What’s New in Musculoskeletal Tumor Surgery 2025

Key topics in musculoskeletal tumor surgery are covered in the new JBJS Specialty Update What’s New in Musculoskeletal Tumor Surgery. Here, we present the 5 most impactful studies, as selected by coauthor Aaron Gazendam, MD, MSc, FRCSC.

Reconstruction

The utility of computer-assisted navigation in the treatment of primary pelvic bone sarcomas was explored in a matched cohort study consisting of a navigation group (63 patients) and a non-navigation group (145 patients). Computer-assisted navigation was associated with better disease-specific survival rates and an improved ability to attain negative bone margins. Functional outcomes did not differ between the groups¹.

Surgical Margins

In a study of extremity bone sarcomas, Gazendam et al. evaluated the accuracy of intraoperative frozen-section assessment relative to the final pathology and assessed its impact on surgical management. Intraoperative frozen-section analysis demonstrated a low positive predictive value and was associated with unnecessary additional resections, leading the study authors to call into question its routine use².

Pediatric Bone Sarcomas

The accuracy of standard and novel methods for predicting adult height was assessed in 56 patients treated for pediatric sarcoma. Growth impairment related to treatment was often underestimated when using standard prediction tools such as the Paley multiplier method. In comparison, the novel sarcoma-specific prediction model developed by the study authors demonstrated higher accuracy³.

Immunotherapy Strategies

Researchers investigated whether the addition of perioperative pembrolizumab to preoperative radiotherapy and surgery would improve disease-free survival rates in a randomized trial including 143 patients with stage-III soft-tissue sarcoma of the extremity. Pembrolizumab was associated with greater disease-free survival compared with the control, with 2-year rates of 67% and 52%, respectively⁴.

Local Therapies and Limb Salvage

The role of chemotherapy in primary synovial sarcoma treatment was studied using a national U.S. registry⁵. Neoadjuvant chemotherapy was linked with reduced odds of amputation, “reinforcing the value of aggressive limb-salvage strategies,” write Specialty Update authors Drs. Gazendam and Kendal.

What’s New in Musculoskeletal Tumor Surgery is freely available at JBJS.org.

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.

Recent OrthoBuzz posts include: What’s New in Musculoskeletal Infection, What’s New in Orthopaedic Rehabilitation, and What’s New in Shoulder and Elbow Surgery.

References

1. Li Z, Li L, Deng Z, Yang Y, Duan F, Zhang Q, Niu X, Liu W. Long-term outcomes of computer navigation-assisted resection for primary pelvic sarcomas. Bone Joint J. 2025 May 1;107-B(5):561-70.
2. Gazendam A, Clever D, Zhang L, Griffin A, Tsoi K, Wunder J, Ferguson P. The utility of intraoperative marrow margin frozen section in extremity bone sarcoma resection. J Surg Oncol. 2024 Sep;130(3):574-8.
3. Prigmore B, Lindsay SE, Agloro A, Doung YC, Gundle KR, Hayden JB, Ramsey DC. Can we accurately predict adult height in pediatric patients who undergo treatment for sarcoma? Clin Orthop Relat Res. 2025 Feb 6;483(7):1338-46.
4. Mowery YM, Ballman KV, Hong AM, Schuetze SM, Wagner AJ, Monga V, Heise RS, Attia S, Choy E, Burgess MA, Bae S, Pryor DI, Van Tine BA, Tinoco G, Chmielowski B, Freeman C, Gronchi A, Meyer CF, Dickson MA, Hartner L, Davis LE, Powers BC, Moding EJ, Weinhold KJ, van de Rijn M, Brigman BE, Riedel RF, Kirsch DG. Safety and efficacy of pembrolizumab, radiation therapy, and surgery versus radiation therapy and surgery for stage III soft tissue sarcoma of the extremity (SU2C-SARC032): an open-label, randomised clinical trial. 2024 Nov 23;404(10467):2053-64.
5. Wahle CF, Newman-Hung NJ, Sakowitz S, Federman N, Singh AS, Bernthal NM, Benharash P, Wessel LE. Neoadjuvant chemotherapy is associated with reduced amputation risk in synovial sarcoma of the lower extremity. J Surg Oncol. 2025 Jul;132(1):217-25.