We present the management and outcome of patients who presented following internal fixation of primary malignant tumours of the femur.

This is a retrospective study of eleven patients. All underwent internal fixation of pathological or impending fractures of the femur in the assumption of metastatic disease, or prior to diagnosis of primary malignancy. Data was collected from database records and case notes.

The mean age was 47 years (range 13 – 73). Six patients were male and five female. Tumour type was osteosarcoma (3), MFH (3), chondrosarcoma (2), Ewing’s sarcoma (1), fibrosarcoma (1) and liposarcoma (1). The site of the lesion was proximal in six cases and distal in five. Nine patients presented initially with pathological fractures and two with lytic lesions. The mode of fixation was DHS (3), AO screws (1), antegrade IM nailing (2), retrograde IM nailing (3), Blade plate (1) and DCS fixation (1). No patients underwent biopsy prior to fixation. Surgical treatment at the Bone Tumour Unit was excision and segmental endoprosthetic replacement (5), total femoral replacement (2), hip disarticulation (2), above knee amputation (1) with one patient dying prior to surgery. Eight patients also received chemotherapy and three radiotherapy. Four patients had local recurrences, three presented with metastatic disease and five more went on to develop metastases. Two patients died within one year of initial surgery, three more within two years and none have so far survived five years. Three patients are still alive.

We believe that internal fixation of primary malignant tumours has a detrimental effect on limb salvage and survival, emphasising the absolute necessity of pre-operative investigation of solitary bone lesions.

Background: The purpose of this prospective study is to analyse the histological results of the treatment of deep chondral defects with autologous chondrocyte transplantation in patients with articular cartilage defects of the knee joint.

Methods: Patients with articular cartilage defects of the knee joint were recruited prospectively and underwent autologous chondrocyte transplantation. Chondrocytes from a non-weight bearing area of the knee were harvested, isolated and cultured in vitro. Subsequent reimplantation involved injection of the chondrocytes into the defect which was then sealed with a porcine IIIII collagen membrane. Postoperatively, patients were evaluated at one year by clinical assessment, arthroscopy and histological examination. The presence of hyaline cartilage in the transplanted region was determined by staining with Erlich’s H & E, Safranin 0 and polarised light microscopy and by imimmohistochemical analysis with S100. Confirmation of the presence of hyaline cartilage was further assessed by examination of Type 11 collagen messenger RNA expression using PCR.

Results: Thirty four patients were recruited between July 1998 and November 2001, with a median age of 31 years (range 15–51 years). Of the 34 patients treated, 17 had right-sided lesions, 15 had left-sided lesions and two patients had bilateral lesions. Solitary lesions were treated in 36 knees with two defects being treated in one knee (37 defects in total). The defects were located on the medial femoral condyle in 22 cases, the lateral femoral condyle in eight, the trochlea in two and the patella in five cases. The defect size ranged from 1–7 cm2 (mean area 2.88cm2). The follow-up of the patients ranged from 1–39 months (mean 19 months). Twenty five patients had at least one-year follow-up. Of these patients, using the BritIberg Rating, six patients had excellent results, with 11 good, six fair and two poor. The mean Lysholin and GilIquist scores improved from 44.7 pre-op to 76.2 one-year post-op and the mean Verbal Numerical Pain Scores improved from 7.1 to 1.1. Arthroscopy revealed that the transplants were level with the surrounding surface in most cases. Biopsy at one year confirmed the presence of hyaline cartilage in 13 out of 19 cases (70%).

Conclusion: Although long-term follow-up is currently unavailable, autologous chondrocyte transplantation can provide, with careful patient selection and meticulous surgical technique, an effective treatment for cartilage defects of the knee. The histological results are extremely encouraging and chondrocyte transplantation may be the only procedure to allow regeneration of hyaline cartilage.

Introduction: Articular cartilage defects within the knee joint have poor capacity for repair. The purpose of this study is to analyse the short-term clinical and histological results of the treatment of deep chondral defects with autologous chondrocyte transplantation.

Methods: This is a prospective study involving twenty-two consecutive patients receiving autologous chondrocyte transplantation. Chondrocytes from a non weight bearing area of the knee are harvested, then isolated and cultured in vitro. Re-implantation involves injection of the chondrocytes into the defect which is then sealed with a porcine I/III collagen membrane. Evaluation consists of clinical assessment, arthroscopy and histological examination. Histological evaluation consists of examination of a biopsy of the transplanted area one-year post-op. Staining techniques include the use of Erlich’s H & E, Safranin O and S100. Using polarised light, the absence of the fibrillar nature of fibrocartilage confirms the presence of hyaline cartilage. Further confirmation can be gained by the examination of messenger RNA content, confirming the presence of type II collagen.

Results: The patients were treated between July 1998 and December 2000. The age range of the patients was 15–51 years (mean age 31 years). Of the 22 patients treated, 13 had right-sided lesions, 11 had left-sided lesions with two patients receiving bilateral procedures. Solitary lesions were treated in 23 knees with two defects being treated in one knee (25 defects in total). The defects were located on the medial femoral condyle in 17 cases, the lateral femoral condyle in five, the trochlea in two and the patella in one case. The defect size ranged from 1–5.4cm2 (mean area 2.65cm2). The follow-up of the patients ranges from 3-30 months (mean 16 months). Thirteen patients have at least one-year follow-up. Of these patients, using the Brittberg Rating, two patients have excellent results, with six good, four fair and one poor. The mean Lysholm and Gillquist scores improved from 50 pre-op to 72 one-year post-op and the mean Verbal Numerical Pain Scores improved from 7.2 to 2.6. Arthroscopy revealed that the transplants were level with the surrounding surface in most cases. Biopsy at one year confirmed the presence of hyaline cartilage in 10 out of 13 cases.

Conclusion: Although the results are short-term, autologous chondrocyte transplantation can provide, with careful patient selection and meticulous surgical technique, an effective treatment for cartilage defects of the knee. The histological results are extremely encouraging and chondrocyte transplantation may be the only procedure to allow regeneration of hyaline cartilage.

Introduction: We discuss the use of the SMILES (Stanmore Modular Individualised Lower Extremity System) in revision knee arthroplasty and review the outcome of 32 cases.

Methods: The SMILES prosthesis incorporates a rotating hinge knee joint. It can overcome the major problems of bone loss and ligamentous laxity. 32 prostheses were used in 30 patients as salvage revision procedures between Sept. 1991 and Sept. 1998. Patients receiving surgery for tumours were excluded. The minimum follow-up was two years with a mean follow-up of 4 years and six months. The age of the patients ranged from 36–85 years (mean 68years and 6months). 18 of the patients were male. The original pathology was OA in 23 patients and RA in 7 patients. The number of previous arthroplasties ranged from 1–4. The main indications for a SMILES prosthesis were aseptic loosening, periprosthetic fracture and infection, in the presence of bone loss and ligamentous laxity.

Results: The patients were assessed using the Knee Society Rating Score. The mean knee score improved from 26 pre-op to 68 post-op while the mean fiction score improved from 27 to 75. Overall Knee Society scores improved from a mean of 26 to 72. The average range of motion was 60 degrees pre-op and 90 degrees post-op. Complications included: failure to eradicate infection in two patients, with one patient needing amputation; infection of the prosthesis leading to revision in one, and failure of the tibial component needing revision.

Conclusion: The Smiles has produced satisfactory results in the short to medium term, offering an alternative to amputation in some cases. The cost compares favourably with other designs and the use is increasing in frequency.

Introduction: Articular cartilage defects in the knee joint have poor capacity for repair. The purpose of this study is to analyse the short-term results of the treatment of deep chondral defects with autologous chondrocyte transplantation with the use of a collagen membrane.

Methods: This is a prospective study involving twentytwo consecutive patients receiving autologous chondrocyte transplantation. Chondrocytes from a non weight bearing area of the knee are harvested, then isolated and cultured in vitro. Re-implantation involves injection of the chondrocytes into the defect which is then sealed with a porcine I/III (Chondro-gide) membrane. Evaluation consists of clinical assessment, arthroscopy and histological examination.

Results: The patients were treated between July 1998 and December 2000. The age range of the patients was 15–51 years (mean age 31 years). Of the 22 patients treated, 13 had right-sided lesions, 11 had left-sided lesions with two patients receiving bilateral procedures. Solitary lesions were treated in 23 knees with two defects being treated in one knee (25 defects in total). The defects were located on the medial femoral condyle in 17 cases, the lateral femoral condyle in five, the trochlea in two and the patella in one case. The defect size ranged from 1–5.4cm² (mean area 2.65cm²). The follow-up of the patients ranges from 1–28 months (mean 14 months). Thirteen patients have at least one-year follow-up. Of these patients, using the Brittberg Rating, two patients have excellent results at one year, with six good, four fair and one poor. The mean Lysholm and GilIquist scores improved from 50 pre-op to 72 one-year post-op and the mean Verbal Numerical Pain Scores improved from 7.2 to 2.6. Arthroscopy revealed that the transplants were level with the surrounding surface in most cases. Biopsy at one year confirmed the presence of hyaline cartilage in 10 out of 13 cases.

Conclusion: Although the results are short-term, autologous chondrocyte transplantation using the Chondro-gide membrane can provide, with careful patient selection, an effective treatment for cartilage defects of the knee. Chondrocyte transplantation may be the only procedure to allow regeneration of hyaline articular cartilage.