Aims

The aim of this retrospective study was to assess the incidence of early periprosthetic femoral fracture (PFF) associated with Charnley-Kerboull (CK) femoral components cemented according to the ‘French paradox’ principles through the Hueter anterior approach (HAA) in patients older than 70 years.

Periprosthetic femoral fracture (PFF) following primary total hip arthroplasty (THA) is of raising concern with the aging of the population. The aim of this retrospective study was to assess the incidence of early PFF associated with Charnley- Kerboull (CK) stems cemented line-to-line according to the “French paradox” principles through the anterior approach (AA) in patients older than 70 years old.

This monocentric study involved 25 surgeons with various level of experience. From a prospectively collected database, all CK stems (AmisK®, Medacta, Castel San Pietro, Switzerland) done consecutively from January 2018 to May 2022 through the AA in patients older than 70 years were included. The measured parameters included canal flare index (CFI), morphological cortical index (MCI), canal-calcar ratio (CCR), ilium-ischial ratio (IIR), ilium overhang, and anterior superior iliac spine (ASIS) to greater trochanter distance. Dorr classification was also recorded.

A total of 416 CK stems performed by 25 surgeons were included. All patients had a minimal 3-month follow-up. The mean age was 77.4 years, and the mean BMI was 25.3 kg/m². According to the Dorr classification 240 hips were of Dorr type A, 144 Dorr type B, and 2 Dorr type C. Mean CFI, MCI, CCR, IIR and ASIS-GT were 3.8, 0.5, 2.8, 2.5, and 101mm, respectively. Amongst the 416 THAs, one (0.24%; 95% CI 0.20 – 0.28%) early PFF Vancouver type B2 fracture that occurred 24 days postoperatively was observed.

This study demonstrated that CK stems cemented according to the “French Paradox” were associated with an extremely low rate of early PFF in patients over 70 years. The observed results are better than those reported with uncemented or taper slip cemented stems. Longer follow-up is warranted to evaluate further rate of fracture that may occur during the bone remodeling process around the femoral component.

Aims

The primary aim of this study was to determine the morbidity of a tibial strut autograft and characterize the rate of bony union following its use.

Aim

Periprosthetic joint infection (PJI) is a major complication of prosthetic implantation and needs a combined surgical and antimicrobial treatment. One-stage revision results usually in similar cure rate than two-stage (around 85–92%), but antibiotic therapy duration is not well established. The aim of study was to evaluate the efficacy of a short six-weeks antibiotic course in hip and knee PJIs after one-stage replacement arthroplasty (RA).

Aims

Resection of the proximal humerus for the primary malignant bone tumour sometimes requires en bloc resection of the deltoid. However, there is no information in the literature which helps a surgeon decide whether to preserve the deltoid or not. The aim of this study was to determine whether retaining the deltoid at the time of resection would increase the rate of local recurrence. We also sought to identify the variables that persuade expert surgeons to choose a deltoid sparing rather than deltoid resecting procedure.

Introduction

Total hip replacement (THR) is one of the most widely used and most successful orthopedic procedures performed in developed countries. The burden of revision surgery, however, has become a major issue in terms of both volume and cost. Technical errors at the time of the index operation are known to be associated with an increased rate of revision.

Statistical methods, such as the CUSUM test, which have been developed for the manufacturing industry to monitor the quality of products, have come to the attention of health-care workers as a result of centers with protracted periods of inadequate performance. In orthopedics, these methods have been used to monitor the quality of total hip replacement in a tertiary care department using conventional imaging techniques.

Biplane low-dose X-ray imaging (EOS) may allow an easy, patient-friendly, way to retrieve data on the position of implants immediately postoperatively. Therefore real-time feedback is provided to surgeons and performance adjusted accordingly

Conventional cemented acetabular components are reported to have a high rate of failure when implanted into previously irradiated bone. We recommend the use of a cemented reconstruction with the addition of an acetabular reinforcement cross to improve fixation.

We reviewed a cohort of 45 patients (49 hips) who had undergone irradiation of the pelvis and a cemented total hip arthroplasty (THA) with an acetabular reinforcement cross. All hips had received a minimum dose of 30 Gray (Gy) to treat a primary nearby tumour or metastasis. The median dose of radiation was 50 Gy (Q1 to Q3: 45 to 60; mean: 49.57, 32 to 72).

The mean follow-up after THA was 51 months (17 to 137). The cumulative probability of revision of the acetabular component for a mechanical reason was 0% (0 to 0%) at 24 months, 2.9% (0.2 to 13.3%) at 60 months and 2.9% (0.2% to 13.3%) at 120 months, respectively. One hip was revised for mechanical failure and three for infection.

Cemented acetabular components with a reinforcement cross provide good medium-term fixation after pelvic irradiation. These patients are at a higher risk of developing infection of their THA.

Cite this article: Bone Joint J 2015;97-B:177–84.

In this study we randomised 140 patients who were due to undergo primary total knee arthroplasty (TKA) to have the procedure performed using either patient-specific cutting guides (PSCG) or conventional instrumentation (CI).

The primary outcome measure was the mechanical axis, as measured at three months on a standing long-leg radiograph by the hip–knee–ankle (HKA) angle. This was undertaken by an independent observer who was blinded to the instrumentation. Secondary outcome measures were component positioning, operating time, Knee Society and Oxford knee scores, blood loss and length of hospital stay.

A total of 126 patients (67 in the CI group and 59 in the PSCG group) had complete clinical and radiological data. There were 88 females and 52 males with a mean age of 69.3 years (47 to 84) and a mean BMI of 28.6 kg/m² (20.2 to 40.8). The mean HKA angle was 178.9° (172.5 to 183.4) in the CI group and 178.2° (172.4 to 183.4) in the PSCG group (p = 0.34). Outliers were identified in 22 of 67 knees (32.8%) in the CI group and 19 of 59 knees (32.2%) in the PSCG group (p = 0.99). There was no significant difference in the clinical results (p = 0.95 and 0.59, respectively). Operating time, blood loss and length of hospital stay were not significantly reduced (p = 0.09, 0.58 and 0.50, respectively) when using PSCG.

The use of PSCG in primary TKA did not reduce the proportion of outliers as measured by post-operative coronal alignment.

Cite this article: Bone Joint J 2015;97-B:56–63.

Purpose of the study: The objective was to assess the diagnostic yield of angioscanner evaluation of arterial invasion of limb tumours before surgery.

Material and methods: This was a prospective study conducted from January 2005 to May 2008 designed to assess 55 arterial segments and limb or pelvic tumours on the preoperative angioscan. Screen displays of the radiographic images were reread conjointly but radiologists using vascular analysis software. Contact of a large vessel with the tumour was classified as follows: fatty line, contact less than 90° of the vessel circumference, contact less than 180°, contact ≥ 180°. Intraoperative vessel-tumour contact was classified as follows: cleavable, non-dissectible. Agreement between the angioscan and the operative findings was analysed.

Results: Forty-five arteries were cleavable and ten non-dissectible. All arteries that were separated from the tumour by a fatty plane or were in contact over less than 90° of the circumference of the vessel were cleavable at surgery (n=37/37). The sensitivity, specificity and diagnostic accuracy and the rate of positive scan for probable arterial contact > 180° were 90, 93, 93 and 13.5% respectively.

Conclusion: The angioscanner provides a satisfactory means for predicting vascular invasion of limb and pelvic tumours and contributes pertinently to the pre-operative work-up.

Purpose of the study: Extra-abdominal desmoids tumours are benign tumours generally managed by more or less wide surgical resection. This surgery can be mutilating and carries a risk of recurrence to the order of 50% according to several authors.

Material and methods: We followed a series of 26 patients from 1989 to 2009 with non-operated extra-abdominal desmoids tumours. Our objective was to study the clinical, radiographic and pathological course of these tumours and identify prognostic factors. For 11 patients, no medical or surgical treatment was delivered beyond the diagnostic biopsy; for 15, the tumour recurred after surgery and no other adjuvant treatment was given.

Results: Twenty-four tumours stabilised at 13.2 months on average for primary tumours and 20.9 for recurrent tumours. Thus en general, the tumour progression was less than 3 years. In all cases, once the tumour stopped progressing, it did not progress again. One primary tumour regressed spontaneously and one recurrence continued to progress at last follow-up of 23 months. Surgery was not required for any of the patients, excepting biopsy procedures to confirm diagnosis. MRI was the exploration of choice for follow-up.

Discussion: This series, which is the largest devoted to followed extra-abdominal desmoid fibromas, confirms recent data in the literature. A wait-and-see attitude should always be discussed with this type of tumour.

Purpose of the study: Secondary chondrosarcoma is rare (1% of malignant bone tumours). Most cases develop from solitary exostosis or concern an exostosis disease. Localisations predominate in the girdles. Management is difficult and no consensus has been reached. The purpose of this study was to present a series of 25 secondary chondrosarcomas in order to improve diagnostic and therapeutic management.

Material and methods: This was a retrospective analysis of 25 cases of secondary chondrosarcoma (10 on solitary exostosis and 15 on exostosis disease) treated by one surgical team from 1970 to 2008. The epidemiological features, clinical signs, radiographic findings, type of treatment and outcome at last follow-up were analysed for the two groups.

Results: Patients with secondary chondrosarcoma were 10 to 20 years young than those with primary chondrosarcoma. There were an equivalent number of men and women and the predominant sites involved flat bones in both groups. The radiographic signs of sarcomatous degeneration most widely observed included heterogeneous calcifications, irregular contours, and soft tissue invasion. Tumours were generally well differentiated. The rate of local recurrence after surgery was 15% at five years and 20% at ten years. Mortality was 2% at five years and 5% at ten years. Most of the deaths occurred after local recurrence. Metastases were identified in four patients after the initial resection. The rate of local recurrence was lower after wide surgical resection.

Discussion: The real objective with secondary chondrosarcoma is to ensure a regular effective follow-up of these patients with a known risk of recurrence (exostosis disease) in order to recognise early signs of sarcomatous degeneration. One of the most reliable signs is recent development of unusual pain on a known exostosis. Education of at-risk patients is crucial and should enable early screening and detection.

Conclusion: Secondary chondrosarcoma occurs 10 to 20 years earlier than primary sarcoma and generally involves the girdles. Outcome and management practices are similar to primary chondrosarcoma. The most important issue is to ensure good patient follow-up in order to enable early diagnosis in patients at risk.

Purpose of the study: We present our cases of hemangiopericytomas treated surgically in our department of orthopaedic oncology. The purpose of this work was to study this vascular tumour rarely reported in the orthopaedic surgery in order to establish epidemiological, management, and prognostic elements.

Material and methods: This was a retrospective descriptive study of patients seen since 1995 with benign (n=4) or malignant (n=16) hemangiopericytoma. The large majority were FNCLCC grade 2. Mean follow-up was ten years. Course before diagnosis was longer for benign tumours (14 years) than malignant tumours (0.9 years). Tumour localization was the lower limb (55%), the upper limb (3%) (constantly involving the scapular girdle) and isolated tumours (sternum, dorsal tumours). Two patients presented metastasis at diagnosis. A biopsy was obtained in all cases.

Results: The sample contained soft haemorrhagic tissue in all cases. The typical histology was a proliferating vascular architecture with either a fibrous or muscular component. Immunohistochemistry studies revealed positive labelling for vimentin and CD99. The diagnosis of malignancy was particularly difficult, often because of the poor knowledge of pericyte differentiation. For the benign tumour, treatment consisted in resection followed by clinical and radiographic surveillance every six months. No recurrence was observed at more than five years follow-up. For the malignant tumours, all patients were given neoadjuvant chemotherapy followed by wide resection. Adjuvant chemotherapy, determined according to the resection margins and presence of not of metastasis, was instituted for 60% of patients and associated with radiotherapy for two. The total-remission survival for malignant tumours was 60% at five years. Local recurrence was noted in 18% of patients and development of metastasis in 10%. Mortality was 20%.

Discussion: The histology diagnosis was not straightforward, particularly for confirming the benign nature of the tumour; search for specific markers is needed for routine diagnosis.

Conclusion: The results obtained in this series provide valuable information for the diagnosis of sarcoma, particularly concerning the controversial issue of the aggressiveness of malignant tumours.

The purpose of this study was to define immediate post-operative ‘quality’ in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance.

The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

Purpose of the study: Primary bone tumors of the sacroiliac joint are difficult to diagnose. We present the procedure used to resect these tumors and reconstruct the pelvic ring, and the carcinological and functional outcome.

Materials and Methods: This was a retrospective analysis of a consecutive series of patients treated for a tumor of the iliac bone or of the sacrum which involved the sacroiliac joint. Tumor grading was based on the Enneking classification and the functional outcome on the MSTS score.

Results: From 1986 to 2003, 24 patients were treated for a a tumor involving the sacroiliac joint. Six with invasion of the sacral body. The histology was osteosarcoma (n=8), chondrosarcoma (n=8), malignant hystiocytofibroma (n=3), Ewing’s sarcoma (n=2), schwannoma (n=1), leiomysarcoma (n=1) and haemangiopericytoma (n=1). Seventeen patients were given neoadjuvant chemotherapy. A wide crest approach was used to access both aspects of the pelvic ring. Neurological sacrifice was required in six patients. Operative time was 5.27 hours on average. Reconstruction was achieved with an autograft and instrumentation. The resection was wide in 11 cases, marginal in 12, and contaminated in one. The mean follow-up was 4.77 years. Ten patients died from their disease. Survival was correlated with the quality of the resection and with the initial tumor stage. Hemisacrectomy did not affect survival. Bone healing was achieved in 13 patient, ten who survived. The mean MSTS score was 48% at last follow-up in 14 survivors. For the nine patients who did not require neurological sacrifice, the mean score was 58%. For the five other patients, the mean score was 38% This score was 65% in patients with bone healing and 8% in those with nonunion.

Discussion: The survival of patients with a tumor of the sacroiliac joint is basically related to the histological diagnosis and the quality of the resection. If the disease can be controlled, the method of the reconstruction proposed here enables bone healing with a satisfactory functional result when neurological sacrifice can be avoided.

Purpose of the study: The rate of failure can be high for massive reconstruction prostheses after tumor resection. We studied the causes and possible factors of failure.

Material and methods: The series included 91 patients who underwent surgery from 1972 to 1994 for resection of a bone tumor involving the knee joint. A GUEPAR prosthesis was implanted in all cases for reconstruction (megaprosthesis in 58 cases and composite prosthesis in 33). The extensor system had to be reconstructed in 37 patients. A GUEPAR II implant was used in 73 patients; 48 of these implants had an antirotation system. The analysis was retrospective. Outcome was studied in terms of survival and independent factors predictive of failure unrelated to the tumor.

Results: Mean follow-up was 72 months. At last follow-up, 68 patients were living disease free. There were nine cases of rupture of the extensor system. Preservation of a continuous extensor system at the time of bone resection reduced the risk of rupture (p=0.036). Seven allografts fractured, two loosened, and six became infected. Use of an allograft did not reduce the risk of loosening (p=0.17). Intraxial laxity was observed in 17 patients. Use of an antirotation system was a factor of risk of intraxial laxity (p=0.0023) but not of aseptic loosening. Aseptic loosening was observed in 18 patients: 10 femur reconstruction and 8 tibia reconstruction. The difference was not significant (p=0.6). In all, 104 revisions were required in 53 patients; 36 revisions of the prosthesis, 23 of them for mechanical causes. Overall median survival, excepting tumor-related causes, was 130 months. It was 130 months for femur reconstructions and 117 for tibia reconstructions (p=0.57). Age, length of resection, tumor location, use of an allograft, and use of an antirotation system were not found to be significant prognostic factors for implant survival.

Discussion: As reported by many others, we found that the rate of failure of massive prostheses for infectious and mechanical causes remained high in patients treated for bone tumors involving the knee joint. Survival of massive implants is much lower than that of gliding prostheses.

Conclusion: Technical progress is required to improve the survival of massive implants used for the treatment of bone tumors involving the knee joint.

Purpose of the study: Diagnosis and treatment of primary malignant tumors of the pelvis raise difficult problems. The purpose of this retrospective study was to analyze the functional and cancerological results observed after surgical treatment in a single center.

Material and methods: Between 1973 and 2002, 24 patients (16 men and 8 women) underwent surgery in our unit for histological proven malignant tumors. A posterior approach was used for curettages and sacrectomies of the apex. A combined anterior and posterior approach was used for total sacrectomy and hemisacrectomy. Oncological results were assessed in terms of local recurrence, presence of metastasis and patient status at last follow-up. Overall survival and disease-free survival were calculated with the Kaplan-Meier method.

Results: Mean age was 53.38 years. Mean follow-up in our series was 54 months. Mean time to diagnosis was 16 months. Pain was the predominant symptom. Sixteen patients presented neurological manifestations and the digital rectal examination was positive in all. Chondroma was the most frequent histological type (18/24). None of the patients had metastatic disease at diagnosis. A posterior approach was used for 15 patients and a combined approach for the others. There was a clear correlation between type of resection and volume of blood loss (p=0.0002). Wide dissection was wide in five patients, marginal in five and oncologically insufficient in 14. Mean operative time was 1.34 hours for posterior approaches and 9 hours for combined approaches. The postoperative period was uneventful for ten patients. Infection was the most frequent complication. Adjuvant radiotherapy, delivered in 16 patients, effectively retarded the occurrence of local recurrence. Functional disorders were correlated with the level of the neurological sacrifice. At least one S3 root had to be preserved to limit the urological and digestive incapacity. At last follow-up, local recurrence was present in 12 patients. Mean time to first recurrence was 32 months. There was a strong correlation between quality of the resection and time to local recurrence. There was a significant difference between patients with a wide resection and those with an oncologically insufficient resection (p=0.0312). Five patients had metastases. Five-year actuarial survival was 73±12%. At ten years it was 32±14%. Local recurrence-free survival was 55±11% at five years and zero at 10 years.

Discussion and conclusion: In light of these results, factors of poor prognosis were: late diagnosis, soft tissue invasion, proximal extension, marginal or insufficient resection.

Purpose of the study: Composite knee prostheses using a massive implant and an allograft is one option for joint reconstruction after extensive resection of the knee joint for bone tumor. Implant survival after resection of the proximal tibia is not well documented. We analyzed survival and complications in 26 composite knee prostheses.

Material and methods: A composite prosthesis was implanted in 26 patients after resection of a tumor of the proximal tibia. Median length of resection was 14 cm (range 9–20 cm). A GUEPAR massive implant was used in all cases. Allografts were sterilized with gamma radiation. Median length of the tibial stem was 30 cm (range 20–38 cm). The stem was cemented in the allograft and in the tibia.

Results: Median patient survival was 68 months. At last follow-up, 19 patients were living disease free. Among the 26 allografts, seven had fractured and five were partially resorbed. Seven allografts exhibited signs of fusion at the junction with the recipient bone. Seven reconstructions of the extensor system failed (rupture). Conversely, there were no ruptures in patients whose extensor system could be preserved (continuity) at tumor resection. Six composite prosthesis were infected, four early (< 2 months) and two late. There were four cases of local recurrence. Globally, 48 secondary procedures were required in 21 patients: 26 for mechanical defects, 13 for infection, 7 for local recurrence and 2 for postoperative complications (necrosis of the tibialis anterior in both). There were 14 revisions: 9 composite prostheses were replaced, fusion was performed in 2 patients, and 3 patients required amputation. Median survival of the reconstructions, considering all failures together, was 102 months (95%IC 64.3-Inf). Median survival, including all failures for local recurrence, was 105 months (95%IC 101-Inf).

Discussion: The rate of failure and of complications is high for massive knee prosthesis combined with a radiated allograft for reconstruction of the proximal tibia. There is no series reported in the literature. When possible, the extensor system should be preserved.

Conclusion: We currently use massive knee prostheses without allografts, reconstructing the extensor system with a vastus medialis flap.

Purpose: Hinged knee prostheses are mainly used for reconstruction after major tumour resection. Aseptic loosening is the main problem with these implants. One of the solutions proposed to reduce the rate of loosening is to add a hydroxyapatite collar on the shaft stems. This work was conducted to study bone ingrowth with a new hinged implant with a hydroxyapatite collar at the junction between the zone of resection and the shaft.

Material and methods: Twenty-nine massive prostheses with a hydroxyapatite collar were implanted between 1998 and 2001. Nine patients were excluded from the analysis because follow-up was less than two years. This retrospective analysis thus compared twenty massive prostheses with twenty matched hinged GUEPAR prostheses without a collar. Bony ingrowth was measured on plain x-rays (two orthogonal views) at 6, 12, 24, and 36 months. Filling of the gap between the bone and the implant was also assessed. Signs of loosening were noted.

Results: Mean bony ingrowth in implants with a hydroxyapatite collar was 6.58 mm at 6 months 9.84 mm at 12 months, 12.3 mm at 24 months and 13.25 mm at 36 months. Mean bony ingrowth in the implants without a hydroxyapatite collar was 1.65 mm at 6 months, 3.31 mm at 12 months, 4.8 mm at 24 months and 4.35 mm at 36 months. In the implants with a collar, gap filling was partial in five cases and total in 15. In implants without a collar, there was no gap filling in eight cases, partial filling in two cases and total filling in fifteen cases.

Discussion: Prostheses with a hydroxyapatite collar enable better radiological bony ingrowth than observed in implants without a hydroxyapatite collar. Gap filling is better for prostheses with a collar. There was no case of loosening at last follow-up for implants with a hydroxyapatite collar.

Conclusion: In light of these results, shaft anchorage appears to be better with implants with a hydrosyapatite collar. Confirmation of improvement in clinical outcome and lower rate of aseptic loosening will require longer follow-up.

Purpose: We report a retrospecitve series of 88 benign osteolytic tumours of the knee treated by curettage-filling between 1973 and 2000. The purpose of this analysis was to evaluate the role of curettage-filling in the treatment of this type of tumour.

Material and methods: Mean patient age was 31 years. The sex ratio was 1. Pain was the main sign and 9% of patients had a pathologic fracture. An equivalent number of tumours were found in the lower extremity of the femur and the upper extremity of the tibia. We analysed clinical features, imaging findings, treatments and complications, recurrence, and treatment of recurrence.

Results: Giant-cell tumours predominated (n=63), followed by aneurysmal cysts (n=7) and chondroblastomas (n=6). Tumours were treated by curettage associated with filling (n=83) and osteosynthesis (n=51). There were six cases of mechanical complications, but only two required total knee arthroplasty. No re-operations for arthrolysis were required. The recurrence rate after curettage was 23%; a second curettage-filling was performed after 90% of the recurrences.

Discussion: This study confirms that curettage-filling is the standard surgical treatment for benign osteolytic tumours of the knee, independently of histological type. This simple procedure with a low complication rate enables preservation of the joint in young subjects. We prefer this approach to resection-arthroplasty. We were unable to identify any factor predictive of local recurrence (histologic type of osteolytic tumour). Repeated curettage-filling is an appropriate treatment for recurrence.

Purpose: The purpose of this work was to analyse and compare survival in patients with osteosarcoma (OS) or Ewing sarcoma (EW) of the pelvis as a function of treatment.

Material and methods: This retrospective series included 31 patients with OS (n=15) or EW (n=16) of the pelvis who were given a homogeneous therapeutic sequence associating chemotherapy, surgery and/or radiotherapy. Mean follow-up was 37 months (2–144). Mean age was 20 years for EW and 28 years for OS. Localisations in the pelvis were: zone I (n=12), zone I and II (n=4), zone II (n=1), zone II and III (n=7), zone III (n=1), and zone I, II and III (n=6). All patients were given chemotherapy, 15 underwent surgery, and 16 were given radiotherapy alone. Five patients were given complementary radiotherapy after surgery. Actuarial survival curves were compared with the logrank test. Comparison factors were presence of surgical resection, presence of initial or secondary metastasis, tumour response (radiographic measure), and pathology (good or poor responder) after chemotherapy.

Results: Five-year survival rate for patients with EW was 53%, 31% for OS. There was no significant difference in survival rates between tumour type. The only factor significantly correlated with lower survival rate was presence of initial metastasis.

Discussion and conclusion : The pelvic localisation of osteosarcoma and Ewing sarcoma is a factor of poor prognosis. Unlike data reported in the literature, surgery did not appear to influence outcome, not being found to be a factor of better prognosis. Surgery does however appear to improve short-term survival. In the pelvic localisation, osteosarcoma appears to have a poorer prognosis in terms of survival than Ewing tumour.