The aims of this study were to evaluate the incidence
of local argyria in patients with silver-coated megaprostheses and
to identify a possible association between argyria and elevated
levels of silver both locally and in the blood. Between 2004 and
2011, 32 megaprostheses with silver coatings were implanted in 20
female and 12 male patients following revision arthroplasty for
infection or resection of a malignant tumour, and the levels of
silver locally in drains and seromas and in the blood were determined.
The mean age of the patients was 46 years (10 to 81); one patient
died in the immediate post-operative period and was excluded. Seven patients (23%) developed local argyria after a median of
25.7 months (interquartile range 2 to 44.5). Patients with and without
local argyria had comparable levels of silver in the blood and aspiration
fluids. The length of the implant did not influence the development
of local argyria. Patients with clinical evidence of local argyria
had no neurological symptoms and no evidence of renal or hepatic
failure. Thus, we conclude that the short-term surveillance of blood
silver levels in these patients is not required. Cite this article:
The development of local recurrence after multimodal treatment of osteosarcoma is associated with a very poor prognosis. The importance of clear surgical margins has been demonstrated in multiple studies, however up to date there are no studies defining which margin width is safe from an oncological perspective. The purpose of this retrospective analysis was to evaluate whether margin width or other surgical and tumour-related factors influence the development of local recurrence in osteosarcoma patients. The files of 1867 consecutive patients with high-grade central osteosarcoma of the extremities, the pelvic bones and the shoulder girdle, who had achieved a complete surgical remission during combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group (COSS) protocols between 1986 and 2005, were reviewed. Of those, the data required were available for 1369 patients, who were the subject of this analysis. Eighty of these patients developed a local recurrence during the course of their illness. The median surgical margin width amounted to 45 mm (range, 0 to 140 mm) in the local recurrence (LR) group and 50 mm (range, 0 to 350 mm) in the non-local recurrence (NLR) group (p=0.106). No statistically significant difference between the two groups was found regarding tumour size (mean, 10.38 cm and 9.53 cm respectively, p=0.169), T-status (p=0.225) and presence of pathological fracture (p=0.231). However infiltration of the soft tissue beyond the periosteum was documented in 58.8% of the patients with local recurrence and only in 36.9% of the rest (p=0.003). Furthermore, in 50% of the LR group the biopsy had been performed in a centre other than the one performing the definitive tumour resection, compared to 30.2% of the NRL group (p=0.001). In conclusion, the absolute metric width of surgical margins does not define oncological safety. Local recurrence is more likely to develop in patients with soft tissue infiltration beyond the periosteum or those biopsied in a centre other than the one performing the tumour resection.
