Rajesh Rana

Background The evolution of metals and alloys in orthopedics has significantly improved the management of bone-related disorders, particularly osteoporosis, where decreased bone density and fragility complicate implant stability and healing. Traditional materials such as stainless steel and cobalt-chromium alloys provided strength and wear resistance but were associated with challenges like stress shielding and implant loosening. Materials and Methods To address these limitations, titanium alloys emerged as a superior alternative due to their biocompatibility, lightweight nature, and bone-like elasticity, making them suitable for osteoporotic patients. Recent advancements have led to the development of magnesium-based biodegradable implants and nitinol (shape-memory alloy), which enable minimally invasive procedures and provide dynamic support. Additionally, porous and bioactive coatings, such as hydroxyapatite (HA), have been introduced to enhance osseointegration and implant fixation in compromised bone. Results The integration of pharmacological strategies, such as bisphosphonates and sclerostin antibodies, with advanced implant surfaces has further enhanced bone regeneration. Emerging innovations, including 3D-printed personalized implants and smart alloys capable of adapting to physiological changes, show promise for improved long-term stability and faster recovery in osteoporotic patients. Conclusion The continuous development of orthopedic materials has paved the way for more effective treatments for osteoporosis, addressing key challenges such as implant stability, stress shielding, and bone regeneration. Innovations in bioactive coatings, biodegradable metals, and personalized implants represent the future of orthopedic care, offering improved outcomes for patients with compromised bone health. However, continuous research is essential to optimize these technologies for broader clinical applications.

Introduction: Giant cell tumor (GCT) of bone is a benign but locally aggressive tumor, commonly affecting the epiphysis of long bones in young adults. Skip lesions in GCT – defined as discontinuous tumor foci within the same bone – are exceedingly rare, particularly in the appendicular skeleton. Simultaneous recurrence and skip lesions in the same bone have been rarely documented. Case Report: We report a rare case of a 21-year-old female with a recurrent GCT of the proximal femur, previously treated with curettage, bone cementing, and fixation. Two years post-recurrence, she developed a skip lesion in the distal femur along with pulmonary metastases. Management included neoadjuvant denosumab, excision of the proximal lesion with megaprosthesis reconstruction, and curettage and cementation of the distal lesion with plate fixation. Post-operative follow-up showed significant clinical improvement and no recurrence or metastasis progression. Conclusion: This case highlights an exceptionally rare presentation of recurrent GCT with a skip lesion in the same bone and asymptomatic pulmonary metastases. Early recognition, appropriate imaging, and a multidisciplinary approach – including denosumab therapy and surgical reconstruction – are essential for favorable outcomes in such aggressive and atypical cases. Keywords: Giant cell tumor of bone, skip lesion, proximal femur, denosumab, megaprosthesis reconstruction.

Introduction: Bone neoplasms represent a diverse group of malignancies that significantly impact morbidity and mortality. These tumors primarily affect the appendicular skeleton and, while less common than other malignancies, are particularly notable due to their prevalence in adolescents and young adults. Given their potential for rapid growth and high metastatic potential, these neoplasms can be life-threatening. This study aims to explore the relative frequencies, age, and sex distributions, as well as the anatomical and clinico-pathological characteristics of bone tumors in a tertiary care hospital. Materials and methods: This retrospective cross-sectional study was conducted in the histopathology section of the Department of Pathology at a tertiary care medical college in Western India over 18 months (January 2023 to June 2024). All histopathologically confirmed cases of bone tumors, both benign and malignant, were analyzed based on the WHO's recent fifth-edition classification. Clinical data, including age, sex, and anatomical site, along with radiological investigations, were also reviewed for final diagnosis. Results: A total of 63 patients, ranging from three months to 66 years old, with a mean age of 25.8 years, were included in the study. Of these, 34 (53.9%) were male and 29 (46.03%) were female, resulting in a male-to-female ratio of 1.17:1. The highest incidence of primary bone tumors occurred in the 11-20 years age group. Benign tumors accounted for 36 cases (57.11%), while 27 cases (42.85%) were malignant. Giant cell tumors (GCTs) were the most common, with 12 cases (19.04%), followed by osteochondroma with 11 cases (17.46%). Among malignant tumors, osteosarcoma was the most frequent, with 11 cases (17.46%), followed by Ewing’s sarcoma with 10 cases (15.87%). Conclusion: The majority of tumors in this cohort were benign, with a slight male predominance, particularly among young adults. The diagnosis of bone tumors requires a comprehensive approach, including clinical evaluation, radiological correlation, and histopathological examination (HPE). In certain cases, immunohistochemistry is essential for an accurate diagnosis, staging, and the development of an effective treatment plan.

Introduction: Giant cell tumor of bone (GCTB) is a rare yet locally aggressive neoplasm primarily affecting young adults. Its hallmark features include multinucleated osteoclast-type giant cells and mononuclear tumor cells. Treatment with denosumab, an anti-RANK ligand antibody, has shown efficacy, but it alters histomorphology, posing diagnostic challenges. Co-occurrence with achondroplasia, though rare, warrants consideration in bone lesion evaluations. Case Report: A 30-year-old male with achondroplasia presented with a proximal femur GCT, a rare association. Neoadjuvant denosumab was administered due to thin tumor cortex and cortical breech. Surgical excision with bone cement filling and Philo’s plate supplementation was performed. Histopathological examination post-treatment revealed the absence of osteoclast-type giant cells, extensive necrosis, hyalinization, and mononuclear infiltrates. Discussion: Denosumab induces a reduction in osteoclast numbers, causing tumor shrinkage and sclerosis, while altering typical GCT histology. Similar findings were noted in the literature, including stromal changes like spindle-shaped cells, inflammation, vascular proliferation, and hemosiderin-laden foamy macrophages. Recognition of these alterations is crucial for accurate diagnosis. Conclusion: GCT, though rare, presents distinct histopathological features aiding diagnosis. Denosumab treatment modifies tumor morphology, necessitating thorough clinical evaluation for accurate diagnosis post-treatment. Understanding, these challenges is essential for optimal management of GCT cases. Keywords: Giant cell tumor, achondroplasia, denosumab therapy, challenges in histopathology.

Objective: It aims to assess the efficacy of these treatments, specifically in the presence of osteoporotic bone conditions. The findings of this study offer insights into the suitability of TEA as an alternative treatment option in such cases. Methods: In this study, sixty patients with distal humerus fractures were divided into two groups. The first group received ORIF for fracture fixation, while the second group underwent primary TEA treatment. The study evaluated various outcomes, including elbow range of movement, elbow stability, and comparison of Mayo Elbow Performance Scores (MEPS) between the two groups at three- and twelve-month follow-up periods. Results: In the three- and twelve-month follow-up periods, noticeable differences in elbow motion range were observed between the ORIF and TEA groups. The ORIF group experienced more significant restrictions in daily activities due to stiffness and pain, unlike the TEA group. However, both groups showed improvements in elbow function after one year. Furthermore, there were significant differences in the mean MEPS between the two groups at the three- and twelve-month follow-up period. However, no considerable differences were found between these periods within either group. Conclusion: TEA is emerging as a promising option for elderly patients with comminuted distal humerus fractures, considering the osteoporotic bone condition. The results of this study hold substantial implications for the decision-making process in treatment selection.

Septic arthritis of the hip in late childhood leads to different sequelae. These cases are often missed and lead to various disabilities like hip subluxation, limb length discrepancy, and limping. The primary goal is always to reproduce a concentrically reduced stable hip. We are presenting a 13-year child with sequelae of septic arthritis of the hip with dislocation. The child had septic arthritis of the hip two years back. The patient had a superolateral acetabular defect and was treated with triple innominate steel osteotomy. The osteotomy increased the acetabular head coverage and gave a stable congruent hip to the child. Late childhood septic arthritis cases can produce acetabular defects without involving the femoral head leading to dislocation. Such cases can be effectively treated with triple innominate pelvic osteotomy, giving good head coverage with stable congruent hips.

Introduction: Avascular necrosis (AVN) of patella is a very rare condition and occurs in very few case. Although underlying etiology is still unknown, some expert suggest that its due to interruption of blood supply to patella which may be due to high velocity trauma or may be due to long term history of steroid intake. Here are the findings of our case AVN patella and reviews of earlier literature. Case Report: We present a case of a AVN patella in a 31-year-old male. The patient presented with pain in knee with stiffness and tenderness at knee followed by decrease range of movement of knee. Magnetic resonance imaging showed irregular cortical outline of patella with degenerative osteophytes-suggestive of osteonecrosis of patella. It was treated conservatively with physiotherapy for range of movement of knee. Conclusion: ORIF with extensive exploration and infection may compromise that the vascularity of patella may lead to AVN of patella. As the disease is non-progressive, it is better to manage such patients conservatively with range of movement brace so as to decrease the chance of complication associated with surgical intervention. Keywords: Avascular necrosis, patella, range of movement, non-progressive, physiotherapy.

Pigmented villonodular synovitis (PVNS) is a locally aggressive benign tumour of the synovial membrane and tendon sheath. The unique presentation of this tumour is hemosiderin deposition with synovial proliferation. Depending on the situation, surgical excision is always the first line of treatment with adjuvant radiotherapy. Arthroscopic excision is preferred in some intraarticular nodular PVNS cases. This is a rare pigmented villonodular synovitis involving flexor hallusis longus, flexor digitorum longus, and tibialis posterior (TP). The tumour was entirely extra-articular without any joint involvement. The tumour was the diffuse type of PVNS and was treated by excision followed by radiotherapy. There is no recurrence till nine months of follow-up.

Introduction: A giant cell tumor (GCT) is a benign tumor of bones which commonly arises from epiphysis of long bones. The tumor is locally aggressive and rarely metastasizes to the lungs. GCT of small bones of the foot and ankle is very rare. The GCT of the talus is very rare, and only a few case reports and series are described in the literature. In general, the GCT is monostotic, and few incidences of multicentricity have been described in the foot and ankle bones literature. Here are the findings of our case GCT of talus and reviews of earlier literature. Case Report:We present a case of a GCT of the talus in a 22-year-old female. Patient presented with pain in ankle with mild swelling and tenderness at ankle. Radiograph and Computer tomography scan conformed an eccentric osteolytic lesion on anterolateral part of talus body. Magnetic resonance imaging showed no extra osseous extension or articular surface breach. Biopsy conformed the lesion to be giant cell tumor. The tumor was reated with curettage and bone cement filling. Conclusion: Giant cell tumor of talus is extremely rare and presentation of these tumor may change. Curettage and bone cementing are an effective method of treatment. It gives early weight bearing and rehabilitation. Keywords: Giant cell tumor, talus, osteolytic lesion, curettage, Giant cell tumor of small bones.