Introduction: The aims of the study were to analyse the presenting features of chondroasarcoma for prognostic significance, to observe the effects of grade and surgical management on local recurrence, metastasis and survival: and to assess the significance of delays to consultation and treatment.

Methods: From Scottish Bone Tumour Registry Records, 24 proximal humeral chondrosarcomas were treated between 1937 and 2002 in several hospitals in Scotland. Clinical records were available for all patients. Only 4 patients were eventually lost to follow-up. Age at presentation ranged for 16 to 79 (median 56) and male to female ration was 2:1. Patients were followed up for a range of 5 months to 24 years (median 6.5 years). Tumour histology was systematically reviewed: 5 (22%) were grade 1, 12 (52%) were grade 2, and 6 (26%) were grade 3. Dedifferentiated tumours were considered as grade 3.

Results: Pain was almost invariable (23/24), but its severity increased with grade. In the absence of pathological fracture (fracture in 4 Patients), swelling was significantly associated with increasing grade (X2+8.56, p+0.0139), as was symptom progression (X2=7.52, p=0.0232). Delay in diagnosis was calculated separately as ‘patient delay’ (range 0–69 months) and ‘doctor delay’ (range 0–132 months). No improvement in diagnostic delay was noted in this time period (1937–2002)

All cases were biopsied. 37% of these were excisional biopsies, 29% were incisional biopsies and 17% were needle biopsies. 21 patients (88%) received definitive surgery. Of these 5 had forequarter amputations (24%), 11 cases were excised marginally (52%), and 5 cases curetted (24%). Surgical choice was highly dependent on grade (X2=4.9256, p=0.005). In all cases the intent was curative.

2 patients had metastasis disease at diagnosis, and 5 developed metastases after definitive surgery. 4 patients had local recurrence (all had undergone wide local excision). All patients with grade 1 tumours remained disease free. Cumulative survival at 5 years was 57% and at 10 years 42%. Patient age did not affect survival. 5 year survival in grade 1, 2 and 3 tumours was 100%, 83% and 20% respectively. 4 of 5 patients undergoing amputation developed metastases and survival was significantly worse in the amputation group. Local recurrence in the wide local excision group did not diminish prospects for survival.

Discussion: Swelling predicts aggressive disease; as found in studies in childhood sarcomas. Progressive symptoms and serve pain are additional features indicative of high histological grade. In contract to improvements noted in several other studies, patient delay is highly variable and has not been demonstrably reduced over time.

Curettage was chosen for most grade 1 and some grade 2 tumours. Although maintenance of function is far better, our study provides no evidence that curettage results in increased local recurrence rates. Indeed, local recurrence in the wide local excision group did not depress survival figures. Because of early death in the amputation group, we would recommend avoidance of amputation in favour of wide local excision in almost all cases if possible. Age alone should not be a factor in determining surgical treatment.

Purpose: To assess the long-term outcome of Schanz subtrochanteric abduction osteotomy (SO) in patients with long-standing dislocation of the hip

Patients and methods: Between 1962–1981, 11 patients were treated with a SO. Nine patients, in whom 16 SO procedures were performed, were available for follow-up. Seven hips had had failed surgery in infancy, 9 hips had not been operated on previously. The average age at the time of SO was 17.8 (12–29) years. The degree of dislocation at the time of SO was classified according to Eftekhar type B: subluxation; (4 hips); type C: dislocation with neo-acetabulum, (8 hips) patients, and type D: high dislocation, no neo-acetabulum (4 hips). The indications to perform SO were fatigue and a painful lurch in 14 hips and a flexion/adduction contracture with pain in 2 hips. Post-operatively, patients were immobilised in suspended traction for 6–8 weeks, followed by progressive weight-bearing. Follow-up averaged 21 (14–37) years. Follow-up included the Harris-Hip score and ADL-score (Barthel-index); working status, sexual problems, ROM, hip/knee instability and radiographic examination.

Results: Ten secondary surgical procedures were performed at an interval of 6–19 years following SO: shelf procedure ( 5); Epiphyseodesis (3) and total hip (2). The shelf procedures were performed for residual hip pain, at an average of 12 years. The total hips were performed after 17 and 19 years following SO. Both have failed and had complicated hip-revisions. ROM was severely restricted in 4 patients. The mean Harris hips score was 76 ( 27–97). One of six bilateral cases and 2 of 4 unilateral cases had poor functional results. All patients had unlimited ADL activities; 7 patients regularly participated in cycling and swimming. Three female patients experienced minor sexual problems, due to limited abduction. Four patients had 400 excessive valgus at the knee, without clinical or radiographic symptoms. Leg-length discrepancy varied from 0–3 cm.

Conclusion: 1. The results of SO in patients with Eftekhar C/D were surprisingly fair, and poor in type B, subluxation.

Purpose: Outome after arthroscopic management of anterior instability of the shoulder has varied since the early series. The results proposed at the 1993 symposium of the French Society of Arthroscopy suggest we should be using this technique with prudence. We report here our experience with patients operated on between 1993 and 1997 who were selected on the basis of the 1993 conclusions that excluded patients with multiple recurrent instability and fractures of the anterior rim of the glenoid cavity.

Material and methods: Sixty-seven shoulders were operated on between 1993 and 1997. Mean follow-up for 58 of these shoulders (86%) was five years. These 58 patients constituted the study group. There were 31 men and 27 women, mean age 25 years, who had 30 recurrent shoulder dislocations, 12 shoulder subdislocations and 16 painful unstable shoulders. Forty-six percent of the patients participated in competition-level sports with forced shoulder movements in 39.6% of the cases. The surgical technique involved retightening the inferior glenohumeral ligament that was fixed with resorbable sutures. Immobilisation with elbow-to-body contention was strictly applied for three weeks at least followed by progressive rehabilitation exercises until renewed sports activities starting four months postoperatively.

Results: The mean overall Duplay score was 85.5 (sport 21/25; stability 18/25; mobility 24/25; pain 22/25). Outcome was good and very good in 82.7% of the patients, fair in 8.6%, and poor in 5 (recurrence). Subjectively, 55% of the patients were very satisfied, 27.5% were satisfied, 15.5% were disappointed and 1.7% were displeased. There were four complications (one infection cured with antibiotic therapy with a final score of 100 and three serious cases of capsulitis that recovered before one year). Gender, age, type and duration of instability, level of sports activity, and articular laxity appeared to affect outcome.

Discussion: The rate of failure (8.6%) is similar to that with open surgery (4.6% in the SOFCOT symposium 1999) and would be well below the rates observed in the 1993 arthroscopy series although the different patient selection does not allow valid comparison.

Conclusion: Arthroscopic stabilisation of the shoulder is a technically difficult procedure that has progressively shown its effectiveness after an appropriate learning curve and in carefully selected patients. Favourable elements include age over 20 years, competition level sports activity, recent instability, and absence of constitutional hyperlaxity.