Aims. 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. Methods. Of 285 patients who underwent wide resection for soft-tissue sarcoma between 2014 and 2021 at our institution, 78 patients with tumours in the medial thigh were extracted from our database. Information on clinicopathological characteristics, preoperative treatment, surgical treatment (use of VSS, blood loss volume, operating time), and postoperative course (complications, postoperative haemoglobin changes, total drainage volume, and drainage and hospitalization durations) were obtained from medical records. We statistically compared clinical outcomes between patients whose surgery did or did not use VSS (VSS and non-VSS groups, respectively). Results. There were 24 patients in the VSS group and 54 in the non-VSS group. There were no significant differences between the two groups in terms of clinicopathological background. The total drainage volume in the VSS group was significantly less than that in the non-VSS group (1,176 ml vs 3,114 ml; p = 0.018). Moreover, the drainage and hospitalization durations were significantly shorter in the VSS group compared to the non-VSS group (p = 0.017 and p = 0.024, respectively). Conclusion. Our results suggest that use of VSS can help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh. Cite this article: Bone Jt Open 2023;4(6):442–446

Aims. This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations?. Methods. We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results. There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral thigh (p = 0.034), and posterior thigh (p = 0.005). Finally, the maximum severity of preoperative pain and number of pain locations had no significant relationship with PROMs (maximum severity: HHS: p = 0.928, HOS: p = 0.163, iHOT-12 p = 0.233; number of pain locations: HHS: p = 0.211; HOS: p = 0.801; iHOT-12: p = 0.112). Conclusion. Although there was a significant difference in iHOT-12 scores between patients with the most severe pain in the groin or trochanter, and the presence of pain in the trochanter, lower back, lateral thigh, or posterior thigh was related to higher mHHS scores, the majority of preoperative pain characteristics did not have a significant impact on outcomes. Therefore, a broad array of patients with hip OA might expect similar, favourable outcomes from THA notwithstanding preoperative pain characteristics. Cite this article: Bone Jt Open 2022;3(4):332–339

Aims. The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. Patients and Methods. We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological leg-length discrepancy, and femoral offset. The radiological outcomes were considered as continuous and binary outcome variables based on Lewinnek’s ‘safe zone’. Results. Similar trends were seen in all three thigh circumference groups. In multivariable analyses, patients in the largest 20 cm thigh circumference quartile (59 cm to 78 cm) had inclination angles that were a mean of 5.96° larger (95% confidence interval (CI) 2.99° to 8.93°; p < 0.001) and anteversion angles that were a mean of 2.92° larger (95% CI 0.47° to 5.37°; p = 0.020) than the smallest quartile. No significant differences were noted in leg-length discrepancy or offset. Conclusion. There was an associated increase in inclination and anteversion as thigh circumference increased, with no change in the risk of malpositioning the components. THA can be performed using the DAA in patients with large thigh circumference without the risk of malpositioning the acetabular component. Cite this article: Bone Joint J 2019;101-B:529–535

Aims. The incidence of thigh pain with the short stem varies widely across different studies. We aimed to evaluate the incidence and characteristics of post-operative thigh pain after using a particular bladed short stem and its potential risk factors. Patients and Methods. We respectively reviewed 199 consecutive patients who underwent unilateral total hip replacement using the Tri-lock stem from 2013–2016, of which 168 patients were successfully followed up with minimum two year clinical follow-up. All information about thigh pain and pre- and postoperative HHS score were gathered and all preoperative and immediate postoperative radiographs were available for review. Any complications were recorded. Results. Of the 168 patients, 34 (20.2%) patients reported thigh pain at a mean 3.1 years after surgery. Of these, 2 (5.9%) reported severe pain (NRS 5 or more). The pain was persistent (from surgery to final follow-up) in 13 patients (38.2%) and subsided within 2 years in 10 cases (29.4%). The most common site of pain was the lateral thigh (70.6%). The HHS improved from a mean 54.2 points preoperatively to 79.8 postoperatively. In 123 cases with radiographs at more than 2 years follow-up, all femoral stems were well-fixed and no revision surgery was needed at the latest. BMI and CFI were found to be independent risk factors for thigh pain after using this particular stem component. Conclusions. The incidence of thigh pain in Chinese THA patients with a bladed short stem component design is as high as 20%. Among them, nearly 40% will have some disruption in sleep or daily life. More than one-third of the cases of thigh pain were persistent. A larger BMI and patients with a funnel-type morphology of the femoral canal are independent risk factors for thigh pain in the setting of this particular stem component

INTRODUCTION. The extension and flexion gaps are affected by different factors in total knee arthroplasty (TKA). Flexion but not extension gap measurements are influenced by posterior cruciate ligament (PCL) preservation or resection and patella reduction or eversion and thigh weight. If the flexion gap is measured with the thigh placed on the tibia, the measurement results must include the thigh weight; nevertheless, there is no detailed report regarding the thigh weight influence on the flexion gap. In this study, we investigated how thigh weight affected flexion gap measurement. METHODS. Four knees of whole-body fresh-frozen cadavers (Mongolian race) were investigated. The femur and tibia were dissected with a standard measured resection technique. After the femoral component was set, the flexion gap was measured with a knee balancer. The distraction force of 20, 30, and 40 pounds were loaded at the joint level. For each measurement, the influences of the patella reduced or everted (PR or PE) and the PCL preserved or resected (CR or PS) were estimated. The flexion gap was measured five times in four different categories (CR/PR, CR/PE, PS/PR, PS/PE) and the thigh weight was reduced by weights (0, 0.5, 1.0, 2.0, 3.0 kg) using a string and pulley system. During measurement, the femur was just placed on the tibia, and the knee flexion angle was maintained at 90 degrees with a goniometer. After all measurements, the lower limbs were resected, and the thighs were weighed with a scale. Steel-Dwasstest (non-parametric multiple comparison test) were performed for statistical analysis, and p < 0.05 was considered significant. RESULTS. Flexion gap measurement results show over 10 mm difference between the maximum gap (PS/PE, 40 lbs, 3 kg weight reduction) and the minimum gap (CR/PR, 20 lbs distraction, no weight reduction) in this study. When a 0.5 kg weight reduction was applied, there were no significant flexion gap increases compared to no weight reduction situation in almost all categories except for “CR/PR and 40 lbs distraction”. According to the increase of the weight reduction, the flexion gap became larger in all categories. When a 3 kg weight reduction was applied, there were significant flexion gap increases compared to no weight reduction situation in all categories (Table 1-3). The mean thigh weight was 2.3 kg (2.0–2.6 kg). DISCUSSION. The flexion gap is usually measured with the thigh placed on the tibia in TKA, and the measurement results are considered to include the influence of the thigh weight even though this has not been discussed in the literature. From our results, the influence of the thigh weight reduction on the flexion gap was different according to heaviness of the reduction weight. When the reduction weight was over the thigh weight, flexion gap increase relative to the flexion gap without weight reduction was significant in all categories nevertheless different situations of the PCL, patella position, and joint distraction forces. To estimate adequate flexion gap and avoid post-operative flexion gap looseness, the thigh weight should be reduced when the flexion gap is measured

Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant. Methods. All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study. Results. Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. Fifty-two hips (18%) had ≥25% cortical hypertrophy in zone 3 and 91 hips (31%) had ≥25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusion. The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient reported anterior or lateral thigh pain. For any tables or figures, please contact the authors directly

The use of smart trial components is now allowing a better assessment of soft tissue balancing at the time of total knee replacement surgery. A balanced knee can be defined as one that possesses symmetry, ie. equal and centered lateral and medial forces through the full range of flexion. There is still a need for a standard reproducible surgical test to quickly confirm optimized balancing at surgery with such devices. The Heel Push test is the established standard, by pushing the foot in a cephalad direction while supporting the thigh and keeping the leg stable in the vertical plane. A common variation of this test is the Thigh Pull test where the foot is actively assisted during the cephalad pull of the thigh through deep flexion. The test is an open chain test. The Thigh Pull test may be an improvement since the weight of the leg is alleviated and no supplemental compressive forces are introduced. The directional changes of the lower extremity are thus a result of ligamentous tension and balances. The purpose of this study is to compare the two tests using a standard testing methodology and observe the variation in kinetic parameters in a controlled biomechanical setting. A custom l rig was developed, which independently controls all six degrees of freedom about the knee joint. In addition a commercial navigation system was used to derive instantaneous alignment values and flexion angles between the tibia and femur. The pelvis was fixed to the table and the foot was fitted onto a low friction carriage along a slide rail. The knee design used was cruciate retaining. The pressure mapping system was a wireless tibial trial that provided magnitude of load per compartment. The study is a preliminary cadaveric study reporting the data from two. In this experiment the leg was then tested with the Heel Push and Thigh Pull tests after obtaining optimum soft tissue balance of the cadaveric specimen. From this standard neutral state a series of single surgical variables were introduced to mimic common intra-operative surgical corrections. This was achieved through custom tibial liner and angle shims. The results defied theoretical anticipation. Though the total contact forces with heel push were generally higher than with thigh pull, the relative load distribution between compartments did not follow a trend (see Figure 1). Furthermore in deeper flexion the persistence of relatively high contact pressures would suggest that ligaments still generate intra-articular forces despite the much weaker gravitational effect. The clinical relevance lies in the asymmetry of the load distribution between medial and lateral compartment for the two methods tested. The load asymmetry as tested by the Thigh Pull test may correspond to an open chain in swing phase. This asymmetry would force some axial rotation and tibial femoral alignment deviation that can significantly affect the forces at the time of heel strike. The Heel Push test would be more representative of the compressive forces in a closed chain mode as seen during the stance phase of gait

Objectives. Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh. Methods. A total of 18 patients (14 men, four women) underwent total or partial quadriceps resection for soft-tissue sarcoma of the thigh between 2002 and 2014. The number of resected quadriceps was surveyed, knee extension strength was measured with the Biodex isokinetic dynamometer system (affected side/unaffected side) and relationships between these were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D) score and the Short Form 8 were used to evaluate post-operative function and examine correlations with extension strength. The cutoff value for extension strength to expect good post-operative function was also calculated using a receiver operating characteristic (ROC) curve and Fisher’s exact test. Results. Extension strength decreased when the number of resected quadriceps increased (p < 0.001), and was associated with lower MSTS score, TESS and EQ-5D (p = 0.004, p = 0.005, p = 0.006, respectively). Based on the functional evaluation scales, the cutoff value of extension strength was 56.2%, the equivalent to muscle strength with resection of up to two muscles. Conclusion. Good post-operative results can be expected if at least two quadriceps muscles are preserved. Cite this article: A. Tanaka, Y. Yoshimura, K. Aoki, M. Kito, M. Okamoto, S. Suzuki, T. Momose, H. Kato. Knee extension strength and post-operative functional prediction in quadriceps resection for soft-tissue sarcoma of the thigh. Bone Joint Res 2016;5:232–238. DOI: 10.1302/2046-3758.56.2000631

Background. Although thigh pain is an annoying problem after total hip arthroplasty (THA), little information has been known about its natural course. Methods. To determine the frequency, time of onset, and duration of thigh pain after cementless THA, we evaluated 240 patients (240 hips) who underwent primary THA because of femoral head osteonecrosis with the use of a single tapered stem. Results. Twenty-seven patients (11.3%) experienced thigh pain during the follow-up of 3–11 years(mean, 84 months). The pain developed 2–78 months (median, 25 months) after THA. The 75% of pain developed within 36 months. In 25 patients, the pain disappeared postoperatively 1 month-64 months (mean, 17.4 months), and 2 patients (7.4%, 2/27) had persistent thigh pain. There were no differences in the latest Harris Hip Score between the thigh pain group and no thigh pain group. Conclusion. Our results provided basic information about the natural history of thigh pain after cementless THA with a tapered stem design

Aims. Lateral femoral cutaneous nerve (LFCN) injury is a potential complication after the direct anterior approach for total hip arthroplasty (DAA-THA). The aim of this study was to determine how the location of the fasciotomy in DAA-THA affects LFCN injury. Methods. In this trial, 134 patients were randomized into a lateral fasciotomy (n = 67) or a conventional fasciotomy (n = 67) group. This study was a dual-centre, double-blind, prospective randomized controlled two-arm trial with parallel group design and a 1:1 allocation ratio. The primary endpoint was the presence of LFCN injury, which was determined by the presence of numbness, decreased sensation, tingling, jolt-like sensation, or pain over the lateral aspect of the thigh, excluding the surgical scar, using a patient-based questionnaire. The secondary endpoints were patient-reported outcome measures (PROMs) using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS-12). Assessments were obtained three months after surgery. Results. The incidence of LFCN injury tended to be lower in the lateral fasciotomy group (p = 0.089). In the lateral fasciotomy group, there were no significant differences in the mean PROM scores between patients with and without LFCN injury (FJS-12: 54.42 (SD 15.77) vs 65.06 (SD 26.14); p = 0.074; JHEQ: 55.21 (SD 12.10) vs 59.72 (SD 16.50); p = 0.288; WOMAC: 82.45 (SD 6.84) vs 84.40 (SD 17.91); p = 0.728). In the conventional fasciotomy group, there were significant differences in FJS-12 and JHEQ between patients with and without LFCN injury (FJS-12: 43.21 (SD 23.08) vs 67.28 (SD 20.47); p < 0.001; JHEQ: 49.52 (SD 13.97) vs 59.59 (SD 15.18); p = 0.012); however, there was no significant difference in WOMAC (76.63 (SD 16.81) vs 84.16 (SD 15.94); p = 0.107). Conclusion. The incidence of LFCN injury at three months after THA was comparable between the lateral and conventional fasciotomy groups. Further studies are needed to assess the long-term effects of these approaches. Cite this article: Bone Joint J 2023;105-B(12):1252–1258

Objective:. Accurate measurement of the extension and flexion gap is important in total knee arthroplasty (TKA). Particularly, the flexion gap may be influenced by several factors; therefore, tension of the posterior cruciate ligament (PCL), knee extensor mechanism, and the thigh weight may need to be considered while estimating the flexion gap. However, there is no comprehensive study on the flexion gap, including an assessment of the influence of gravity on the gap. The purpose of this study is to investigate the influence of PCL, knee extensor mechanism, and thigh weight on the flexion gap by using a fresh frozen cadaver. Methods:. A fresh frozen lower limb that included the pelvis was used for the assessments. The knee was resected by a measured resection technique and a femoral component was implanted to estimate the component gap. The knee was flexed by precisely 90 degrees using a computer navigation system. The flexion gap was measured in different situations: group A, PCL preserved and patella reduced; group B, PCL preserved and patella everted; group C, PCL resected and patella reduced; and group D, PCL resected and patella everted. In each group, the measurements were obtained under 3 different conditions: 1, knee flexed and the lower limb on the operation table under gravity, as is usually done in TKA; 2, hip and knee flexed 90 degrees to avoid the influence of gravity; and 3, knee set in the same position as in condition 1 and the thigh was held by hand to reduce the influence of the thigh weight. Results:. The flexion gap differed according to groups and conditions. Group B was larger than group A in most conditions and group D was larger than group C. The flexion gap in group D was the largest among the 4 groups. The extensor mechanism had influences to the flexion gap (Table 1). In groups A and B, the flexion gaps were similar under conditions 1, 2, and 3; however, in groups C and D, the flexion gaps in condition 1 were smaller than those in conditions 2 and 3. The thigh weight condition had influences to the flexion gap when the PCL was resected (Table 2). Conclusion:. This is the first systemic report about the influences of PCL, extensor mechanism, and thigh weight on flexion gap measurement in TKA. PCL, extensor mechanism, and thigh weight influence the flexion gap and should be considered during TKA surgery. Especially, careful consideration is necessary to estimate the flexion gap when the PCL is resected and the patella is everted because the flexion gap becomes much wider than other situations

One of major problems in Total Hip Arthroplasty is thigh pain. We have examined the effect of femoral canal injection of Calcium Phosphate Paste (CPP) for cementless THA. CPP is a mixture of alpha Tri-Calcium Phosphate, Tetra-Calcium Phosphate, Calcium Hydrogen Phosphate and Hydroxyapatite. This paste harden in 10 minutes and its stiffness increases to 80Mpa in 3days. Cementless THA were performed in 45 osteoarthritic hips from 1999 to 2002. Eight of 40 patients were male and 32 were female, average age were 62.4 years old ranged 43 to 81. In 11 hips, CPP (10–12g) were filled as a femoral canal filler around the distal end of stem. In 34 hips, as a control, no CPP were filled in the canal. Proximal part of the stem was HA coated on rough metal surface. No thigh pain were observed in CPP group patients. In control group, five hips (14.7%) showed thigh pain (p< 0.05), but walking disability and pain were mild in the first year and improved by the next year. CPP filled in the canal were absorbed slowly on X-ray film, but prevention of thigh pain lasts for long time maximum 3 years. No infections and pulmonary embolism were observed in both series. Filling CPP into the gap between stem tip and femoral canal is useful technique to prevent thigh pain after cementless THA

Conventional wisdom holds that aseptic failure of proximal ingrowth femoral stems should be addressed by revision to a longer femoral stem dependent upon more distal fixation. This is a reliable and time-honoured strategy with a high likelihood of success provided secure initial fixation of the revision stem is obtained. Yet, stems reliant upon more distal diaphyseal fixation are accompanied by a greater risk of physiologic thigh pain attributable to the differential in flexural stiffness of the femoral shaft compared with the prosthetic stem. Contemporary proximal ingrowth femoral stems have become the most popular device used in total hip arthroplasty and are traditionally reserved for primary procedures. Nevertheless, the flat tapered design offers a tight fit between the medial and lateral endosteal cortices of the femur, unimpeded by an increasing anteroposterior dimension of the stem, and provides a secure geometrical block to rotational movement of the stem. In instances when the primary stem is not fit to the endosteal cortex on the anteroposterior radiograph, such as with the Corail or SROM devices, the opportunity may exist for revision with a flat tapered proximal ingrowth stem that is upsized to abut the endosteal femoral cortex. Such a strategy preserves the diaphyseal femur for subsequent revision in these typically young patients and avoids the issue of thigh pain in this active population. Likewise, revision of a well-fixed long stem that is associated with unrelenting thigh pain may be similarly accomplished by revision to a flat proximal ingrowth stem provided the integrity of the upper femur can be maintained during the revision. A prophylactic cerclage wire around the proximal femur is a helpful adjunct when using flat tapered proximal ingrowth stems in the revision setting

We describe three patients with a compartment syndrome of the thigh, two after total hip replacement and one after total knee replacement. Two of the patients were fully anticoagulated. A compartment syndrome of the thigh is a rare, but important complication of joint replacement surgery if patients are receiving anticoagulants. Close observation is needed and when indicated monitoring of the intracompartmental pressure should be done. Early recognition of the signs and symptoms of an acute compartment syndrome and knowledge of the anatomy of the compartments of the thigh will help in the diagnosis and treatment of this potentially devastating complication

INTRODUCTION:. Short femoral stems are receiving increasing attention for less invasive total hip replacement (THR). The purpose of this study is to report our initial experience with a short modular femoral (SMF) stem at a minimum two-year follow up. METHODS:. Twenty-six primary total hip arthroplasties (THAs) using the SMF stem were performed between August 2009 and January 2010. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically up to two years. Radiographs were analyzed to determine the degree of stem migration from its initial postoperative position. These parameters were compared to those of a cohort of 54 patients implanted with a monolithic tapered wedge stem from the same manufacturer over the same time period. RESULTS:. There were three early revisions of the femoral component for thigh pain in the SMF group, and one revision for CoCr allergy, with improvement in HHS from 60 to 89. Radiographically, 20 of 26 stems (76%) migrated into varus in the first six weeks. Of these, eight patients (29.6%) reported moderate to severe thigh pain. Radiographic evidence of isolated lateral cortical hypertrophy at the stem tip was seen in 46% of study patients, and evidence of osteointegration was seen in all cases by one year. Between one and two years post op the pain had resolved in four patients not revised. It was persistent in one patient. Comparative analysis with the control group demonstrated no significant difference in stem subsidence, but a significantly greater varus shift in coronal-plane angulation (Mean 4.3°, SD 3.8° vs. Mean 1.0°, SD 1.1°; p < 0.0001). Mean HHS was lower in the SMF group (85.2 vs. 91.4; p < 0.01) at last follow up. DISCUSSION AND CONCLUSION:. The SMF stem demonstrated a tendency towards migration into a varus position where the lateral stem touches the lateral cortex of the femur, with resulting relatively higher incidence of thigh pain and early aseptic revision

Introduction & aims: Quadriceps muscle wasting is common in patients with osteoarthritis (OA) of the hip and knee. Previous studies,using ultrasound and performing biopsies, have demonstrated quadriceps muscle fibre atrophy. Thigh girth measurements are quoted in textbooks as a means of quantitatively assessing muscle bulk. This study has looked at these measurements in patients with hip and knee OA to see if these measurements are useful. Method: 87 patients (mean age 62, range 36–87) with a diagnosis of OA were seen in the pre-assessment clinic. 47 were awaiting total hip replacement (THR) and 40 were awaiting total knee replacement (TKR).All were awaiting primary arthroplasty and had not had previous joint surgery. Thigh girth measurements were taken at 2 points corresponding with one-third and two-thirds of the length between the anterior superior iliac spine and the tibial tuberosity. These measurements were taken for both thighs. The observed differences were analysed with normal probability plots and paired Student’s t-tests. Results: No significant difference in thigh girth could be detected in patients awaiting total knee replacement. Girth was significantly reduced in the thigh on the side of planned THR. This difference was apparent when measured both proximally and distally. Conclusion: Measurements of thigh girth were not useful indicators of quadriceps wasting in patients awaiting TKR. Patients awaiting THR should have thigh girth measured, those with reduced thigh girth on the side of planned arthroplasty may have quadriceps atrophy and can then be referred for physiotherapy prior to surgery

Introduction: Hip resurfacing has been increasingly used procedure for physiologically young and active patients. Wear properties of the implants are considered to be excellent. We present a case of tumor like swelling of the thigh following metal on metal hip resurfacing. Case report: 56 year old lady underwent metal on metal hip resurfacing for idiopathic osteoarthritis of right hip. Implant size: 38 mm head with 44 mm cup. After 18 months of successful surgery she presented with short duration (2 weeks) history of thigh swelling with pain and stiffness in hip and knee. Clinically gross circumferential swelling of right thigh from inguinal ligament to the knee joint. She had increased serum cobalt chromium levels. Aspiration of hip revealed high levels of cobalt and chromium. Biopsy and intra operative samples at revision revealed “no infection or tumor but non specific inflammatory reaction.”. The patient underwent revision surgery to ceramic-plastic bearing.(THR). 12 months post operative, the swelling has reduced with painless mobile hip and knee joints. Discussion: The metal on metal hip resurfacing could have produced high metal ion wear reaction leading to swelling. Which could be because of small diameter prosthesis with valgus position of femoral component with open cup angle of 49 degrees

Six porous-coated, uncemented femoral components were revised at a mean of 34.5 months for persistent thigh pain. At operation the stems were rigidly stable, difficult to extract, and showed good bony ingrowth. The four men and two women, with an average age of 59 years, all had thigh pain starting within the first year, progressive over time and unresponsive to conservative measures. These cases show that rigid fixation with good bony ingrowth does not guarantee the clinical success of a porous-coated uncemented femoral stem

Intramuscular hemangyomas are benign tumours (0,8% of all hemangyomas). Their aetiology is uncertain but they are possibly congenital, although some seem to be related to trauma. Symptoms (usually pain and swelling) may be present for years. Histological subtypes are cavernous, capillary and mixed. Optimal management includes precise diagnosis and wide excision to prevent local recurrence. Authors present a case of a 79 years male with cavernous hemangyoma of the thigh with three years of evolution. The tumour eroded the femur and the patient had a mass all over the thigh with tension and pain. Diagnosis was suspected by phleboliths seen on x-ray and MRI and was confirmed by open biopsy. Treatment was a complete excision with double approach, medial and lateral, plus prophylactic nailing of the femur. With a four years follow – up, the patient has no sign of recurrence and has a normal function of the inferior limb and a normal gait

Many authors believe that size, histological grade and depth are the best predictors of outcome in soft tissue sarcoma. Enneking’s surgical staging system included compartmental status, and was intended to guide surgical intervention as well as provide prognostic information. Advances in surgical and radiotherapy techniques may mean that extracompartmental status is no longer a poor prognostic factor. We compared a group of popliteal fossa sarcomas with a group from the posterior thigh, and found that although the former group required more extensive surgery to obtain wide margins, their functional and survival outcomes were similar. No single staging system has been generally accepted for extremity soft tissue sarcoma, although histologic grade, size and depth are widely accepted as prognostic indicators. Enneking outlined a surgical staging system which used compartmental status as a predictor of outcome. However, surgical reconstruction and adjuvant radiotherapy have advanced considerably. We wanted to know if a tumour arising in the popliteal fossa still had poorer survival or functional outcome in the light of these advances. We identified twenty-three patients who had sarcomas of the popliteal fossa and forty-six patients who had sarcomas of the nearby posterior thigh compartment. Popliteal sarcomas were not of a different size or more likely to present with metastasis. Popliteal tumours more frequently required reconstructive techniques such as local or free tissue transfer and skin grafting than posterior thigh tumours (39.1% v 4.3% respectively). Popliteal tumours were also more likely to undergo a dissection or reconstruction of the major neurovascular structures of the lower limb (30.4% v 0% respectively). There was no difference in local or systemic recurrence rates between the groups. TESS and MSTS 1987 functional scores also showed no difference between the groups. We conclude that popliteal fossa sarcomas require a greater level of surgical intervention to follow sound principles of sarcoma resection and achieve reconstruction of the ensuing soft tissue defect. However, if these principles are followed in a planned multidisciplinary setting, then survival and functional results similar to the posterior thigh can be expected