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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_20 | Pages 37 - 37
1 Nov 2016
Gupta S Kafchinski L Gundle K Saidi K Griffin A Ferguson P Wunder J
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Biological reconstruction techniques after diaphyseal tumour resection have increased in popularity in recent years. High complication and failure rates have been reported with intercalary allografts, with recent studies questioning their role in limb-salvage surgery. We developed a technique in which large segment allografts are augmented with intramedullary cement and fixed using compression plating. The goal of this study was to evaluate the survivorship, complications and functional outcomes of these intercalary reconstructions.

Forty-two patients who had reconstruction with an intercalary allograft following tumour resection between 1989 and 2010 were identified from our prospectively collected database. Allograft survival, local recurrence-free, disease-free and overall survival were assessed using the Kaplan-Meier method. Patient function was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and the Toronto Extremity Salvage Score (TESS).

The 23 women and 19 men had a mean age of 33 years (14–77). The most common diagnoses were osteosarcoma (n=16) and chondrosarcoma (n=9). There were 9 humerus, 18 femur and 15 tibia reconstructions. At a mean follow-up of 95 months (5–288), 31 patients were alive without disease, 10 were dead of disease and 1 was deceased of other causes. There were 4 local recurrences and 11 patients developed metastatic disease. 5-year local recurrence free survival was 92%, 5-year disease-free survival was 70% and overall survival was 75%. Fourteen of 42 patients (33%) experienced complications: 5 wound healing complications, 4 infections, 2 non-unions, 2 fractures and 1 nerve palsy. Four allografts (9.5%) were revised for complications and 2 (5%) for local recurrence. Mean allograft survival was 85 months (4–288). Mean time to union was 8.2 (3–36) months for the proximal osteotomy site and 8.1 (3–23) months for the distal osteotomy site. The mean score for MSTS 87 was 29.4 (+/− 4.4), MSTS 93 was 83.7 (+/−14.8) and TESS was 81.6 (+/−16.9).

An intercalary allograft augmented with intramedullary cement and compression plate fixation provides a reliable and durable method of reconstruction after tumour resection. Complication rates are comparable to the literature and are associated with high levels of patient function and satisfaction.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 253 - 253
1 May 2009
Saidi K London O Bell RS Griffin AM Saidi K Wunder JS
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Radiation induced pathologic fractures present a difficult problem for musculoskeletal oncologists. The purpose of this study was to determine the outcomes of management of radiation-induced pathologic fractures in a group of patients who had previously undergone combined management of extremity soft tissue sarcoma.

A review of our retrospective database was undertaken. From 1986 to present, thirty-two patients with soft tissue sarcomas were found to have radiation induced pathologic fractures. The records of these patients were reviewed for patient demographics, tumour size and anatomic site, presence of periosteal stripping at time of surgery, radiation dose, time to fracture, fracture treatment and fracture outcome.

There were twenty-three females and nine males with a mean age of sixty-three (range thirty-six to eighty-nine) years. Fractures occurred at a mean of forty-five months after resection of the sarcoma (range three to one hundred and fifty months). Anatomic distribution of fractures were : proximal femur(twelve), femoral diaphysis (eight), distal femur (two) tibia (five), acetabulum (two), metatarsal (two) and patella (one). Periosteal stripping was performed in half of the patients. Twenty-three patients had received high dose radiation (6600Gy). Seven fractures were managed conservatively while twenty-five were treated surgically. Only eleven of the thirty-two fractures united. Six patients underwent amputation, three for local recurrence and three for non-union of their fracture. Eight patients ultimately underwent arthroplasty, while seven patients have persistent non-unions. In the proximal femur, only three out of twelve fractures healed while six patients eventually underwent arthroplasty and three continue to have non-unions. Of eight femoral diaphyseal fractures, only one united. Patients who eventually underwent prosthetic replacement had good function and pain relief.

Radiation induced pathologic fractures are a difficult clinical problem. In particular patients with fractures in the proximal femur often undergo multiple attempts at fixation before definitive management with resection and endoprosthetic replacement. Fractures of the femoral diaphysis rarely heal despite aggressive surgical management. Primary arthroplasty may be considered in some patients as an alternative to fixation in radiation-induced pathologic fractures of the femur in order to avoid long term morbidity and repeated operations.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 131 - 131
1 Mar 2008
Holdsworth D Rajesekaren S Mcerlain D Naudie D Saidi K
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Purpose: Osteoarthritis (OA) is a complex disease process affecting both articular cartilage and underlying bone. An emphasis has been placed on understanding changes in articular cartilage that occur with disease progression, but comparatively little work has been done to understand changes in subchondral bone. The purpose of this study was to evaluate the architectural changes that occur in underlying osteoarthritic bone and to determine their relation to the stages of arthroscopic disease progression.

Methods: Three cadaver knees were evaluated and graded arthroscopically using the Marshall grading system. Representative bone plugs were then extracted from each compartment. Twenty-eight plugs were extracted and imaged using microcomputed tomography (microCT) scanner developed at the Robart’s Research Institute. Volumetric data for each plug biopsy was obtained in 20 minutes of scan time at an isotropic resolution of 68 μm voxels. The data acquired was analyzed using the GE Health Care Scan Control software and reconstruction utility. Subchondral bone thickness bone mineral density (BMD), trabecular thickness (TT), trabecular separation (TS), and structure model index (SMI) were collected and compared in the medial, lateral and patellofemoral compartments of the knees.

Results: No statistical difference was found in any of the parameters when compared with advancing arthroscopic disease progression. When the data was pooled into normal and osteoarthritic specimens, BMD was found to be significantly decreased (p < 0.05) in osteoarthritic bone. A decrease in BVF and an increase in SMI approached significance in osteoarthritic bone.

Conclusions: Further investigation is required for a complete understanding of the architectural changes that occur in subchondral bone with disease progression. A better understanding of OA would have clinical implications in primary and secondary disease prevention. Funding: Other Education Grant