are presented in the form of four nodules in total, two apical and two basal¹ 1 Próspero JD, Baptista PPR, Amary MFC, Santos PPC. Paratireóides: estrutura, funções e patologia. Acta Ortop Bras. 2008;17(2):53-7. https://doi.org/10.1590/S1413-78522009000200011 https://doi.org/10.1590/S1413-7852200900... . Topographic variations are common—the parathyroid glands can be located near the larynx or even in the mediastinum, near the thymus¹ 1 Próspero JD, Baptista PPR, Amary MFC, Santos PPC. Paratireóides: estrutura, funções e patologia. Acta Ortop Bras. 2008;17(2):53-7. https://doi.org/10.1590/S1413-78522009000200011 https://doi.org/10.1590/S1413-7852200900... . Microscopically, they are made up of two main types of cells, clear and oxyphilic; the former secrete parathyroid hormone (PTH), and the latter have a still obscure function—all are arranged in a chordonal arrangement, interspersed with lobes of fatty tissue¹ 1 Próspero JD, Baptista PPR, Amary MFC, Santos PPC. Paratireóides: estrutura, funções e patologia. Acta Ortop Bras. 2008;17(2):53-7. https://doi.org/10.1590/S1413-78522009000200011 https://doi.org/10.1590/S1413-7852200900... ,² 2 Jambeiro JES, Guedes A, Mattos ESR, Guedes AAL, Freire ANM, Freire MDM, et al. Osteíte fibrose cística. Rev Cient HSI. 2023;7(1):18-30. .

Introduction: Giant cell tumor of bone (GCTB) mainly affects young adults’ long bone epiphyses, threatening bone strength and joint function. Surgery is the primary treatment, although post-surgery recurrence is significant. This study analyzes patient profiles, treatments, and outcomes for GCTB in Brazil. Methods: We retrospectively assessed local recurrence, metastasis, and treatment approaches in 643 GCTB patients across 16 Brazilian centers (1989-2021), considering regional differences. Results: 5.1% (n=33) developed pulmonary metastases, 14.3% (n=92) had pathological fractures, and the local recurrence rate was 18.2% (n=114). Higher rates of pulmonary metastases (12.1%) and advanced tumors (Campanacci III, 88.9%) were noted in lower-income North and Northeast regions. The North also had more pathological fractures (33.3%), extensive resections (61.1%), and amputations (27.8%). These regions faced longer surgical delays (36-39 days) than the South and Southeast (27-33 days). Conclusions: Our findings corroborate international data, underscoring regional disparities in Brazil that may lead to worse outcomes in disadvantaged areas. This highlights the need for improved orthopedic oncology care in Brazil’s economically and structurally challenged regions. Level of Evidence III; Retrospective Cohort.

Background: The specific risk factors for surgical site infection (SSI) in orthopaedic oncology patients undergoing endoprosthetic reconstruction have not previously been evaluated in a large prospective cohort. In the current study, we aimed to define patient- and procedure-specific risk factors for SSI in patients who underwent surgical excision and endoprosthetic reconstruction for lower-extremity bone or soft-tissue tumors using the prospectively collected data of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Methods: PARITY was a multicenter, blinded, randomized controlled trial with a parallel 2-arm design that aimed to determine the effect of a long duration (5 days) versus short duration (24 hours) of postoperative prophylactic antibiotics on the rate of SSI in patients undergoing surgical excision and endoprosthetic reconstruction of the femur or tibia. In this secondary analysis of the PARITY data, a multivariate Cox proportional hazards regression model was constructed to explore predictors of SSI within 1 year postoperatively. Results: A total of 96 (15.9%) of the 604 patients experienced an SSI. Of the 23 variables analyzed in the univariate analysis, 4 variables achieved significance: preoperative diagnosis, operative time, volume of muscle excised, and hospital length of stay (LOS). However, only hospital LOS was found to be independently predictive of SSI in the multivariate regression analysis (hazard ratio per day = 1.03; 95% confidence interval = 1.01 to 1.05; p < 0.001). An omnibus test of model coefficients demonstrated that the model showed significant improvement over the null model (χ² = 78.04; p < 0.001). No multicollinearity was found. Conclusions: This secondary analysis of the PARITY study data found that the only independent risk factor for SSI on multivariate analysis was hospital LOS. It may therefore be reasonable for clinicians to consider streamlined discharge plans for orthopaedic oncology patients to potentially reduce the risk of SSI. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.