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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIII | Pages 1 - 1
1 Jul 2012
Thomson W Porter D Demosthenous N Elton R Reid R Wallace W
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Metastatic osteosarcoma is seen in 10-20% of patients at initial presentation with the lung the most common site of metastasis. Historically, prognosis has been poor. We studied trends in survival in our small developed nation and aimed to identify correlations between the survival rate and three factors: newer chemotherapy, advances in radiological imaging and a more aggressive approach adopted by cardiothoracic surgeons for lung metastases.

Our national bone tumour registry was used to identify patients at the age of 18 or under, who presented with metastatic disease at initial diagnosis between 1933 and 2006. There were 30 patients identified. Kaplan-Meier analysis was used to determine survival rates and univariate analysis was performed using the Cox regression proportional hazards model.

Median survival has improved over the last 50 years; highlighted by the ‘Kotz’ eras demonstrating incremental improvement with more effective chemotherapy agents (p=0.004), and a current 5-year survival of 16%. Aggressive primary and metastatic surgery also show improving trends in survival. Three patients have survived beyond five years. The introduction of computerised tomography scanning has led to an increase in the prevalence of metastases at initial diagnosis.

Metastatic osteosarcoma remains with a very poor prognostic factor, however, aggressive management has been shown to prolong survival.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVIII | Pages 17 - 17
1 Jun 2012
Thomson W Porter D Demosthenous N Elton R Reid R Wallace W
Full Access

Metastatic osteosarcoma is seen in 10-20% of patients at initial presentation with the lung the most common site of metastasis. Historically, prognosis has been poor. We studied trends in survival in our small developed nation and aimed to identify correlations between the survival rate and three factors: newer chemotherapy, advances in radiological imaging and a more aggressive approach adopted by cardiothoracic surgeons for lung metastases.

Our national bone tumour registry was used to identify patients at the age of 18 or under, who presented with metastatic disease at initial diagnosis between 1933 and 2006. There were 30 patients identified. Kaplan-Meier analysis was used to determine survival rates and univariate analysis was performed using the Cox regression proportional hazards model.

Median survival has improved over the last 50 years; highlighted by the ‘Kotz’ eras demonstrating incremental improvement with more effective chemotherapy agents (p=0.004), and a current 5-year survival of 16%. Aggressive primary and metastatic surgery also show improving trends in survival. Three patients have survived beyond 5 years. The introduction of computerised tomography scanning has led to an increase in the prevalence of metastases at initial diagnosis.

Metastatic osteosarcoma remains with a very poor prognostic factor, however, aggressive management has been shown to prolong survival.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVIII | Pages 8 - 8
1 Jun 2012
Demosthenous N St Mart J Jenkins P Chappel A Cheng K
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Obtaining informed consent for an operation is a fundamental daily interaction between orthopaedic surgeon and patient. It is based on a patient's capacity to understand and retain information about the proposed procedure, the potential consequences of having it and the alternative options available. We used validated tests of memory on 59 patients undergoing lower limb arthroplasty to assess how well they learned and recalled information about their planned procedure. All patients showed an ability to learn new material, however, younger age and higher educational achievement correlated with better performance. These results have serious implications for orthopaedic surgeons discussing planned procedures. They identify groups of patients who may require enhanced methods of communicating the objectives, risks and alternatives to surgery. Further research is necessary to assess interventions to improve communication prior to surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 402 - 402
1 Jul 2010
Demosthenous N MacDonald D Simpson A
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Introduction: Limb lengthening with external fixators has been associated with many complications including pin tract infections, damage to neurovascular structures, joint stiffness, delayed consolidation, and pain. These can lead to a detrimental functional outcome and psychological upset with a consequent negative impact on patients’ quality of life. The Intramedullary Skeletal Kinetic Distractor (ISKD) is a fully implantable device that may offer a better functional and psychological outcome. The aim of this study therefore was to evaluate the functional and psychological outcome in a series of patients undergoing femoral lengthening with the ISKD.

Methods: Twenty patients underwent intramedullary lengthening via ISKD. Eighteen of these had lost femoral bone length secondary to trauma, and two were affected by congenital limb shortening (one had both femora lengthened at different time intervals). Patients completed Toronto Extremity Salvation Score (TESS) (to evaluate subjective physical disability), and Short Form 36 (SF36) questionnaires pre and post-operatively.

Results: Patients’ post operative TESS scores demonstrated a significant improvement in patient perception of their physical disability. SF36 responses after surgery improved in several areas including physical functioning, role limitation due to emotional problems, social functioning, mental health, pain experienced and change in health; the greatest improvements seen in role limitation due to emotional problem, social functioning, mental health, pain, and change in health.

Discussion: These results indicate that limb lengthening with the ISKD improves patients’ overall quality of life decreasing post operative pain, improving their social functioning and mental health, overall ISKD lengthening improves how the patients perceive their health and physical disability.