Hindquarter amputations for bone or soft tissue sarcoma cause a high degree of disability in patients and are associated with high morbidity rates. The goal of this study is to determine prognostic factors for outcome and analyse quality of life after resection, in order to better select patients who are more likely to benefit from a hindquarter amputation. Our prospectively collected database was searched for all patients treated with a hindquarter amputation between 1989 and 2015. Clinical and histopathological features were analysed for their prognostic value using Kaplan-Meier and Cox proportional hazard analysis. Endpoints were set at recurrent disease and death. Also, functional and social outcome as well as pain was assessed from the hospital charts in the patients that are still alive. 82 patients underwent a hindquarter resection in the given time frame. Of these patients, 63 were treated with a curative intent. The median hospital stay was 25 days, and 49% of the patients had wound complications. The in-hospital mortality was 6%. The 5-year overall survival in the whole group was 31%, while disease free survival was 26%. As expected, patients with metastases at presentation had a significantly worse outcome, while patients with locally recurrent sarcoma had the same outcome as patients with primary sarcoma. For those patients treated with curative intent, younger age was correlated with better survival, while higher histological grade was correlated with worse disease free survival. The functional and social outcome for patients who survived more then one year varied widely, with about 50% of the patients living an acceptable social life with reasonable pain levels and mobility status. Hindquarter amputations for sarcoma patients are still indicated for a select group of patients. Younger patients and/or patients with low grade sarcomas are more likely to benefit form this resection in terms of survival and long term function. However, for patients with less favourable prognostic factors a hindquarter operation might be an unreasonable palliative option

Background. Advances in diagnosis and treatment should mean that hindquarter amputation is now rarely needed. Unfortunately this is not the case. We have performed 166 of these amputations in the past 36 years. We have investigated the reasons why this procedure is still required and the outcomes following it. Method. A retrospective review of data stored on a prospective database. Results. Hindquarter amputation was used as treatment for 15% of all primary bone tumours affecting the pelvis. 146 were performed with curative intent but 20 were performed purely for palliation, usually to relieve pain. 96 of the procedures were needed as part of primary treatment, with the other 70 being needed following failure of local control after other surgical procedures. The indication for amputation in primary disease was almost always due to a significant delay in diagnosis, allowing tumours (particularly chondrosarcomas) to become massive by the time of diagnosis. The peri-operative mortality was 3% and 45% had major wound healing problems or infection. The median survival times after curative and palliative procedures were 36 months and 8 months respectively. The survival after hindquarter amputation for curative intent at 1, 3 and 5 years was 74%, 60% and 48%. Overall survival was better with chondrosarcoma – 52% of the patients surviving more than 10 years had chondrosarcoma. Phantom pain was a significant problem; fewer than 10% use their prosthesis regularly. Despite this functional scores averaged 61% – not significantly worse than patients who had undergone pelvic replacements!. Conclusion. Hindquarter amputation is still regularly required both for primary and salvage treatment in musculoskeletal oncology. Earlier diagnosis of pelvic tumours may avoid its use. Survival is not surprisingly worse than for tumours at other sites

Introduction. The success of total hip replacement in the young has consistently been worse both radiologically and clinically when compared to the standard hip replacement population. Methods. We describe the clinical and radiological outcome of 58 consecutive polished tapered stems (PTS) in 47 patients with a minimum of 10 years follow-up (mean 12 years 6 months) and compared this to our cohort of standard patients. There were 22 CPT stems and 36 Exeter stems. Results. Three patients with 4 hips died before 10 years and one hip was removed as part of a hindquarter amputation due to vascular disease. None of these stems had been revised or shown any signs of failure at their last follow-up. No stems were lost to follow-up and the fate of all stems is known. Survivorship with revision of the femoral component for aseptic loosening as the endpoint was zero and 4% (2 stems) for potential revision. The Harris hip scores were good or excellent in 81% of the patients (mean score 86). All the stems subsided within the cement to a mean total of 1.8mm (0.2-8) at final review. There was excellent preservation of proximal bone and an extremely low incidence of loosening at the cement bone interface. Cup failure and cup wear with an associated periarticular osteolysis was a serious problem. 19% of the cups (10) were revised and 25% of the hips (13) had significant periarticular osteolysis associated with excessive polyethylene wear. Discussion. The outcome of polished tapered stems in this age group is as good as in the standard age group and superior to other non PTS designs in young patients. This is despite higher weight and frequent previous surgery. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis