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Mr Morris explained everything he had done with my knee replacement and answered all my questions with the knowledge he has and put me completely at ease throughout the whole time

The humerus is a relatively common site for primary bone tumour or metastatic bone disease. In our database of 4870 primary bone tumours and 3916 metastatic bone tumours, the humerus accounted for 9% (n = 448) and 14% (n = 543) of cases. However,...

Implant Reconstruction of the Humeral Diaphysis: Total Humerus Prosthesis

Revision total hip arthroplasty has excellent results but is challenging surgery. A myriad of considerations and complications face the surgeon but ca…

Hints and tips in revision hip surgery

Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing’s sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing’s sarcoma and chemotherapy for both Ewing’s sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors’ experiences.

Pelvic bone sarcomas, prognostic factors, and treatment: A narrative review of the literature

Histological grade has been regarded as the most important prognostic factor in conventional central chondrosarcoma. To evaluate whether the presence …

Intraosseous conventional central chondrosarcoma does not metastasise irrespective of grade in pelvis, scapula and in long bone locations

MRI imaging can sometimes overestimate IA joint involvement and needs to be correlated with clinical signs. In the light of our findings, we would recommend EA resections when imaging shows effusion combined with either disease in Hoffa’s fat pad or retinaculum, or pathological fractures.

Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee

ics along with a review of the literature to assess the clinical efficacy of this emerging treatment....

The use of silver-coated orthopaedic implants: are all... : Current Orthopaedic Practice

The osseous pelvis is a well-known area of various primary and secondary bone tumours, tumour mimics, and infections. Isolated lesions of the pubis (I…

Isolated lesions of the pubis

Following the resection of an extensive amount of bone in the treatment of a tumour, the residual segment may be insufficient to accept a standard length intramedullary cemented stem. Short-stemmed endoprostheses conceivably have an increased risk of aseptic loosening. Extra-cortical plates have been added to minimise this risk by supplementing fixation. The aim of this study was to investigate the survivorship of short-stemmed endoprostheses and extra-cortical plates.
Conclusion

When extensive resections of bone are required in the surgical management of tumours, and in revision cases, the addition of extra-cortical plates to short medullary stems has shown non-inferiority to standard length medullary stems and minimises aseptic failure.

Minimising aseptic loosening in extreme bone resections custom-made tumour endoprostheses with short medullary stems and extra-cortical plates

Background:
The radiological work-up of patients with patellofemoral disorders continues to be debated. The interchangeability of the tibial tubercle–trochlear groove (TT-TG) distance between computed tomography (CT) and magnetic resonance imaging (MRI) has recently been questioned. In addition, a new measurement—the tibial tubercle–posterior cruciate ligament (TT-PCL) distance—has shown that not all patients with a pathological TT-TG distance (&gt;20 mm) have lateralization of the tibial tubercle. Another factor to consider when looking at the position of the tibial tubercle is the knee joint rotation, defined as the angle between the femoral dorsal condylar line and the tibial dorsal condylar line.
Conclusion:
Based on a statistically significant mean difference (4.11 mm) and only a fair ICC (0.54 and 0.48) for raters comparing the 2 modalities, the measurements for the TT-TG cannot be used interchangeably between CT and MRI. Therefore, currently accepted values for TT-TG based on CT scans should not be applied to an MRI scan. The TT-PCL measurement is a measure of true lateralization of the tibial tubercle, while the TT-TG is an amalgamated measure of true lateralization and knee joint rotation.

Defining the Role of the Tibial Tubercle–Trochlear Groove and Tibial Tubercle–Posterior Cruciate Ligament Distances in the Work-up of Patients With Patellofemoral Disorders

Navigation in surgery has increasingly become more commonplace. The use of this technological advancement has enabled ever more complex and detailed surgery to be performed to the benefit of surgeons and patients alike. This is particularly so when applying the use of navigation within the field of orthopedic oncology. The developments in computer processing power coupled with the improvements in scanning technologies have permitted the incorporation of navigational procedures into day-to-day practice. A comprehensive search of PubMed using the search terms “navigation”, “orthopaedic” and “oncology” yielded 97 results. After filtering for English language papers, excluding spinal surgery and review articles, this resulted in 38 clinical studies and case reports. These were analyzed in detail by the authors (GM and JS) and the most relevant papers reviewed. We have sought to provide an overview of the main types of navigation systems currently available within orthopedic oncology and to assess some of the evidence behind its use.

Navigation in Musculoskeletal Oncology: An Overview - Indian Journal of Orthopaedics

Introduction

The aim of this study was to identify patients with malignant hand lesions, establish the proportions of those that were metastases and review their clinical course.
Methods

A retrospective search of a prospective tumour database was carried out to identify all patients treated at our unit with hand metastases. Patient demographics were recorded including site of primary malignancy, region of the hand involved, management of their metastasis and clinical outcome.
Results

Overall, 149 patients were identified with a malignant tumour of the hand. Ten had a metastatic lesion. There were 3 women and 7 men with a median age of 68 years (range: 28–91 years) at presentation. All presented with non-mechanical hand pain while four had pain and swelling. The median interval from symptom onset to diagnosis was eight weeks. The minimum follow-up duration was four months.
Three patients had no history of malignancy. Of the remaining seven patients, three had other known metastases. Six patients underwent solely palliative radiotherapy. Three patients had amputation. One was treated with surgical excision and radiotherapy. One had an amputation and axillary node clearance.
All but one patient had died by the time of the latest follow-up appointment. The median time to death following identification of acrometastases was 18 months. Sites of primary disease were skin (n=4), lung (n=3), kidney (n=2) and neuroendocrine system (n=1). The thumb was the most commonly affected location.
Conclusions

This study demonstrates that patients presenting with non-mechanical hand pain should be considered to have a malignant process until proved otherwise, particularly in patients with thumb symptoms and a history of prior malignancy.

Bone metastases of the hand

The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of…

Surgical Innovation in Sarcoma Surgery

This study aimed to evaluate the differences in biomechanical properties of biceps tenodesis when performed with sheathed versus unsheathed screws and…

An analysis of the biomechanics of interference screw fixation and sheathed devices for biceps tenodesis

Abstract
Background and Objectives

Should the threshold for orthopaedic oncology surgery during the coronavirus disease-2019 (COVID-19) pandemic be higher, particularly in men aged 70 years and older? This study reports the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during, respiratory complications and 30-day mortality during the COVID-19 pandemic.

Methods

This prospective observational cohort study included 100 consecutive patients. The primary outcome measure was 14-day symptoms and/or SARS-CoV-2 test. The secondary outcome was 30-day postoperative mortality.

Results

A total of 100 patients comprising 35 females and 65 males, with a mean age of 52.4 years (range, 16-94 years) included 16 males aged greater than 70 years. The 51% of patients were tested during their admission for SARS-CoV-2; 5% were diagnosed/developed symptoms of SARS-CoV-2 during and until 14 days post-discharge; four were male and one female, mean age 41.2 years (range, 17-75 years), all had primary malignant bone or soft-tissue tumours, four of five had received immunosuppressive therapy pre-operatively. The 30-day mortality was 1% overall and 20% in those with SARS-CoV-2. The pulmonary complication rate was 3% overall.

Conclusions

With appropriate peri-operative measures to prevent viral transmission, major surgery for urgent orthopaedic oncology patients can continue during the COVID-19 pandemic. These results need validating with national data to confirm these conclusions.

The Royal Orthopaedic Hospital Nhs Foundation Trust

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