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Catalin Cirstoiu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Cretu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Sergiu Iordache Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Mihnea Popa Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Serban Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Adrian Cursaru Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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  • Bone metastases are difficult to treat surgically, necessitating a multidisciplinary approach that must be applied to each patient depending on the specifics of their case.

  • The main indications for surgical treatment are a lack of response to chemotherapy, radiation therapy, hormone therapy, immunotherapy, and bisphosphonates which is defined by persistent pain or tumor progression; the risk of imminent pathological bone fracture; and surgical treatment for single bone metastases.

  • An important aspect of choosing the right treatment for these patients is accurately estimating life expectancy. Improved chemotherapy, postoperative radiation therapy, and sustainable reconstructive modalities will increase the patient’s life expectancy.

  • The surgeon should select the best surgical strategy based on the primary tumor and its characteristics, the presence of single or multiple metastases, age, anatomical location, and the functional resources of the patient.

  • Preventive osteosynthesis, osteosynthesis to stabilize a fracture, resections, and reconstructions are the main surgical options for bone metastases.

  • Resection and reconstruction with a modular prosthesis remain the generally approved surgical option to restore functionality, increase the quality of life, and increase life expectancy.

  • Preoperative embolization is necessary, especially in the case of metastases of renal or thyroid origin. This procedure is extremely important to avoid complications, with a major impact on survival rates.

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Joaquim Soares do Brito Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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André Spranger Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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Paulo Almeida Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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José Portela Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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Irene Barrientos-Ruiz Orthopedics Department, University Hospital of La Paz, Madrid

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extensive soft tissue involvement and fungation) Yu et al 20 Curettage plus PMMA plus internal fixation and oral bisphosphonates 0.0% 0% ∅ Saibaba et al 28 Curettage plus phenol plus subchondral bone graft plus gel foam layer

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Antal Imre Department of Orthopaedics, Semmelweis University, Budapest, Hungary

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Sápi Zoltán Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest

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Szendrői Miklós Department of Orthopaedics, Semmelweis University, Budapest, Hungary

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with or without local adjuvant therapy or resection in healthy tissue. Bisphosphonate, effectively used in osteoporosis and metastatic bone diseases, was the first systematic drug studied regarding treatment of GCTB. The most commonly used zoledronic

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Irina-Anca Eremia Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania

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Bogdan Serban Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania

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Mihnea Popa Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania

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Adela Iancu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

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Silvia Nica Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania

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Catalin Cirstoiu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania

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with the administration of bisphosphonates and denosumab, highlighting the significance of reducing skeletal-related events ( 5 , 7 ). Recent research emphasizes the significance of vascular endothelial growth factor (VEGF) inhibitors in extending

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Olga D. Savvidou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Panagiotis Koutsouradis Department of Orthopaedic Surgery, 417 Veterans Hospital (NIMTS), Athens, Greece

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George D. Chloros First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Ioannis Papanastasiou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Thomas Sarlikiotis First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Aggelos Kaspiris Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras, Greece

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Panayiotis J. Papagelopoulos First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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-steroidal anti-inflammatory drugs, opioids and bisphosphonates have been used to treat patients reporting bone pain, with the most favourable outcomes detected in individuals treated with bisphosphonates, mainly pamidronate. 69 , 70 Although most lesions

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Miklós Szendrői Department of Orthopaedics, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Imre Antal Department of Orthopaedics, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Attila Szendrői Department of Urology, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Áron Lazáry National Center for Spinal Disorders, H-1126 Budapest, Királyhágó u.1., Hungary

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Péter Pál Varga National Center for Spinal Disorders, H-1126 Budapest, Királyhágó u.1., Hungary

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improved chemotherapy and radiotherapy, new targeted therapy such as bisphosphonates and denosumab (antigen against RANKL) reduce skeletal-related events (SREs). A broad spectrum of surgical options is available for reconstruction of defects. Many of the

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