Background: There are no evidence based guidelines on the surveillance of cemented total hip arthroplasty. We reviewed the outcomes of those patients undergoing this procedure in 1996 & 1997.

Methods: The patients were identified from theatre log books. The follow up date was then retrieved from the electronic patient record system used at our institution. From these we recorded the age, sex, side of procedure, evidence of radiological loosening & time of revision surgery. The data with regards to radiological evidence of loosening & revision surgery were then analysed using a ® statistical software package. From this we were able to plot Kaplan-Meier survival & hazard plots.

Results: We identified 425 primary total hip arthroplasties. Using radiological evidence of loosening as the end point we found that there was an initial peak and a peak at 8 years. There was a 10 year survival rate of 85.8%. Using revision surgery as the end point we found that there was, again, an initial peak & a peak at 8 years. There was a 10 year survival rate of 91.5%.

Conclusions: Once the patient has made it through the first post operative year they do not need to be followed up again until 8 years assuming they remain asymptomatic.

Background: There are no evidence based guidelines on the surveillance of cemented total hip arthroplasty. We reviewed the outcomes of those patients undergoing this procedure in 1996 & 1997.

Methods: The patients were identified from theatre log books. The follow up date was then retrieved from the electronic patient record system used at our institution. From these we recorded the age, sex, side of procedure, evidence of radiological loosening & time of revision surgery. The data with regards to radiological evidence of loosening & revision surgery were then analysed using a XXX statistical software package. From this we were able to plot Kaplan-Meier survival & hazard plots.

Results: We identified 425 primary total hip arthroplasties. Using radiological evidence of loosening as the end point we found that there was a peak initially and a peak at 8 years. There was a 10 year survival rate of 85.8%. Using revision surgery as the end point we found that there was, again, an initial peak & a peak at 8 years. There was a 10 year survival rate of 91.5%.

Conclusions: Once the patient has made it through the first post operative year they do not need to be followed up again until 8 years assuming they remain asymptomatic.

Tension band wire fixation continues to be the most popular method of fixation for displaced olecranon fractures despite several biomechanical studies questioning the validity of the tension band concept. Our aim was to compare the outcome of the tension band wire (TBW) method with plate fixation. 58 consecutive olecranon fractures underwent internal fixation in 58 patients between September 2000 and December 2004. There were 30 male and 28 female with a mean age at the time of surgery of 52.5 years for the TBW group (range 19 to 88) and 46.1 for the plate group (range 19 to 72). Patients were excluded if they were less than 16 years of age. Choice of fixation was based on surgeon preference, fracture pattern and presence of associated injuries. 43 patients were managed with the AO tension band technique and 15 with plate fixation. Clinical assessment and functional analysis was performed using Helm’s scoring system. Radiographic assessment was performed to assess the quality of reduction. All fractures were displaced and classified according to Colton’s classification. Mean follow up was 13 months (range 6 to 18) and similar for the two groups. For the TBW group 41 (95 %) had a fair or good result. 27 (62.8%) patients had symptomatic metal prominence requiring implant removal. In the plate fixation group 14 (94%) had a fair or good functional result despite having more complex fractures. Only 2 (18%) patients required implant removal for symptomatic metalwork, including one failure due to a technical problem. Similar functional results were seen with plating and tension band wiring of displaced olecranon fractures. Despite meticulous technique, tension band wire fixation still has an unacceptably high complication rate with symptomatic metal prominence requiring further surgery. To avoid this problem, we recommend plating, even for the more simple olecranon fractures.

Purpose: Chondroblastomas are a lesion of immature cartilage found in a typically epiphyseal location. The peak incidence is in teenagers. Current surgical treatment is a balance between complete excision, with potential for physeal and articular cartilage damage, and local recurrence. A minimally invasive technique with a low complication rate providing effective treatment may be provided by radiofrequency (RF) thermocoagulation. Already the treatment of choice for Osteoid Osteoma – another lesion that can occur in the epiphysis.1,2,3 Literature to date on clinical use of RF thermocoagulation in chondroblastoma is scarce.4 The high water content of chondroblastoma should ensure its sensitivity to RF ablation. Our units experience in osteoid osteoma has been extended to RF thermocoagulation of chondroblastoma.

Patients: Four patients were treated with RF thermocoagulation for a chondroblastoma. Minimum follow up one year.

Methods: A RITA Starburst probe thermocoagulates the lesion for at least 5 minutes at 90 degrees centigrade. Overnight stay and outpatient follow up until skeletal mature, or two years following treatment.

Results: Two chondroblastomas were in the proximal tibia, one in the distal femur and one in the proximal humerus. One patient had surgery previously and one patient presented with collapse of the proximal tibial plateau. All patients were treated successfully and are pain free. All patients, accepting the one with pre-existing collapse, have a full range of movement. There has been no local recurrence at one year.

Conclusion & Discussion: Our experience suggests that radiofrequency thermocoagulation is a safe and effective treatment method for patients with chondroblastoma.

To assess the efficacy of the current surveillance programme for patients with sarcoma we undertook a prospective analysis of all patients with sarcoma treated between 1990 and 1995. The patients routinely enter a surveillance programme which consists of regular clinical evaluation, CXR and radiological imaging.

We reviewed 643 cases of sarcoma with mean follow up 8. 4 years (range 6. 2–11. 3). Local recurrence occurred in 14% of cases and 34% developed metastases. The cumulative survival at 10 years was 59%. 46% of the deaths were directly attributable to metastases.

For the soft tissue sarcomas 15% of the local recurrences were picked up at surveillance appointment and 70% were picked up early by the patient. For the sarcomas of bony origin 36% were picked up at surveillance and 57% were picked up early by the patient.

Pulmonary metastasis was by far the common metastasis with 82% developing these. 78% were identified by surveillance CXR of which 83% were asymptomatic and 34% went on to thoracotomy and metastectomy. Of the other metastases a third were picked up during surveillance and all were symptomatic.

Surveillance programmes have a role in the management of patients with sarcoma, allowing the earlier identification of local recurrence and metastasis. Clinical evaluation and CXR were found to be, in particular, valuable tools, but patient education and open access to clinics is also important.

Due to advances in the assessment and treatment of patients with metastatic bone disease, the survival has improved in recent years.

It was the aim of this met-analysis to assess the outcome of patients with metastatic bone disease across Europe.

Five major bone tumour treatment centres participated in the met-analyses. Data had been collected prospectively and was retrieved from the databases for the purpose of this study. All patients were referred to the bone tumour centre for assessment and possible surgical treatment.

The data of almost 2500 patients were analysed. The average age at diagnosis was 60 years and the male to female ratio was 1:1.07.

The overall 5-year survival was 35%, but this was significantly better in metastatic disease of the thyroid and breast as well as multiple myeloma.

The number and site of metastases or the presence of a pathological fracture were not prognostic factors in terms of survival. Patients who were female or younger than 50 years of age at time of diagnosis had a better outcome.

This registry will be expanded and more information analysed to try and provide useful information about prognostic factors and outcome for patients with meta-static bone disease.

Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease and, of the remaining 15, four had above-knee amputations for complications. Infection occurred in seven patients; in five it was related to the lengthening procedure. Aseptic loosening is inevitable in the younger children and only two have avoided a revision, amputation or other major complication; both were aged 12 years at the time of the initial surgery. Despite this, 11 children are alive with a functioning leg and a mean Musculoskeletal Tumour Society functional score of 83%. The lengthening mechanisms used in our series required extensive open operations. We are now using a simpler, minimally invasive, technique which we hope will decrease the incidence of complications. At present, the use of extendible prostheses of the proximal tibia remains an experimental procedure.