Costantino Errani | Università di Bologna (original) (raw)
Papers by Costantino Errani
Skeletal radiology, May 7, 2024
European journal of orthopaedic surgery & traumatology, Feb 16, 2024
European journal of orthopaedic surgery & traumatology, Apr 5, 2024
CardioVascular and Interventional Radiology, May 15, 2023
La revisione femorale nel bone loss estrem
Orthopaedic Proceedings, Apr 1, 2012
Aim To evaluate outcome and complications of knee arthrodesis with a modular prosthetic system (M... more Aim To evaluate outcome and complications of knee arthrodesis with a modular prosthetic system (MUTARS(r) Implantcast), as primary and revision implants in musculoskeletal oncology. Method Between 1975 and 2009, 24 prostheses were used for knee arthrodesis. Nineteen in oncologic cases: 6 osteosarcomas, chondrosarcoma, synovial sarcoma and metastatic carcinoma 3 each, 2 pigmented villonodular synovitis (PVNS), malignant fibrous hystiocitoma and giant cell tumour 1 each. Patients were grouped into: A) primary implants, B) revision implants. Group A included 9 patients: 8 arthrodeses after extra-articular resection with major soft tissue removal, 1 after primary resection following multiple excisions of locally recurrent PVNS. Group B included 15 patients: 12 arthrodeses for infection (5 infected TKAs, 7 infected megaprostheses), 2 for failures of temporary arthodesis with Kuntscher nail and cement, 1 for recurrent chondrosarcoma in previous arthrodesis. Results Oncologic outcome ata mean follow-up of 6 years (ranging 1 to 26), showed 13 NED (68.4%), 2 NED after treatment of relapse (10.5%), 1 alive with metastases (5.3%), 2 dead with disease (10.5%) and one dead of other disease (5.3%). Complications causing failure were observed in 12 patients (50%): 11 infections at mean of 14 months (6 in arthrodeses as revision for previous infections, 5 in group A), 1 femoral stem breakage at 4.8 years (in group B). Treatment of infections was: amputation in 6, “one stage” in 1, “two stage” with new arthrodesis in 4 (1 subsequently amputated for recurrent infection). The breakage was revised, had further traumatic breakage at 2 years and a second revision. Conclusion Arthrodesis with modular prosthetic system is indicated after major extra-articular resection or in revisions of severely failed previous reconstructions. High infection rate should be prevented with good soft tissue coverage, by flaps if needed.
European Spine Journal, Mar 1, 2023
Journal of Vascular and Interventional Radiology, Apr 1, 2023
Current Oncology, Jul 17, 2023
Archives of Orthopaedic and Trauma Surgery, Jun 10, 2021
To quantify union rate, complication rate, reintervention rate, as well as functional outcome aft... more To quantify union rate, complication rate, reintervention rate, as well as functional outcome after vascularized fibular bone grafts (VFGs) for the treatment of long-bone defects. A comprehensive search was performed in the PubMed, Web of Science, and Cochrane databases up to August 18, 2020. Randomized controlled trials, comparative studies, and case series describing the various techniques available involving VFGs for the reconstruction of segmental long-bone defects were included. A meta-analysis was performed on union results, complications, and reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black’s “Checklist for Measuring Quality”. After full-text assessment, 110 articles on 2226 patients were included. Among the retrieved studies, 4 were classified as poor, 83 as fair, and 23 as good. Overall, good functional results were documented and a union rate of 80.1% (CI 74.1–86.2%) was found, with a 39.4% (CI 34.4–44.4%) complication rate, the most common being fractures, non-unions and delayed unions, infections, and thrombosis. Donor site morbidity represented 10.7% of the total complications. A 24.6% reintervention rate was documented (CI 21.0–28.1%), and 2.8% of the patients underwent amputation. This systematic review and meta-analysis documented good long-term outcomes both in the upper and lower limb. However, VFG is a complex and demanding technique; this complexity means an average high number of complications, especially fractures, non-unions, and vascular problems. Both potential and limitations of VFG should be considered when choosing the most suitable approach for the treatment of long-bone defects.
Giornale Italiano di Ortopedia e Traumatologia, Oct 14, 2016
Clinical Orthopaedics and Related Research, May 6, 2020
Histopathology, Jul 30, 2023
European Journal of Orthopaedic Surgery and Traumatology, May 19, 2021
Reconstruction of the distal femur in children following resection of bone sarcoma is challenging... more Reconstruction of the distal femur in children following resection of bone sarcoma is challenging. The main problem in children is the small size of bone and a possible limb-length discrepancy at the end of skeletal growth secondary to the loss of the physes. We reported the results of a new surgical technique for distal femur reconstruction after bone tumor resection in children. We analyzed 5 patients with distal femoral sarcomas who underwent intra-articular resection and reconstruction with resurfaced allograft–prosthetic composite at a mean follow-up of 70 months. There were 2 males and 3 females, with a mean age of 10 years (range 8–12) at the time of the diagnosis. All patients were affected by high-grade osteosarcoma. The patients’ medical records were reviewed for clinical and functional outcomes as well as post-operative complications. The functional evaluation of the patients was done at the end of the follow-up using Musculoskeletal Tumor Society scoring system. The minimal follow-up was 24 months. At the last follow-up, 4 patients were continuously disease-free. We excluded one patient who died of disease secondary to lung metastases 16 months after the surgery. Complications occurred in 2 of 4 patients at 17 months and 24 months, respectively. One patient developed deep infection who required the removal of the original reconstruction and, once the infection was treated, the patient underwent reconstruction with an expandable prosthesis. An allograft fracture occurred in another of the 4 patients at 24 months after the first surgery, thus the original reconstruction was removed and the patient underwent reconstruction with modular prosthesis. In the two patients who retained the original reconstruction at the time of their latest follow-up, the mean implant survival time was 70 months. These patients had an excellent MSTS score (29.5 points) and walked without support or limitations with an active knee range of motion of > 90° and complete active extension of the knee. No degenerative changes of the articular surface of the proximal tibia and the patella were observed at the time of the last follow-up. Growth of the physis of the proximal tibia was observed in all the patients during follow-up and no angular deformity of the joint was observed. The limb discrepancy was 4 cm and 2 cm, respectively. Resurfaced allograft–prosthetic composite may represent an alternative surgical technique for distal femur reconstruction in children with bone sarcomas. Although its success is limited by high risk of complications, resurfaced allograft–prosthetic composite seems to be a viable option to preserve the bone stock and the physis of the proximal tibia in selected young patients, minimizing a potential limb-length discrepancy at the end of the skeletal growth.
Musculoskeletal Surgery, Feb 12, 2022
Approximately 80% of desmoid tumors (DTs) show spontaneous regression or disease stabilization du... more Approximately 80% of desmoid tumors (DTs) show spontaneous regression or disease stabilization during first-line active surveillance. Medical treatment can be considered in cases of disease progression. This systematic review aimed to evaluate the effectiveness and toxicity of each medical treatment by reviewing only the studies that included progressive disease as the inclusion criterion. We searched the EMBASE, PubMed, and CENTRAL databases to identify published studies for progressive DTs. The disease control rates of the medical treatments, such as low-dose chemotherapy with methotrexate plus vinblastine or vinorelbine, imatinib, sorafenib, pazopanib, nilotinib, anlotinib, doxorubicin-based agents, liposomal doxorubicin, hydroxyurea, and oral vinorelbine for progressive DTs were 71–100%, 78–92%, 67–96%, 84%, 88%, 86%, 89–100%, 90–100%, 75%, and 64%, respectively. Low-dose chemotherapy, sorafenib, pazopanib, nilotinib, anlotinib, and liposomal doxorubicin had similar toxicities. Sorafenib and pazopanib were less toxic than imatinib. Doxorubicin-based chemotherapy was associated with the highest toxicity. Hydroxyurea and oral vinorelbine exhibited the lowest toxicity. Stepwise therapy escalation from an initial, less toxic treatment to more toxic agents is recommended for progressive DTs. Sorafenib and pazopanib had limited on-treatment side effects but had the possibility to induce long-term treatment-related side effects. In contrast, low-dose chemotherapy has some on-treatment side effects and is known to have very low long-term toxicity. Thus, for progressive DTs following active surveillance, low-dose chemotherapy is recommended in young patients as long-term side effects are minor, whereas therapies such as sorafenib and pazopanib is recommended for older patients as early side effects are minor.
European Journal of Orthopaedic Surgery & Traumatology, 2021
Purpose Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free fla... more Purpose Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free flaps are indicated only when pedicle flaps are considered inadequate; however, they are associated with a higher risk of flap failure, longer surgical times, and technical difficulty. To determine the skin defect size that can be covered by a pedicle flap, we investigated the clinical outcomes and complications of reconstruction using pedicle flaps vs. free flaps after sarcoma resection. Methods We retrospectively studied the medical records of 24 patients with soft-tissue sarcomas who underwent reconstruction using a pedicle ( n = 20) or free flap ( n = 4) following wide tumour resection. Results All skin defects of the knee, lower leg, and ankle were reconstructed using a pedicle flap. Skin defects of the knee, lower leg, and ankle were covered by up to 525 cm 2 , 325 cm 2 , and 234 cm 2 , respectively. The amount of blood loss was significantly greater in the free-flap group than in the pedicle flap group ( p = 0.011 ). Surgical time was significantly shorter in the pedicle flap group than in the free-flap group ( p = 0.006 ). Total necrosis was observed in one (25%) patient in the free-flap group; no case of total necrosis was observed in the pedicle flap group. Conclusion Less blood loss, shorter surgical time, and lower risk of total flap necrosis are notable advantages of pedicle flaps over free flaps. Most skin defects, even large ones, of the lower extremities following sarcoma resection can be covered using a single pedicle flap or multiple pedicle flaps.
Skeletal radiology, May 7, 2024
European journal of orthopaedic surgery & traumatology, Feb 16, 2024
European journal of orthopaedic surgery & traumatology, Apr 5, 2024
CardioVascular and Interventional Radiology, May 15, 2023
La revisione femorale nel bone loss estrem
Orthopaedic Proceedings, Apr 1, 2012
Aim To evaluate outcome and complications of knee arthrodesis with a modular prosthetic system (M... more Aim To evaluate outcome and complications of knee arthrodesis with a modular prosthetic system (MUTARS(r) Implantcast), as primary and revision implants in musculoskeletal oncology. Method Between 1975 and 2009, 24 prostheses were used for knee arthrodesis. Nineteen in oncologic cases: 6 osteosarcomas, chondrosarcoma, synovial sarcoma and metastatic carcinoma 3 each, 2 pigmented villonodular synovitis (PVNS), malignant fibrous hystiocitoma and giant cell tumour 1 each. Patients were grouped into: A) primary implants, B) revision implants. Group A included 9 patients: 8 arthrodeses after extra-articular resection with major soft tissue removal, 1 after primary resection following multiple excisions of locally recurrent PVNS. Group B included 15 patients: 12 arthrodeses for infection (5 infected TKAs, 7 infected megaprostheses), 2 for failures of temporary arthodesis with Kuntscher nail and cement, 1 for recurrent chondrosarcoma in previous arthrodesis. Results Oncologic outcome ata mean follow-up of 6 years (ranging 1 to 26), showed 13 NED (68.4%), 2 NED after treatment of relapse (10.5%), 1 alive with metastases (5.3%), 2 dead with disease (10.5%) and one dead of other disease (5.3%). Complications causing failure were observed in 12 patients (50%): 11 infections at mean of 14 months (6 in arthrodeses as revision for previous infections, 5 in group A), 1 femoral stem breakage at 4.8 years (in group B). Treatment of infections was: amputation in 6, “one stage” in 1, “two stage” with new arthrodesis in 4 (1 subsequently amputated for recurrent infection). The breakage was revised, had further traumatic breakage at 2 years and a second revision. Conclusion Arthrodesis with modular prosthetic system is indicated after major extra-articular resection or in revisions of severely failed previous reconstructions. High infection rate should be prevented with good soft tissue coverage, by flaps if needed.
European Spine Journal, Mar 1, 2023
Journal of Vascular and Interventional Radiology, Apr 1, 2023
Current Oncology, Jul 17, 2023
Archives of Orthopaedic and Trauma Surgery, Jun 10, 2021
To quantify union rate, complication rate, reintervention rate, as well as functional outcome aft... more To quantify union rate, complication rate, reintervention rate, as well as functional outcome after vascularized fibular bone grafts (VFGs) for the treatment of long-bone defects. A comprehensive search was performed in the PubMed, Web of Science, and Cochrane databases up to August 18, 2020. Randomized controlled trials, comparative studies, and case series describing the various techniques available involving VFGs for the reconstruction of segmental long-bone defects were included. A meta-analysis was performed on union results, complications, and reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black’s “Checklist for Measuring Quality”. After full-text assessment, 110 articles on 2226 patients were included. Among the retrieved studies, 4 were classified as poor, 83 as fair, and 23 as good. Overall, good functional results were documented and a union rate of 80.1% (CI 74.1–86.2%) was found, with a 39.4% (CI 34.4–44.4%) complication rate, the most common being fractures, non-unions and delayed unions, infections, and thrombosis. Donor site morbidity represented 10.7% of the total complications. A 24.6% reintervention rate was documented (CI 21.0–28.1%), and 2.8% of the patients underwent amputation. This systematic review and meta-analysis documented good long-term outcomes both in the upper and lower limb. However, VFG is a complex and demanding technique; this complexity means an average high number of complications, especially fractures, non-unions, and vascular problems. Both potential and limitations of VFG should be considered when choosing the most suitable approach for the treatment of long-bone defects.
Giornale Italiano di Ortopedia e Traumatologia, Oct 14, 2016
Clinical Orthopaedics and Related Research, May 6, 2020
Histopathology, Jul 30, 2023
European Journal of Orthopaedic Surgery and Traumatology, May 19, 2021
Reconstruction of the distal femur in children following resection of bone sarcoma is challenging... more Reconstruction of the distal femur in children following resection of bone sarcoma is challenging. The main problem in children is the small size of bone and a possible limb-length discrepancy at the end of skeletal growth secondary to the loss of the physes. We reported the results of a new surgical technique for distal femur reconstruction after bone tumor resection in children. We analyzed 5 patients with distal femoral sarcomas who underwent intra-articular resection and reconstruction with resurfaced allograft–prosthetic composite at a mean follow-up of 70 months. There were 2 males and 3 females, with a mean age of 10 years (range 8–12) at the time of the diagnosis. All patients were affected by high-grade osteosarcoma. The patients’ medical records were reviewed for clinical and functional outcomes as well as post-operative complications. The functional evaluation of the patients was done at the end of the follow-up using Musculoskeletal Tumor Society scoring system. The minimal follow-up was 24 months. At the last follow-up, 4 patients were continuously disease-free. We excluded one patient who died of disease secondary to lung metastases 16 months after the surgery. Complications occurred in 2 of 4 patients at 17 months and 24 months, respectively. One patient developed deep infection who required the removal of the original reconstruction and, once the infection was treated, the patient underwent reconstruction with an expandable prosthesis. An allograft fracture occurred in another of the 4 patients at 24 months after the first surgery, thus the original reconstruction was removed and the patient underwent reconstruction with modular prosthesis. In the two patients who retained the original reconstruction at the time of their latest follow-up, the mean implant survival time was 70 months. These patients had an excellent MSTS score (29.5 points) and walked without support or limitations with an active knee range of motion of > 90° and complete active extension of the knee. No degenerative changes of the articular surface of the proximal tibia and the patella were observed at the time of the last follow-up. Growth of the physis of the proximal tibia was observed in all the patients during follow-up and no angular deformity of the joint was observed. The limb discrepancy was 4 cm and 2 cm, respectively. Resurfaced allograft–prosthetic composite may represent an alternative surgical technique for distal femur reconstruction in children with bone sarcomas. Although its success is limited by high risk of complications, resurfaced allograft–prosthetic composite seems to be a viable option to preserve the bone stock and the physis of the proximal tibia in selected young patients, minimizing a potential limb-length discrepancy at the end of the skeletal growth.
Musculoskeletal Surgery, Feb 12, 2022
Approximately 80% of desmoid tumors (DTs) show spontaneous regression or disease stabilization du... more Approximately 80% of desmoid tumors (DTs) show spontaneous regression or disease stabilization during first-line active surveillance. Medical treatment can be considered in cases of disease progression. This systematic review aimed to evaluate the effectiveness and toxicity of each medical treatment by reviewing only the studies that included progressive disease as the inclusion criterion. We searched the EMBASE, PubMed, and CENTRAL databases to identify published studies for progressive DTs. The disease control rates of the medical treatments, such as low-dose chemotherapy with methotrexate plus vinblastine or vinorelbine, imatinib, sorafenib, pazopanib, nilotinib, anlotinib, doxorubicin-based agents, liposomal doxorubicin, hydroxyurea, and oral vinorelbine for progressive DTs were 71–100%, 78–92%, 67–96%, 84%, 88%, 86%, 89–100%, 90–100%, 75%, and 64%, respectively. Low-dose chemotherapy, sorafenib, pazopanib, nilotinib, anlotinib, and liposomal doxorubicin had similar toxicities. Sorafenib and pazopanib were less toxic than imatinib. Doxorubicin-based chemotherapy was associated with the highest toxicity. Hydroxyurea and oral vinorelbine exhibited the lowest toxicity. Stepwise therapy escalation from an initial, less toxic treatment to more toxic agents is recommended for progressive DTs. Sorafenib and pazopanib had limited on-treatment side effects but had the possibility to induce long-term treatment-related side effects. In contrast, low-dose chemotherapy has some on-treatment side effects and is known to have very low long-term toxicity. Thus, for progressive DTs following active surveillance, low-dose chemotherapy is recommended in young patients as long-term side effects are minor, whereas therapies such as sorafenib and pazopanib is recommended for older patients as early side effects are minor.
European Journal of Orthopaedic Surgery & Traumatology, 2021
Purpose Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free fla... more Purpose Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free flaps are indicated only when pedicle flaps are considered inadequate; however, they are associated with a higher risk of flap failure, longer surgical times, and technical difficulty. To determine the skin defect size that can be covered by a pedicle flap, we investigated the clinical outcomes and complications of reconstruction using pedicle flaps vs. free flaps after sarcoma resection. Methods We retrospectively studied the medical records of 24 patients with soft-tissue sarcomas who underwent reconstruction using a pedicle ( n = 20) or free flap ( n = 4) following wide tumour resection. Results All skin defects of the knee, lower leg, and ankle were reconstructed using a pedicle flap. Skin defects of the knee, lower leg, and ankle were covered by up to 525 cm 2 , 325 cm 2 , and 234 cm 2 , respectively. The amount of blood loss was significantly greater in the free-flap group than in the pedicle flap group ( p = 0.011 ). Surgical time was significantly shorter in the pedicle flap group than in the free-flap group ( p = 0.006 ). Total necrosis was observed in one (25%) patient in the free-flap group; no case of total necrosis was observed in the pedicle flap group. Conclusion Less blood loss, shorter surgical time, and lower risk of total flap necrosis are notable advantages of pedicle flaps over free flaps. Most skin defects, even large ones, of the lower extremities following sarcoma resection can be covered using a single pedicle flap or multiple pedicle flaps.