Massive posterosuperior cuff tears (mRCT) retracted to the glenoid are surgically challenging and often associated with high retear rates. Primary repair is a less-favourable option and other salvage procedures such as SCR and tendon transfers are used. This study presents clinical and radiological outcomes of muscle advancement technique for repair of mRCT. Sixty-one patients (mean age 57±6, 77% males and 23% females) (66 shoulders) underwent all-arthroscopic rotator cuff repair that included supraspinatus and infraspinatus subperiosteal dissection off scapular bony fossae, lateral advancement of tendon laminae, and tension-free double-layer Lasso Loop repair to footprint. Pre-and post-operative range of motion (ROM), cuff strength, VAS, Constant, ASES, and UCLA scores were assessed. Radiologic assessment included modified Patte and Goutallier classifications. All patients had MRI at 6 months to evaluate healing and integrity of repair was assessed using Sugaya classification with Sugaya 4 and 5 considered retears. Advanced fatty degeneration (Goutallier 3-4) was present in 44% and 20% of supraspinatus and infraspinatus. Tendon retraction was to the level of or medial to glenoid in 22%, and just lateral in 66%. 50.8% mRCT extended to teres minor. Subscapularis was partially torn (Lafosse 1-3) in 46% and completely torn (Lafosse 4-5) in 20%. At mean follow-up (52.4 weeks), a significant increase in ROM, Relative Cuff Strength (from 57% to 90% compared to contralateral side), VAS (from 4 ±2.5 to 1±1.7), Constant (50±17.8 to 74 ±13.0), ASES (52 ±17.5 to 87 ±14.9), and UCLA (16± 4.9 to 30 ±4.9) scores were noted. There were six retears (10%), one failure due to P. acnes infection. 93% returned to pre-injury work and 89% of cases returned to pre-injury sport. Satisfaction rate was 96%. Muscle advancement technique for mRCT is a viable option with low retear rates, restoration of ROM, strength, and excellent functional outcomes.
Complications such as implant loosening, infection, periprosthetic fracture or instability may lead to revision arthroplasty procedures. There is limited literature comparing single-stage and two-stage revision shoulder arthroplasty. This study aims to compare clinical outcomes and cost benefit between single-stage and two-stage revision procedures. Thirty-one revision procedures (mean age 72+/-7, 15 males and 16 females) performed between 2016 and 2021 were included (27 revision RSA, 2 revision TSA, 2 failed ORIFs). Two-stage procedures were carried out 4-6 weeks apart. Single-stage procedures included debridement, implant removal and washout, followed by re-prep, re-drape and reconstruction with new instrumentations. Clinical parameters including length of stay, VAS, patient satisfaction was recorded preoperatively and at mean 12-months follow up. Cost benefit analysis were performed. Seven revisions were two-stage procedures and 24 were single-stage procedures. There were 5 infections in the two-stage group vs 14 in the single-stage group. We noted two cases of unstable RSA and 8 other causes for single-stage revision. Majority of the revisions were complex procedures requiring significant glenoid and/or humeral allografts and tendon transfers to compensate for soft tissue loss. No custom implants were used in our series. Hospital stay was reduced from 41+/-29 days for 2-stage procedures to 16+/-13 days for single-stage (p<0.05). VAS improved from 9+/-1 to 2+/-4 for two-stage procedures and from 5+/-3 to 1+/-2 for single-stages. The average total cost of hospital and patient was reduced by two-thirds. Patient satisfaction in the single-stage group was 43% which was comparable to the two-stage group. All infections were successfully treated with no recurrence of infection in our cohort of 31 patients. There was no instability postoperatively. 3 patients had postoperative neural symptoms which resolved within 6 months. Single-stage procedures for revision shoulder arthroplasty significantly decrease hospital stay, improve patients’ satisfaction, and reduced surgical costs.
Acromioclavicular joint (ACJ) dislocations is a common disorder amongst our population for which numerous techniques have been described. It is thought that by using this novel technique combining a CC and AC repair with a reconstruction will result in high maintenance of anatomical reduction and functional results. 12 consecutive patients ACJ dislocations were included. An open superior clavicular approach is used. Firstly, the CC ligaments are repaired after which a CC reconstruction is performed using a tendon allograft. Secondly, the AC ligaments are repaired using an internal brace construct combined with a tendon allograft reconstruction (Figure 1). The acute:chronic ratio was 6:6. Only IIIB, IV and V AC-joint dislocations were included. The Constant-Murley Score improved from 27.6 (8.0 – 56.5) up to 61.5 (42.0 – 92.0) at 12 months of follow up. Besides one frozen shoulder from which the patient recovered spontaneously no complications were observed with this technique. The CCD was reduced from 18.7 mm (13.0 – 24.0) to 10.0 mm (6.0 – 16.0) and 10.5 mm (8.0 – 14.0) respectively 12 weeks and 12 months postoperatively. There is some evidence, suggesting to address as well as the vertical (coracoclavicular (CC) ligaments) as the horizontal (acromioclavicular (AC) ligaments) direction of instability. This study supports addressing both entities however comparative studies discriminating chronic as acute cases should be conducted to further clarify this ongoing debate on treating ACJ instability. This study describes a novel technique to treat acute and chronic Rockwood stage IIIB – IV ACJ dislocations with promising short-term clinical and radiological results. This suggests that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical as well as horizontal stability in ACJ dislocation is considered key to accomplish optimal long-term results.
Bone fracture toughness is an important parameter in resistance of bone to monotonic and fatigue failure. Earlier studies on bone fracture toughness were focused on either cortical or cancellous bone, separately [1, 2]. Reported fracture toughness values indicated that cortical bone is tougher to break as compared to cancellous bone. In order to understand complete fracture of a whole bone, the interface between cortical and cancellous bone (named as corticellous bone) might play a crucial role and is interesting topic of research. The goal of this study was to identify fracture toughness in terms of J integral and fracture mechanism of the corticellous bone. Corticellous bone samples (single edge notch bend specimen or SENB) were prepared from bovine proximal femur according to ASTM E399-90 standard (Fig.1). For corticellous bone, samples were prepared in such way that approximately half of the sample width consist of cortical bone and another half is cancellous bone. Precaution was taken while giving notch and pre-crack to corticellous bone that pre-crack should not enter from cortical to cancellous portion. All specimens were tested using a universal testing machine (Tinius Olsen, ± 100 N) under displacement rate of 100 µm/min until well beyond yield point. The fracture toughness parameter in terms of critical stress intensity (KIC) was calculated according to ASTM E399-90 as given by,
Where, P = applied load in kN, S = loading span in cm, B = specimen thickness in cm, W = specimen width in cm, a = total crack length, f(a/W) = geometric function. After the fracture test the J integral of each specimen was calculated using following equation. [ASTM E1820].
Where, Jel is J integral of the elastic deformation, Jpl is J integral of the plastic deformation, E′=E for plane stress condition and E′= E/(1−ν2) for plane strain condition (E is elastic modulus; ν is Poisson's ratio), bo = W−ao, height of the un-cracked ligament, and Apl is the area of the plastic deformation part in the load–displacement curve.Introduction
Material and Methods
Glenoid baseplate fixation for reverse shoulder arthroplasty relies on the presence of sufficient bone stock and quality. Glenoid bone may be deficient in cases of primary erosions or due to bone loss in the setting of revision arthroplasty. In such cases, the best available bone for primary baseplate fixation usually lies within the three columns of the scapula. The purpose of this study was to characterise the relationship of the three columns of the scapula independent of glenoid anatomy and to establish the differences between male and female scapular anatomy. Fifty cadaveric scapulae (25 male, 25 female) were analysed using CT-based imaging software. The surface geometries of the coracoid, scapular spine and inferior scapular column were delineated in the sagittal plane. A linear best-fit line was drawn to establish the long axis of each column independent of the glenoid. The width of the glenoid was measured and points marked at the midpoint of each measurement. A best-fit line starting at the supra glenoid tubercle passing through the midpoints was chosen as the superior inferior (SI) axis of the glenoid. An orthogonal plane to the scapular plane was developed parallel to the glenoid face. The axis representing each of the three columns of the scapula and the SI axis of the glenoid, were projected onto this plane. The relationship between each column was analysed with respect to each other and with respect to the SI glenoid axis. Thus, measurements obtained gave the relationships of the three columns of the scapula (independent of the glenoid) and their relationships to the long axis of the glenoid (dependant on the glenoid). Comparisons were made between males and females using the independent t-tests.Background
Methods
We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells. We seeded mouse skeletal muscle cells C2C12 on the hydroxyapatite/calcium sulphate biomaterial and the phenotype of the cells was analysed. To mimic surgical conditions with leakage of extra cellular matrix (ECM) proteins and growth factors, we cultured rat bone cells ROS 17/2.8 in a bioreactor and harvested the secreted proteins. The secretome was added to rat muscle cells L6. The phenotype of the muscle cells after treatment with the media was assessed using immunostaining and light microscopy.Objectives
Materials and Methods
Component positioning in total hip arthroplasty (THA) is critical to achieve optimal patient outcomes. Recent literature has shown acetabular component positioning may be inaccurate using traditional techniques. Robotic-assisted THA is a recent platform introduced to decrease the risk of malpositioned components. However, to date, a paucity of data is available comparing the intra-operative component position generated by the navigation system to post-operative radiographs. The purpose of this study was to compare the component position measurements of a navigation system, used during robotic-assisted THA, to component position measurements obtained on post-operative radiographs.Background
Purpose
Pre-operative and postoperative analgesia in total hip arthroplasty (THA) involves multimodal analgesia using differing classes of drugs and varying introductions of these agents. Postoperative opioid-related events can slow recovery and increase patients' length of stay. Long-acting local anesthetics can reduce early postoperative pain at the surgical site, potentiating a decrease of opioid intervention needed postoperatively. Decreasing opioid use while maintaining adequate pain control could reduce opioid-related events, increase patient time to first ambulation and decrease length of stay. The purpose of this study was to compare liposomal bupivacaine to bupivacaine for postoperative analgesia. Between November 2012 and February 2013, 57 consecutive patients that underwent THA and hip resurfacing received either an intraoperative injection of liposomal bupivacaine or bupivacaine alone. All patients received a combination of medications prior to the procedure including celecoxib 400 mg by mouth, pregabalin 75 mg by mouth and 1gm of intravenous acetaminophen. The study group received 20 cc of liposomal bupivacaine, combined with 40 cc 0.25% bupivacaine with epinephrine and 20 cc of normal saline. The control group received 60 ml of 0.25% bupivacaine with epinephrine. Data was prospectively collected including average visual analog pain scale (VAS), opioid consumption, time to first ambulation, hospital length of stay measured by days, and post-operative opioid-related adverse drug events.Background
Methods
Several recent reports have documented high frequency of malpositioned acetabular components, even amongst high volume arthroplasty surgeons. Robotic assisted total hip arthroplasty (THA) has the potential to improve component positioning; however, to our knowledge there are no reports examining the learning curve during the adoption of robotic assisted THA. The purpose of this study was to examine the learning curve of robotic assisted THA as measured by component position, operative time, intra-operative technical problems, and complications.Background
Purpose
To demonstrate the role of an antibiotic containing bone substitute, native bone active proteins and muscle transforming into bone.
Recurrent osteomyelitis was eradicated and filled with a gentamycin eluting bone substitute (Cerament™l G) consisting of sulphate and apatite phases and covered by a muscle flap. C2C12 muscle cells were seeded on the bone substitute in-vitro and their phenotype was studied. Another muscle cell line L6 was seeded with osteoblast conditioned medium containing bone active proteins and specific markers were studied for bone differentiation.
A chronic, longstanding, fistulating osteomyelitis was operated with radical eradication and filling of the cavity with gentamycin eluting bone substitute. At one year, the patient had no leg pain and a healed wound. Significant bone was also seen in the overlaying muscle, at one month post-op disappearing after 6-months. Local delivery of gentamycin had a protective effect on bone formation. C2C12 cells seeded on the gentamycin eluting bone substitute depicted no difference in proliferation when compared to plain bone substitute and expressed 4 folds higher Alkaline phosphatase (ALP) compared to controls. C2C12 cells expressed proteins and genes coding for collagen type 1 (Col 1), osteocalcin (OCN), osteopontin (OPN) and bonesialoprotein (BSP). L6 cells cultured with osteoblast conditioned medium remained uninucleated and expressed osteoblastic proteins like Col 1, OCN, OPN and BSP.
Bone substitute with gentamycin leads to differentiation of mesenchymal cells into bone in-vitro. Native bone active proteins from an osteoblast culture can induce differentiation of muscle cells in-vitro. Clinical observations with rapid bone formed in the bone substitute and in some cases in the muscle are a consequence of both leakage of bone active proteins and also from osteoprogenitor cells coming from the overlaying muscle interacting with the osteoinductive bone substitute.
The purpose of this study was to evaluate A total of 60 Sprague-Dawley rats (125 g to 149 g) were implanted
subcutaneously with SWCNT/PLAGA composites (10 mg SWCNT and 1gm
PLAGA 12 mm diameter two-dimensional disks), and at two, four, eight
and 12 weeks post-implantation were compared with control (Sham)
and PLAGA (five rats per group/point in time). Rats were observed
for signs of morbidity, overt toxicity, weight gain and food consumption,
while haematology, urinalysis and histopathology were completed
when the animals were killed.Objectives
Methods
Patella resurfacing is becoming more routine in total knee replacements with recent reports indicating improved long term outcomes. Despite this, patella osteotomy relies heavily on how the cutting jig is applied rather than on fixed anatomical landmarks. Recognised complications of asymmetric patella resection are patella fractures, patella maltracking, bony impingement and pain. Accurate instruments have been developed for other aspects of total knee replacements. However cutting guides for the patella tend to be cumbersome with poor reproducibility. Patella tilt is defined as the angle subtended by a line joining the medial and lateral edges of the patella and the horizontal. Keeping this angle to a minimum results in congruent alignment of the patella button within the trochlear groove. Current patella cutting jigs do not take this angle into consideration as they require full eversion of the patella laterally, not only making accurate placement of the jig difficult but also putting excessive strain on the surrounding soft tissue. This study describes a new cutting technique for the patella osteotomy which is referenced off the distal femoral condyles ensuring a more accurate and reproducible cut without having to evert the patella. With the femoral component trial in situ and the patella in its normal anatomical lie, the knee is flexed to 30°. The patella cutting jig is then applied in the usual manner making sure that adequate thickness of patella remains but it is placed parallel to a line joining the two condyles of the femoral component. By cutting the patella in this position parallel to the distal femoral condyles, patella tilt is minimised and the patella button will be aligned evenly within the trochlear groove. Currently all patients requiring patella resurfacing at our institution are undergoing this technique and the short term results have been very promising. This study presents a novel patella cutting technique that utilises a fixed landmark to ensure a more accurate and reproducible osteotomy. We are planning a large scale trial comparing pre- and post-operative knee scores and radiological assessment of patients having this new technique compared to standard cutting techniques. This will allow us to report on the longer term effects and pave the way for better patella resurfacing instrumentation.
Prospective Randomised Control trial of 300 patients over a period of 3 years, 1 year post op follow up. Local ethic approval was attained for the study. Inclusion criteria: Age > 60, Consented to Participate in the study, Unstable Inter trochanteric fracture a) Sub trochanteric b) Medial Comminution c) Reverse Obliquity D)Severe Osteoporosis. Patients selected were randomized to Intra medullary Nail vs Hips screw. Variety of markers have been assessed: Pre OP: - Mechanism of injury, Mobility status, Pre OP ASA, Pre Op haemoglobin, living Conditions. Intra OP:- I.I Time, Time taken, Surgeon experience, Intra OP complications. Post OP:- Haemoglobin, mobility, radiographic analysis-Fracture stability and Tip Apex Distance, Thrombo embolic Complications. Follow up: - 6 weeks, 3,6,12 month follow up. There is considerable debate in literature regarding superiority of Compression Hip screw over Intra medullary nail for fixation of stable per trochanteric fractures of the femur. Biomechanical studies have shown superiority of Intra medullary device over a Compression Hip screw. Tenser et all showed an advantage over combined bending and compression failure. Mohammad et al found unstable subtrochanteric fractures with a gamma nail were stiffer. Kerush-Brinker showed that gamma nail had significantly greater fatigue strength and fatigue life. In unstable fractures Baumgartner et al found less intra op complications and less fluoroscopic time for a compression hip screw compared to a short intra medullary nail. There have been significant reports of fracture at the Tip of a short intra medullary nail. We think this complication can be avoided by using a long intra medullary device. Both in Australia and abroad the choice of which device to use depends largely on the preference of the surgeon.
We propose a model of care where by Regular scheduled outreach visits by a Single team provides more dependability of care and understanding of the local needs and cultural practises. Thereby titrating the care to meet local needs rather than enforcing the Western model of care to a very different cultural background. I have been fortunate as a SET 4 Registrar to be involved with an Outreach team to Latouka Hospital. Spear headed by Dr M McAuliffe over the last 3 years the annual visit has taken shape as a dependable way of providing care to the community of Latouka. The team has evolved over the years to involve Dr Brazel, Dr Tetsworth, Dr Bansi, and our scrub staff. The team consists of 2 teams which visit Latouka every 6 months and help institute a multimodal care plan. 1) Regularity of visits helps build confidence locally and engraves the foundations of dependability of care. 2) Difficult and complex cases are discussed in specially earmarked clinics held every 6 months providing a brain storming sessions to the local clinicians and helping them achieve the best care for the patients under the restrictions of the local infrastructure. 3) Regular teaching sessions / practical workshops are held for the registrars and junior doctors empowering them to carry the baton once the visiting team leaves. 4) Regular follow up of the patients operated upon is attained to titrate care to the locals based upon the local needs and cultural practises. 5) Helping the surgical teams, nurses, radiographers, physiotherapists formulate protocols of care and comparing them to the protocols used in Australia/NZ. 6) Creating an educational fund for the local registrars enabling them to attend observer ships and courses in Australia/New Zealand. We think that this model of care provides a much more organised and long term benefit to the local community compared to erratic visits by volunteer teams. A similar model of care, if instituted over many divisional hospitals of the South Pacific, will be vital in improving the health care needs of the locals and provide the local staff with the much needed support they deserve.
Many patients who had previous proximal femoral osteotomies develop deformities that may not be amenable to total hip replacement (THR) with standard off-the-shelf femoral stems. Previous studies have shown high revision rates (18% at 5–10 years follow-up). Computer-assisted-design computer-assisted-manufacture (CAD-CAM) femoral stems are indicated but the results are not known. We assessed the clinical results of THR using CAD-CAM femoral stems specifically for this group of patients. We included patients with previous proximal femoral osteotomy and significant deformity who underwent THR with CAD-CAM femoral stem operated by the senior author (AHN) from 1997 with a minimum of 5 years follow-up. We noted revision rates, associated complications and functional outcome. Radiological outcomes include assessment for loosening defined as development of progressive radiolucent lines around implant or implant migration.Introduction
Methods
Revision total hip arthroplasty is a common operation. The MP Link (Waldemar Link, Hamburg, Germany) system is a distally loading, modular, tapered femoral stem component for revision hip surgery. MP Link in revision total hip arthoplasty was investigated clinically, radiologically and with Oxford hip scores. A prospective study was conducted of 43 patients undergoing revision total hip arthroplasty with MP Link prostheses between 2004 and 2010. The patients were operated upon by one of the senior authors (JM, JS, RC). Outcome data was collected in clinic and via patient questionnaires.Aims
Methods
To study the surgical outcome of multi-fragmentary, un-reconstructable radial head fractures managed acutely by a radial head prosthetic replacement, we retrospectively reviewed nineteen radial head fractures that were treated acutely with a radial head replacement, over a four-year period in three district general hospitals. Nineteen patients were clinically and radiologically assessed for this study. Functional assessment was performed with the Mayo elbow performance score (MEPS). No patient achieved full functional range of motion. The average range of flexion was 110° (range 80° to 120°), average extension deficit of 35° (range 30° to 45°), average pronation was 35° (range 0° to 65°), and average supination was 50° (range 30° to 85°). Complications included implant removal due to loosening (n=1), elbow stiffness (n=2), and instability (n=1), the latter case requiring a revision of the radial head prosthesis. Some degree of persistent discomfort was noticed in all cases. Five patients were tolerant of the final functional outcome. The average Mayo elbow score was 68/100 (range 55 to 80). One patient had an intra-operative fracture of the radial metaphysis during insertion of the implant. Radial head replacement in general orthopaedic, low volume practice failed to achieve satisfactory results. Contrary to popular belief, it is a technically demanding operation, for which surveillance should be continued for a minimum of one year. Strict indications for prosthetic replacement should be followed and implant selection has yet to be proven to make a significant positive contribution. Our review highlights the need for a stricter adherence to indications; surgery should not be under-estimated and devolved to trainees, and our understanding of the radial axis of the elbow and forearm remains relatively rudimentaryConclusions
A new surgical hybrid technique involving the combination of autologous bone plug(s) and autologous chondrocyte implantation (AOsP-ACI) was used and evaluated as a treatment option in 15 patients for repair of large osteochondral defects in knee (N=12) and hip joints (N=3). Autologous Osplugs were used to contour the articular surface and the autologous chondrocytes were injected underneath a biological membrane covering the plug. The average size of the osteochondral defects treated was 4.5cm2. The average depth of the bone defect was 26mm. The patients had a significant improvement in their clinical symptoms at 12 months with significant increase in the Lysholm Score and Harris Hip Score (p = 0.031). The repaired tissue was evaluated using Magnetic Resonance Imaging, Computerised Tomography, arthroscopy, histology and immunohistochemistry (for expression of type I and II collagen). Magnetic Resonance Imaging, Computerised Tomography and histology at 12 months revealed that the bone plug became well integrated with the host bone and repair cartilage. Arthroscopic examination at 12 months revealed good lateral integration of the AOsP-ACI with the surrounding cartilage. Immunohistochemistry revealed mixed fibro-hyaline cartilage. We conclude that the hybrid AOsP-ACI technique provides a promising surgical approach for the treatment of patients with large osteochondral defects. This study highlights the use of this procedure in two different weightbearing joints and demonstrates good early results which are encouraging. The long term results need to be evaluated.
Chondrosarcoma is a malignant tumour and accounts for approximately 20% of bone sarcomas. The pelvis is one of the commonest sites. Chondrosarcoma of the pelvis lends itself to surgical excision and is relatively resistant to irradiation and chemotherapy. A long term survival analysis of this challenging condition is rarely reported in literature. We review and evaluate the oncological and functional results of all the patients operated at our centre and we analyse the survival analysis of these patients with special focus on the prognostic factors. Fifty-four consecutive patients with chondrosarcoma of the pelvis who were treated at the Royal National Orthopaedic Hospital, Stanmore, UK between 1987 and 2001 were included in the study. Demographic data, case notes, histopathological results and follow-up data were obtained and statistically analysed. There were 38 males and 16 females with a mean age of 48.4 years [18-77]. The chondrosarcomas were primary [n=38], secondary [n-7] or recurrences [n=9]. The anatomical sites in the pelvis were in the epicentre I [n=24], II [n=20] and III [n=10]. The surgical procedures performed were local resection [n=28], local resection and hip arthroplasty [n=6], hemipelvectomy (+endoprothesis) [n=16], hemipelvectomy [+fibular strut graf] [n=2] and hinquarter amputation [n=2]. The histological grade was Gr [n=27], Gr 2[n=20] and Gr 3 [n=7]. The complication rate was 24%:wound revision [9%], dislocation [8%] and infection [7%]. There was a 5, 10 and 15 year cumulative survival rate of 74%, 65% and 40%. The overall recurrence rate was 24%. The factors associated with a worse prognosis were high histologic tumour grade, increasing patient age, anatomical location in site I and III, primary surgery outside of tumour centre, inadequate surgical margins, and those treated by local extension. Aggressive surgical approach significantly improves the prognosis of the patients with chondrosarcoma of the pelvis.
When performing limb salvage operations for malignant bone tumours in skeletally immature patients, it is desirable to reconstruct the limb with a prosthesis that can be lengthened without surgery at appropriate intervals to keep pace with growth of the contra-lateral side. We have developed a prosthesis that can be lengthened non-invasively. The lengthening is achieved on the principle of electromagnetic induction. The purpose of this study was to look at our early experience with the use of the Non Invasive Distal Femoral Expandable Endoprosthesis. A prospective study of 17 skeletally immature patients with osteosarcoma of the distal femur, implanted with the prosthesis, was performed at the Royal National Orthopaedic Hospital, Stanmore. The patients were aged between 9 and 15 years (mean 12.1 years) at the time of surgery. Patients were lengthened at appropriate intervals in outpatient clinics. Patients were functionally evaluated using the Musculoskeletal Tumour Society (MSTS) Scoring System and the Toronto Extremity Severity Score (TESS). Average time from the implantation to the last follow-up was 18.2 months (range 14-30 months). The patients have been lengthened by an average of 25mm (4.25-55mm). The mean amount of knee flexion is 125 degrees. The mean MSTS score is 77% (23/30; range 11-29) and the mean TESS score is 72%. There have been two complications: one patient developed a flexion deformity of 25 degrees at the knee joint and one patient died of disseminated metastatic malignancy. The early results from patients treated using this device have been encouraging. Using this implant avoids multiple surgical procedures and general anaesthesia. This results in low morbidity, cost savings and reduced psychological trauma. We do need additional data regarding the long-term structural integrity of the prosthesis.
