Aims. We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. Methods. This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. Results. A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). Conclusion. The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170–176

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This study aimed to compare the performance of survival prediction models for bone metastases of the extremities (BM-E) with pathological fractures in an Asian cohort, and investigate patient characteristics associated with survival.

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The risk of postoperative complications after resection of soft-tissue sarcoma in the medial thigh is higher than in other locations. This study investigated whether a vessel sealing system (VSS) could help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh.

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Due to its indolent clinical behaviour, the treatment paradigm of atypical cartilaginous tumours (ACTs) in the long bones is slowly shifting from intralesional resection (curettage) and local adjuvants, towards active surveillance through wait-and-scan follow-up. In this retrospective cohort study performed in a tertiary referral centre, we studied the natural behaviour of ACT lesions by active surveillance with MRI. Clinical symptoms were not considered in the surveillance programme.

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Radiotherapy is a well-known local treatment for spinal metastases. However, in the presence of postoperative systemic therapy, the efficacy of radiotherapy on local control (LC) and overall survival (OS) in patients with spinal metastases remains unknown. This study aimed to evaluate the clinical outcomes of post-surgical radiotherapy for spinal metastatic non-small-cell lung cancer (NSCLC) patients, and to identify factors correlated with LC and OS.

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The modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype.

Aim. The aim of this study was to assess the financial implications of managing skeletal metastases in a tertiary hospital and explore its impact on the provision of acute care trauma services. Methods. We identified 47 patients, surgically treated for skeletal metastases over one-year period. Data were collected on demographics, primary tumour, the bone involved, surgery performed, the type of prosthesis used, length of surgery, hospital stay and the exact indication for orthopaedic intervention. The cost incurred was calculated from the cost of the prosthesis implanted, the number of theatre-sessions utilised and the number of inpatient hospital days. Results. The average age of patients was 68 years (SD 10). The most common primary tumours were myeloma and breast cancer (23% each) followed by prostrate cancer (11%). The neck of femur was involved in 36%, femoral shaft and spine in 21% each and humerus in 19%. Fifty-seven percent patients had fractures, 30% had impending fractures and 13% had symptoms suggesting spinal cord compression. A total of 26 theatre sessions were utilised in operating upon these patients (one every two weeks) and their total hospital stay was 848 days. The total cost incurred was £340,174 over a year which is roughly £7238 per patient. Conclusion. Survival of patients with skeletal metastases is increasing and the true cost of managing them is under recognised and ever increasing. In our unit, one theatre session a fortnight and 2.3 bed days for the whole year were utilised in managing these patients. The opportunity cost forgone by utilising theatre sessions for tumour surgeries and the total cost of hospital stay and prostheses utilised should be taken into consideration when calculating tariffs. This financial burden on busy trauma units should be appropriately reimbursed to ensure high standards of care

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Due to their radiolucency and favourable mechanical properties, carbon fibre nails may be a preferable alternative to titanium nails for oncology patients. We aim to compare the surgical characteristics and short-term results of patients who underwent intramedullary fixation with either a titanium or carbon fibre nail for pathological long-bone fracture.

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The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection.

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The modified Glasgow Prognostic Score (mGPS) uses preoperative CRP and albumin to calculate a score from 0 to 2 (2 being associated with poor outcomes). mGPS is validated in multiple carcinomas. To date, its use in soft-tissue sarcoma (STS) is limited, with only small cohorts reporting that increased mGPS scores correlates with decreased survival in STS patients.

We analysed the gait characteristics of 15 patients with prosthetic reconstruction of the proximal femur after resection of a malignant bone tumour using stride analysis and measurement of oxygen consumption. Compared with normal volunteers their gait was slower, with less cadence and reduced stride length. The mean net energy cost of free walking was 141% of normal. The degree of asymmetry of the single-limb support time correlated with the free-walking velocity and the net energy cost. If they used a single cane the subjects walked with less cadence, longer stride length, and prolonged single-limb support times. The net energy cost of walking and asymmetry of the single-limb support time had a negative correlation with the strength of the hip abductor muscles. Their walking performance was better than that of six subjects who had hip disarticulation

Aim. To investigate the effectiveness of silver coated prostheses in preventing periprosthetic infection in a high-risk group. Methods. We have used silver coated prostheses in 48 endoprosthetic replacements in whom there would be a high expected risk of infection. Results. Between 2006 and 2009 48 patients had silver coated prostheses inserted; 19 primaries, 10 single-stage revisions, and 19 second-stage revisions. Of these, only one (2%) required removal following overwhelming coliform infection. There were four superficial wound infections in the primary group, none in the single-stage group, and 5 in the 2 stage group. Of these patients, one died of metastases, 7 settled with antibiotics ⊞/⊟ wound washout, and one patient is undergoing investigation. Discussion. These early results suggest that silver coating may not prevent infection but seems to help treatment of it by allowing control with simple measures (washout). The cost of the silver coating is about £300. It will be cost effective if it reduces the overall infection risk by 1%

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Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis.

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Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction.

This study reports the experience of one treatment centre with routine surveillance MRI following excision of musculoskeletal sarcoma. The case notes, MRI and histology reports for 57 patients were reviewed. The primary outcome was local tumour recurrence detected on either surveillance MRI in asymptomatic patients, or interval MRI in patients with clinical concern. A total of 47 patients had a diagnosis of soft-tissue sarcoma and ten of a primary bone tumour. A total of 13 patients (22%) had local recurrence. Nine were identified on a surveillance scan, and four by interval scans. The cost of surveillance is estimated to be £4414 per recurrence detected if low-grade tumours with clear resection margins are excluded. Surveillance scanning has a role in the early detection of local recurrence of bone and soft-tissue sarcoma

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Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

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Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up.

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Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction.

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Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur.

Introduction. The diagnosis and subsequent management of sarcoma often requires multiple separate attendances to Hospital and often a prolonged inpatient stay post surgery. Previous research has focused on the physical and emotional aspects of a diagnosis of cancer, but little has been discussed regarding the financial costs incurred by patients and their families. Methods. 40 patients treated at our Unit were contacted and were questioned about the financial costs relating to their diagnosis and treatment. The questionnaire included distance travelled to the Unit, mode of transport, who patients were accompanied by, costs whilst at the Hospital e.g. car parking, days off work and impact on employment and career progression. Results. Patients travelled an average of 88 miles for a return journey to the Unit. They attended an average of 18 out-patient consultations during their treatment. The estimated cost of travel to consultations alone, including parking was £785. The mean length of in-patient stay was 5.4 days. Relatives visited on most days of the in-patient stay with further associated costs. 18 patients felt that progression at work i.e. promotion had been affected by their diagnosis. A further 12 patients had lost / given up their job as a result of the disease. Discussion. The diagnosis, and the subsequent treatment of, Sarcoma has a profound effect on patients. The financial strain incurred by multiple clinic visits, in-patient stays and associated costs adds to the pressure of the diagnosis. Efforts need to be made to ensure that patients are seen in a truly coordinated manner and more use made of new innovations such as web support. An outline of the anticipated financial impact for patients should be given at an earlier stage and earlier liaison with employers ensured such that employers can plan for expected absences