The functional outcome and risk of recurrence following arthroscopic stabilisation for recurrent anterior shoulder instability is poorly defined in large prospective outcome studies. This is the first study to prospectively evaluate these outcomes in patients who have been treated using this technique. We performed a prospective study of a consecutive series of 302 patients (265 men and 37 women, mean age 26.4 years) who underwent 311 (9 bilateral) arthroscopic Bankart repairs for recurrent anterior instability. Patients were evaluated preoperatively and postoperatively at 6 months, and annually thereafter. The chief outcome measures were risk of recurrence and the two-year functional outcomes (assessed using the WOSI and DASH scores).Background
Methods
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.
