Orthopaedic implant-associated rhabdomyosarcoma Journal Article


Authors: Brown, D. E.; Saoud, C.; Antonescu, C. R.; Wexler, L. H.; Bartlett, E. K.; Morris, C. D.
Article Title: Orthopaedic implant-associated rhabdomyosarcoma
Abstract: Background:Metallic implants are widely used in orthopaedic surgery. These implants may have carcinogenic properties, but the incidence of associated malignancies appears to be low, and to date, only case reports and small case series have been reported. We describe a series of patients with soft-tissue sarcoma adjacent to orthopaedic implant.Methods:Cases of soft-tissue sarcomas treated at our institution were reviewed to identify tumors arising next to orthopaedic implant. We collected diagnostic, therapeutic, surgical, and outcome data and conducted genetic testing on the implant-associated tumors and control tumors.Results:We identified 4 cases, all of which were high-grade sclerosing rhabdomyosarcoma. Median age at diagnosis was 50 years (range: 35 to 58 years). Three tumors were in the lower extremity following internal fixation of the tibia and/or fibula, whereas the fourth was posterior to spinal implant. Mean time from implant placement to diagnosis was 19.0 years (range: 10.9 to 24.3 years). Three patients underwent wide surgical resection, whereas one had metastatic disease at diagnosis and declined surgery. All were treated with chemotherapy and radiation. Genetic testing revealed a MYOD1 mutation in all four tumors. The tumor mutational burden and fraction of genome altered were slightly higher in the control tumors than in the implant-adjacent tumors, although the differences were not statistically significant. Median follow-up was 1.7 years (range: 0.8 to 2.6 years). Of the three patients with localized disease, two had no evidence of disease at latest follow-up and one died of unknown cause at 2.6 years. The patient with metastatic disease died of disease at 0.8 years.Conclusions:We found no genetic differences between implant-associated and non-implant-associated rhabdomyosarcomas. Further investigation is needed to understand the contribution of metallic implants to tumorigenesis. Physicians should be aware of this diagnosis when a new mass arises in a patient with long-standing orthopaedic implants. © American Academy of Orthopaedic Surgeons.
Keywords: adult; middle aged; genetics; mutation; case report; pathology; diagnosis; rhabdomyosarcoma; therapy; soft tissue neoplasms; soft tissue tumor; myod protein; etiology; prostheses and implants; prostheses and orthoses; adverse event; humans; human; male; female; myod1 myogenic differentiation protein
Journal Title: Journal of the American Academy of Orthopaedic Surgeons
Volume: 33
Issue: 12
ISSN: 1067-151X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2025-06-15
Start Page: 655
End Page: 662
Language: English
DOI: 10.5435/jaaos-d-25-00160
PUBMED: 40479555
PROVIDER: scopus
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Carol Morris -- Source: Scopus
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MSK Authors
  1. Carol Morris
    80 Morris
  2. Leonard H Wexler
    192 Wexler
  3. Cristina R Antonescu
    901 Antonescu
  4. Carla Saoud
    23 Saoud
  5. Danielle Elizabeth Brown
    1 Brown