Vânia Oliveira

Background/Objectives: Bone metastases from lung cancer can cause pain, pathological fracture, spinal instability, metastatic spinal cord compression and loss of independence. Lung cancer-specific evidence for orthopaedically relevant local management remains fragmented. This review assessed outcomes across spinal, appendicular and pelvic skeletal disease, while explicitly examining the anatomical distribution and limitations of the evidence. Methods: PubMed, Web of Science, Europe PMC and Scopus were searched for original studies published from January 2015 to December 2025. Eligible studies evaluated orthopaedic, surgical, minimally invasive or percutaneous skeletal interventions, including radiotherapy when combined with or directly compared with an orthopaedically relevant local strategy. Two reviewers independently screened studies, extracted data and completed the full Joanna Briggs Institute checklist applicable to each design. Findings were synthesised narratively, with evidence certainty assessed using GRADE. Results: Thirty-three studies comprising 3585 participants with lung cancer were included; 26 were retrospective observational studies. Thirty studies predominantly evaluated axial disease, mainly spinal metastases, whereas only six included appendicular lesions; these categories were not mutually exclusive. Local interventions were associated with pain relief, maintenance or recovery of ambulation, neurological improvement and local symptom control in selected patients. Comparative survival findings were inconsistent and vulnerable to selection bias and confounding by indication; no causal survival benefit of surgery was established. Complication patterns differed by intervention type. Overall certainty was low to very low and was weakest for appendicular and pelvic disease. Conclusions: Orthopaedic management can be clinically important for preserving function and controlling mechanical or neurological complications, but the evidence is substantially stronger for spinal than for extraspinal disease. Treatment should remain multidisciplinary and individualised. The proposed decision frameworks are conceptual and guideline-informed rather than validated treatment algorithms.

Background: Multimodal treatment of bone sarcomas has improved survival and allowed limb salvage surgery in the majority of these patients. Periprosthetic joint infection (PJI) constitutes a challenging complication. Controversy remains regarding the risk factors for PJI. Here, we aim to identify them. We also discuss pathogens and treatments. Methods: The authors reviewed the institutional database to retrieve endoprostheses implanted after bone sarcoma resection from 2014 to 2021. In total, 66 eligible patients were identified. Results: A total of 14 (21.21%) periprosthetic infections were diagnosed. Of these, 10 occurred in men (71.43%, p = 0.143). Mean BMI, age at the time of surgery, and ASA score were significantly higher among patients who developed PJI (p = 0.003, 0.044, and 0.033, respectively). Site was an important factor as well (p = 0.029). The number of comorbidities and the Charlson Comorbidity Index were also higher among these patients (p = 0.264, 0.060, respectively). Histology did not play a role in PJI (p = 0.385). Conclusions: Our data allow surgeons to better understand and control risk factors for PJI. We identified BMI, age, ASA score, site, and the Charlson Comorbidity Index as the main risk factors. Polymicrobial infections and methicillin-resistant Staphylococcus aureus are associated with recurrent infections. A multicentric study with a larger cohort is needed.

Bone metastases occur when cancer cells from the primary tumor spread to the bones. The incidence of bone metastases is increasing due to the longer survival of patients with primary tumors, driven by advances in cancer treatments. In patients with multiple bone metastases, care is primarily palliative, aiming to improve their quality of life through pain relief. Bone metastases are strongly associated with pathological fractures, particularly in the femur. In these cases, minimally invasive treatments such as percutaneous cementoplasty and internal fixation with intramedullary nails are growing in popularity. Methods: This manuscript focuses on studying these two therapies by developing virtual models using ANSYS^® software. Thermal and thermomechanical analyses were conducted to evaluate the heat effect resulting from the polymerization of different types of bone cement and to assess the benefits of combining it with internal fixation using intramedullary nails made of different materials. Results: The results highlight the advantages of combining these two techniques compared to cementoplasty alone. Furthermore, the use of Gentamicin Bone Cement (CMW 3^®) with an intramedullary nail made of either material has been shown to provide a more significant functional improvement. Conclusions: The combination of cementoplasty with internal fixation is more effective than cementoplasty alone. The use of CMW 3^® cement with an intramedullary nail made of either material provides greater control over the growth of the metastatic lesion. The chosen injection angle results in an excessive volume of cement, causing a high degree of thermal necrosis.

Background: Artificial intelligence chatbot tools responses might discern patterns and correlations that may elude human observation, leading to more accurate and timely interventions. However, their reliability to answer healthcare-related questions is still debated. This study aimed to assess the performance of the three versions of GPT-based chatbots about prosthetic joint infections (PJI). Methods: Thirty questions concerning the diagnosis and treatment of hip and knee PJIs, stratified by a priori established difficulty, were generated by a team of experts, and administered to ChatGPT 3.5, BingChat, and ChatGPT 4.0. Responses were rated by three orthopedic surgeons and two infectious diseases physicians using a five-point Likert-like scale with numerical values to quantify the quality of responses. Inter-rater reliability was assessed by interclass correlation statistics. Results: Responses averaged “good-to-very good” for all chatbots examined, both in diagnosis and treatment, with no significant differences according to the difficulty of the questions. However, BingChat ratings were significantly lower in the treatment setting (p = 0.025), particularly in terms of accuracy (p = 0.02) and completeness (p = 0.004). Agreement in ratings among examiners appeared to be very poor. Conclusions: On average, the quality of responses is rated positively by experts, but with ratings that frequently may vary widely. This currently suggests that AI chatbot tools are still unreliable in the management of PJI.

PRIMARY BONE TUMOURS AND METASTASES: CLINICAL APPROACH

This work presents a methodology for the creation of a two-dimensional geometric model of the femur with data obtained from X-ray images. The aim of this work is to evaluate the stress distribution throughout the femur, in order to understand the behavior of the bone in a healthy condition. The strain will, also, be evaluated throughout the femur bone. The numerical analysis is carried out using the finite element method, considering the trabecular and the cortical bone. The isotropic and elastic model is subjected to three different load cases, consisting of one parabolic distributed load over the joint surface and another parabolic distributed in the trochanter to represent the abductor muscle. The results obtained demonstrate an increase of stress in the cortical bone and an increase of strain mainly in the shaft of the femur.