Baylor Scott & White Greater Dallas Orthopaedics

Benign bone tumors

Benign bone tumors are rare, noncancerous growths that can arise from any bone. Because they are rare, management of these tumors by a provider with extensive training and experience in bone tumors provides an optimal outcome.

Benign bone tumors are more common in younger patients and are usually found with a bone mass and/or pain. Often, benign tumors are discovered incidentally when patients have X-rays and MRIs for other reasons. Treatment for benign bone tumors often is just observation with X-ray to see if the tumor is growing over time.

The most common bone tumors include osteochondroma, enchondroma, chondroblastoma, osteoid osteoma, osteoblastoma, hemangioma, non-ossifying fibroma, fibrous dysplasia, lipoma, giant cell tumor and Langerhans cell histiocytosis.

Diagnosing bone tumors

Imaging is necessary to diagnose a bone tumor. Often, multiple tests are ordered, but they must be evaluated carefully by an orthopedic tumor specialist to render an accurate diagnosis. These tumors can often be diagnosed with X-ray, CT scan, MRI, bone scan or PET Scan.

Bone tumor treatment

Asymptomatic bone tumors are often treated by observation. Serial X-rays are usually ordered to make sure that the tumor is not growing. In the case of symptomatic or enlarging tumors, minimally invasive surgery is performed where possible. Usually, the bone tumor is removed carefully, and a bone graft substitute is placed in the defect to restore the patient’s skeletal structure.

Biopsy

A biopsy is often necessary to confirm the diagnosis of a benign bone tumor and is usually done in the setting of a minor outpatient surgery. Tissue can be sent as a frozen section so that the preliminary diagnosis is known the same day. Biopsy of musculoskeletal tumors should be performed by specialists who do this procedure regularly, as an inappropriate biopsy can lead to significant preventable morbidity or severe complications.

Benign soft tissue tumors

Benign soft tissue tumors are fairly common, and the surgeons at Baylor Scott & White Greater Dallas Orthopaedics evaluate hundreds of soft tissue tumors annually. Patients are referred to the clinic with a mass or lump. Often, a clinical diagnosis can be made, and no intervention is required. The local orthopedic surgeons here evaluate thousands of masses annually and are the best-equipped team to render an accurate diagnosis.

Often, imaging is required, such as ultrasound or MRI. Excision of the mass and/or biopsy may be required. Needle biopsy and minimally invasive surgery are often all that is required. Rarely, a benign mass may recur after excision. Common benign soft tissue tumors include lipoma, nerve sheath tumors, hemangioma, fibromatosis, giant cell tumor of tendon sheath/PVNS, ganglion cysts, sebaceous cysts and hematomas.

Diagnosing benign soft tissue tumors

A physical exam by an experienced tumor surgeon is required. In addition, imaging may be necessary to diagnose a benign soft tissue tumor. X-ray, ultrasound and MRI are the tests ordered most frequently to diagnose a benign soft tissue tumor.

Benign soft tissue tumor treatment

Observation may be the only required treatment. If the benign soft tissue tumor is painful, or otherwise bothersome, it can be removed—usually in the outpatient setting.

Biopsy

A biopsy may be necessary to confirm the presumed diagnosis of a benign soft tissue tumor. This is usually done in the setting of a minor outpatient surgery. Tissue may be sent as a frozen section so that the preliminary diagnosis is known the same day. Biopsy of musculoskeletal tumors should be performed by specialists who do this procedure regularly, as an inappropriate biopsy can lead to significant preventable morbidity or severe complications.

Complex reconstruction

The orthopedic surgeons here perform thousands of complex reconstructive surgeries per year, including revision of infected or failed hip, knee, shoulder and elbow replacements. In addition, we perform complex reconstructive surgery for major bone loss. Bone loss can result from infection, osteomyelitis, tumor, surgical complications, joint replacement loosening or traumatic injury. The orthopedic surgeons here have extensive experience and training in complex skeletal reconstruction in the Dallas-Fort Worth Metroplex. We strive to preserve limbs and restore our patients to optimal function.

Avascular necrosis

The direct cause of avascular necrosis, or “bone death,” is a lack of blood supply. Indirectly, a dislocated joint or fracture may interrupt blood flow. Studies also show that osteonecrosis is linked to excessive alcohol intake and the long-term use of high-dose steroidal drugs, as well as certain health conditions and radiation therapy. It can affect all joints and requires medical and surgical treatment. However, this can often be minimally invasive if caught early. Core decompression, the injection of stem cells or bone graft substitute into the dead area, and joint replacement are common surgical procedures performed for avascular necrosis. Because symptoms can be initially mild, some patients do not receive an accurate diagnosis of avascular necrosis until more advanced care is needed.

Osteomyelitis

Osteomyelitis is infection within a bone. Medication and precise surgical technique will eliminate infection, prevent extensive bone damage and allow for salvage of the vast majority of limbs. Osteomyelitis can be complicated and requires a team of doctors that regularly treat bone and joint infections. Baylor Scott & White Greater Dallas Orthopaedics surgeons treat thousands of patients with bone and joint infections and infected joint replacements.

Non/Malunited fractures

If a fracture does not heal properly, it may be a persistent source of pain. In order to restore the bone, revision surgery may be recommended. This may involve a change of hardware, bone grafting or microsurgery to place a vascularized fibular graft. Expertise in this complicated type of surgery is required to optimize outcomes. The surgeons here have performed thousands of corrections of non/malunited fractures.

Revision joint replacement

Joint replacements are usually very reliable procedures. Unfortunately, complications can occur in the immediate postoperative period or years later. Frequent joint replacement-related complications treated at Baylor Scott & White Greater Dallas Orthopaedics include fractures around the prosthetic joint, loosening of the prosthesis, dislocation, instability, painful prosthetic joints, swelling around implants, hematomas, seromas and wound complications related to joint replacement. If these occur, the joint may need to be revised. This involves exploring the joint and possibly replacing all, or part of, the joint prosthesis. These procedures can be very difficult. Expertise in revision surgery optimizes patient outcome. The orthopedic surgeons here perform a large number (>750/yr) of revision joint replacements in the Dallas-Fort Worth area and beyond.

Prosthetic joint infection

Prosthetic joint infection is an uncommon complication of joint replacement procedures. Artificial joints can become infected at the time of the initial joint replacement, or they can become infected later by bacteria in the bloodstream. Treatment can be complicated and may involve a one- or two-stage surgical approach. Baylor Scott & White Greater Dallas Orthopaedics surgeons treat a large number of  periprosthetic infections (>400/yr) in the region. Patient outcome is optimized with an experienced team.

Recovery

Rehabilitation of the affected joint is an important aspect of recovery from replacement. The proper usage of the new joint following surgery strengthens the muscles and facilitates healing. This is achieved with a specific physical therapy program designed for each patient.

General orthopedics

Baylor Scott & White Greater Dallas Orthopaedics also has a large general orthopedic practice. The surgeons here in Dallas and around the Metroplex are able to diagnose and treat hip, knee, shoulder and elbow pain. In addition, our surgeons evaluate fractures, injuries, lacerations, cuts, swelling and all other musculoskeletal complaints. The orthopedic doctors here manage thousands of patients with arthritis and strive to provide non-surgical care (therapy, injections, medications) when possible. If joint replacement is necessary, the orthopedic surgeons use proven, effective techniques to restore function as quickly as possible.

What do orthopedic surgeons do?

The orthopedic surgeons at Baylor Scott & White Greater Dallas Orthopaedics manage many problems within the musculoskeletal system. After diagnosis, the surgeons are able to prescribe customized non-surgical or surgical treatment to best benefit the patient. They often recommend physical therapy and medications to slow the progression of disease or lessen the chances of further injury.

Joint replacement

At Baylor Scott & White Greater Dallas Orthopaedics, we are able to offer hip, knee, shoulder and elbow replacements. These procedures are recommended if non-surgical alternatives are no longer providing effective pain relief. Joint replacements often come with benefits and limitations and require some degree of rehabilitation. In addition, joint replacements are effective procedures that relieve pain and correct deformity. Shoulder and elbow replacements also are able to restore normal function to the affected areas.

Outpatient joint replacements

Due to advances in surgical techniques, anesthesia and physical therapy, we are able to offer knee and shoulder replacements that are performed as day surgery. This procedure usually has a shorter recovery period, an increased range of motion after surgery and minimal damage to the surrounding tissues. This procedure is not for everyone, and careful selection criteria are followed to achieve maximum safety. Patients still have the ability to stay in the hospital, if necessary, or if pain is not controlled adequately.

Are there things I can do to keep my bones strong?

Your bones are the key to long-term health; however, problems such as osteoporosis and lack of exercise can lead to bone loss that may severely impact your quality of life in your older years.

To prevent or slow bone damage, we recommend adequate amounts of calcium and vitamin D. We also encourage patients to opt for weight-bearing exercise and to avoid or limit smoking and drinking.

Malignant bone tumors

Malignant bone tumors are extremely rare and are called bone sarcomas. Experience is important to optimize outcomes. The surgeons here perform a high volume of bone sarcoma surgery in the Dallas-Fort Worth area. Quality outcomes with functional limbs are the expectation. The most common malignant bone tumors include osteosarcoma, chondrosarcoma, Ewing’s sarcoma, lymphoma and myeloma.

Malignant bone tumors can start in any bone and in all age groups. Early diagnosis is the key to success in these patients. Referral to an orthopedic tumor surgeon is necessary to establish the correct diagnosis and institute the best treatment plan in a timely manner.

Diagnosing malignant bone tumors

Imaging is necessary to diagnose a malignant bone tumor. Often, multiple imaging studies must be evaluated carefully by an orthopedic tumor specialist to render an accurate diagnosis. These bone tumors can often be diagnosed with X-ray, CT scan, MRI, bone scan or PET scan.

Biopsy

A biopsy is required to confirm the diagnosis of a malignant bone tumor and is usually done in the setting of a minor outpatient surgery. Tissue can be sent as a frozen section so that the preliminary diagnosis is known the same day. Biopsy of musculoskeletal tumors should be performed by specialists who do this procedure regularly, as an inappropriate biopsy can lead to significant preventable and severe complications.

Malignant bone tumor treatment

Malignant bone tumors are often treated with a combination of surgery, chemotherapy and radiation. Usually, multiple specialists will be involved in the patient’s care, including the surgeon, radiation oncologist and medical oncologist. If surgery is required, the surgeons here remove the tumor and then reconstruct the bone defect with a prosthesis and/or cadaver bone. These surgeries are very complicated and are best done by an experienced surgeon.

Malignant soft tissue tumors

Malignant soft tissue tumors are called soft tissue sarcomas. They are rare and account for less than 1% of all cancers. Management is complicated and often involves doctors from multiple specialties. A combination of surgery, radiation and chemotherapy is often used to get the highest likelihood of a cure. The surgeons here at Baylor Scott & White Greater Dallas Orthopaedics are regional experts in the surgical management of soft tissue sarcoma. Experience is important to optimize outcomes. The surgeons here perform a large volume of sarcoma surgery in the Dallas-Fort Worth Metroplex. Quality outcomes with functional limbs are the expectation.

There are many subtypes of sarcoma, including liposarcoma, fibrosarcoma, synovial sarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma and pleomorphic sarcoma.

Diagnosing malignant soft tissue tumors

Physical exam and evaluation by an experienced musculoskeletal tumor surgeon are required. In addition, imaging is necessary to diagnose a malignant soft tissue tumor. X-ray, ultrasound and MRI are the tests ordered most frequently. CT scan of the chest is often performed to rule out metastatic disease.

Malignant soft tissue tumor treatment

Usually, soft tissue sarcomas require surgical removal and radiation for local control. Chemotherapy is often offered as an adjuvant treatment depending on the exact type of tumor. A team of specialists, including a surgeon, medical oncologist and radiation oncologist, is involved in the treatment process. A low-grade sarcoma may only require surgical excision and observation.

Biopsy

A biopsy is necessary to confirm the presumed diagnosis and subtype of soft tissue sarcoma. This is usually done in the setting of a minor outpatient surgery. Tissue may be sent as a frozen section so that the preliminary diagnosis is known the same day. Biopsy of musculoskeletal tumors should be performed by specialists who do this procedure regularly, as an inappropriate biopsy can lead to significant preventable morbidity or severe complications.

Metastatic bone disease

Cancer in other areas of the body can also spread to the skeleton. Cancers that start in the bone are known as primary bone cancers, which are different from bone metastases. However, bone metastases are much more common, especially in adults. Common types of cancer that spread to the skeleton include breast, prostate, lung, kidney and thyroid. Metastatic tumors can damage the bones and make them more likely to break.

The surgeons here have extensive experience evaluating and treating metastatic bone cancer. Sometimes only observation of the bones on X-ray is all that is needed. To relieve pain and prevent the bone involved from breaking, our surgeons can intervene. The bone can be stabilized internally if needed, but less invasive treatments such as cement injection and radiofrequency ablation are used when appropriate.

Diagnosing metastatic bone disease

Metastatic cancer is often found in bones near the center of the body, including the spine, hip bone, pelvis, humerus, ribs and skull. It is often found on tests done with a primary cancer is first diagnosed.

Metastatic bone disease treatment

Painless metastases may be treated with observation only. If pain and functional limitation are present, the orthopedic surgeons here can intervene to stabilize the bone involved. Often this is done in a minimally invasive fashion in the outpatient surgical setting. Larger, more involved tumors may require more extensive surgery to restore function and eliminate pain.

Biopsy

A biopsy is often necessary to confirm the diagnosis of a metastatic bone tumor and is usually done in the setting of a minor outpatient surgery. Tissue can be sent as a frozen section so that the preliminary diagnosis is known the same day. Biopsy of musculoskeletal tumors should be performed by specialists who do this procedure regularly, as an inappropriate biopsy can lead to significant preventable morbidity or severe complications.

Orthopedic tumors

Baylor Scott & White Greater Dallas Orthopaedics treats a large number of musculoskeletal tumors and sarcomas in the Dallas-Fort Worth region. We specialize in benign and malignant tumors of the bones and soft tissue in adults and children. The surgeons here also have extensive experience in treating patients with metastatic bone disease and multiple myeloma.

Each year, the surgeons here see several thousand orthopedic tumor patients in our orthopedic clinic and perform approximately 1,100 musculoskeletal tumor surgeries. Such volume creates unparalleled experience in Texas and this region of the US. A focus on quality, individualized treatment and efficiency for these complex cases leads to superior outcomes at Baylor Scott & White Greater Dallas Orthopaedics.

Usually, a patient seen by the orthopedic tumor surgeons here with a suspected orthopedic or soft tissue tumor can be seen in the office, a biopsy performed and a diagnosis rendered within a week of referral. We currently accept outpatient referrals, inpatient consultations and hospital transfers from physicians across the region to optimize outcomes for these complicated orthopedic tumor cases.

What are benign tumors?

Benign bone tumors are noncancerous growths that can arise from any bone. They are more common in younger patients and are usually found with a bone mass or pain. Often, benign tumors are discovered incidentally when patients are imaged for other reasons.

What are malignant bone tumors?

Malignant bone tumors can have a wide variety of presenting symptoms. Tumors can occur in any bone and in all age groups. For certain tumors, patients may have fever, chills and weight loss. Early diagnosis is the key to success in these patients, and early referral to a musculoskeletal tumor surgeon is necessary to achieve a correct diagnosis and institute an appropriate treatment plan.

Metastatic cancer

Metastatic cancer occurs when cancer of the bone spreads to other areas of the body. Even if a cancer spreads from bone to bone, it remains metastatic in nature due to the spread from the original site. Cancer in other areas of the body can also spread to the skeleton. Cancers that start in the bone are known as primary bone cancers, which are different from bone metastases. However, bone metastasis is much more common, especially in adults.

Pediatric tumors

A rare specialty that Baylor Scott & White Greater Dallas Orthopaedics provides is pediatric musculoskeletal tumor treatment. In addition to leading the region in musculoskeletal tumor and  sarcoma treatment, our team has a wealth of experience treating both benign and malignant tumors in children of all ages. Pediatric tumor patients receive quality care, and parents are put at ease through effective communication and our concierge pediatric nurse.

Baylor Scott & White Greater Dallas Orthopaedics offers same-day appointment availability. From diagnosis to the completion of chemo, we are by your side.

Pediatric concierge services

It’s our goal to be your single point of contact during your child’s pediatric tumor treatment. That means we take on the responsibility of connecting you with any relevant specialists, including providing referrals for outside physicians and act as a calming and informative voice throughout treatment. Additionally, our team includes a dedicated pediatric care coordinator whose direct phone number is given to parents at the outset of treatment.

Pediatric tumor treatment

Each year, the surgeons here see several thousand orthopedic tumor patients of all ages and perform approximately 1,100 musculoskeletal tumor surgeries. A typical pediatric patient with a suspected orthopedic or soft tissue tumor can be seen by the surgeons here in our office. A biopsy is performed, and a diagnosis is rendered within a week of referral. A treatment plan unique to your child’s case is then developed and carried out by our expert team and network of specialists.

The majority of the pediatric patients seen by Baylor Scott & White Greater Dallas Orthopaedics are in need of tumor treatment. We always begin by confirming a diagnosis, as children are referred to us by physicians who do not specialize in orthopedic tumor identification. The pediatric tumors we treat include:

• Benign bone tumors: Rare, noncancerous growths that can arise on any bone.
• Malignant bone tumors: Extremely rare cancerous growths, also called bone sarcomas.
• Benign soft tissue tumors: Fairly common, noncancerous growths that occur in connective tissue.
• Malignant soft tissue tumors: Extremely rare cancerous growths, also called soft tissue sarcomas.

Revision joint replacement

Joint replacements are usually very reliable procedures. Our surgeons perform over one thousand complex and revision knee, hip, shoulder, and elbow joint replacements annually with a very low (<2%) complication rate. Our surgeons manage a large volume of infected joint replacement in the DFW region.

Baylor Scott & White Greater Dallas Orthopaedics is an experienced regional referral practice for complex primary, revision, and infected joint replacements.

Definitions

• Primary joint replacement - The surgical replacement of a joint, usually for simple arthritis, or degenerative joint disease. Joints commonly replaced are hip, knee, elbow, and shoulder.
• Complex primary joint replacement - Complications exist that may make a replacement more technically difficult. Examples include current or previous fractures, severe deformity, bone loss, previous infection, and metabolic bone diseases.
• Revision joint replacement - The revision of a previous joint replacement that has failed. Revision surgery involves replacing all or part of a previous implant.
• Prosthesis - The device that is implanted to replace the joint. Usually they are made of various metals, ceramic, and plastic.
• Prosthetic joint infection - Bacterial infection of a prosthetic joint can occur early in the postoperative period or years later. Infection may be caused by direct contamination or by spreading through the bloodstream.

Recovery

Rehabilitation of the affected joint is an important aspect of recovery from replacement. The proper usage of the new joint following surgery strengthens the muscles and facilitates healing. This is achieved with a specific physical therapy program designed for each patient.

Revision joint replacement

GDO surgeons perform a large number (750/yr) of revision joint replacements in the DFW area and beyond. Our surgeons perform a large volume of hip, knee, shoulder, and elbow replacement revision surgeries. Many patients with complications of joint replacement are referred to our practice for our expertise.
Joint replacement-related complications treated at GDO include fractures around the prosthetic joint, loosening of the prosthesis, dislocation, instability, painful prosthetic joints, swelling around implants, hematomas, seromas, and wound complications related to joint replacement. If these occur, the joint may need to be revised. This involves exploring the joint and possibly replacing all, or part of, the joint prosthesis. These procedures can be very difficult. Expertise in revision surgery optimizes patient outcome.

Prosthetic joint infection

Prosthetic joint infection is an uncommon complication of joint replacement procedures. Artificial joints can become infected at the time of the initial joint replacement, or they can become infected later by bacteria in the bloodstream. Treatment can be complicated and may involve a one or two stage surgical approach. Our surgeons treat a large number of periprosthetic infections (>400/yr) in the region by a large margin. Patient outcome is optimized with an experienced team.