1. Chondrosarcoma is a malignant tumour of bone with clinical and morphological features which distinguish it from osteosarcoma. 2. Cartilage tumours present an unbroken spectrum in their clinical behaviour and histological appearances from the entirely benign to the frankly malignant. 3. A few chondrosarcomata, particularly those in children and young adults, run a rapidly fatal course but in general they metastasise late and some kill by local extension of the tumour. 4. "Secondary" chondrosarcomata arising from a pre-existing osteocartilaginous exostosis or enchondroma are mostly low grade tumours. 5. The first appearance of an osteocartilaginous exostosis after skeletal maturity, renewed growth, or pain unassociated with a fracture, should arouse suspicion of malignancy in any cartilage tumour. 6. Cartilage tumours of the trunk and upper end of femur and humerus are especially liable to sarcomatous change. 7. Although most benign cartilage tumours occur in the hand and foot they rarely become malignant with the exception of those in the calcaneus. 8. If biopsy is necessary it should be of the incisional type, a generous amount of material being removed from the edge of the tumour. Calcified, degenerate areas must be avoided. 9. In low grade tumours microscopic fields judged to be malignant by Lichtenstein and Jaffe's well established criteria may be scanty and many paraffin sections should be examined. Absence of mitotic figures, heavy calcification and poor vascularity are no guarantee of benignity. 10. Information as to the site of the tumour and age of the patient must be available to the pathologist if a useful report is to be given. 11 . In "borderline" tumours or where any difficulty in diagnosis arises the clinical, radiographic and histological features must all be taken into account and treatment based on the most unfavourable features. 12. Chondrosarcoma is a radio-resistant tumour and treatment is by radical excision or amputation. 13. Malignant cartilage cells implanted in the tissues at operation will often continue to grow and in all instances the biopsy wound and surrounding tissues must be removed en bloc with the tumour. 14. Small, low grade, readily accessible, peripheral tumours may be successfully treated by excision with a wide margin of healthy tissue. 15. In the limbs or
Vitamin E-diffused, highly crosslinked polyethylene (VEPE) and porous titanium-coated (PTC) shells were introduced in total hip arthroplasty (THA) to reduce the risk of aseptic loosening. The purpose of this study was: 1) to compare the wear properties of VEPE to moderately crosslinked polyethylene; 2) to assess the stability of PTC shells; and 3) to report their clinical outcomes at seven years. A total of 89 patients were enrolled into a prospective study. All patients received a PTC shell and were randomized to receive a VEPE liner (n = 44) or a moderately crosslinked polyethylene (ModXLPE) liner (n = 45). Radiostereometric analysis (RSA) was used to measure polyethylene wear and component migration. Differences in wear were assessed while adjusting for body mass index, activity level, acetabular inclination, anteversion, and head size. Plain radiographs were assessed for radiolucency and patient-reported outcome measures (PROMs) were administered at each follow-up.Aims
Patients and Methods
The aims of this study were to evaluate the abductor function in moderate and severe slipped capital femoral epiphysis (SCFE), comparing the results of a corrective osteotomy at the base of the femoral neck and osteoplasty with 1) A total of 24 patients (mean age 14.9 years (Aims
Patients and Methods
Accurate placement of the acetabular component is essential in
total hip arthroplasty (THA). The purpose of this study was to determine
if the ability to achieve inclination of the acetabular component
within the ‘safe-zone’ of 30° to 50° could be improved with the
use of an inclinometer. We reviewed 167 primary THAs performed by a single surgeon over
a period of 14 months. Procedures were performed at two institutions:
an inpatient hospital, where an inclinometer was used (inclinometer
group); and an ambulatory centre, where an inclinometer was not
used as it could not be adequately sterilized (control group). We excluded
47 patients with a body mass index (BMI) of > 40 kg/m2,
age of > 68 years, or a surgical indication other than osteoarthritis
whose treatment could not be undertaken in the ambulatory centre.
There were thus 120 patients in the study, 68 in the inclinometer
group and 52 in the control group. The inclination angles of the acetabular
component were measured from de-identified plain radiographs by
two blinded investigators who were not involved in the surgery.
The effect of the use of the inclinometer on the inclination angle
was determined using multivariate regression analysis.Aims
Patients and Methods
Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men; their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (Aims
Patients and Methods
Aims
Patients and Methods
The aim of this study was to examine the results of the acetabular
distraction technique in achieving implantation of a stable construct,
obtaining biological fixation, and producing healing of chronic
pelvic discontinuity at revision total hip arthroplasty. We identified 32 patients treated between 2006 and 2013 who underwent
acetabular revision for a chronic pelvic discontinuity using acetabular
distraction, and who were radiographically evaluated at a mean of
62 months (25 to 160). Of these patients, 28 (87.5%) were female.
The mean age at the time of revision was 67 years (44 to 86). The patients
represented a continuous series drawn from two institutions that
adhered to an identical operative technique.Aims
Patients and Methods
It is important to consider sagittal pelvic rotation when introducing
the acetabular component at total hip arthroplasty (THA). The purpose
of this study was to identify patients who are at risk of unfavourable
pelvic mobility, which could result in poor outcomes after THA. A consecutive series of 4042 patients undergoing THA had lateral
functional radiographs and a low-dose CT scan to measure supine
pelvic tilt, pelvic incidence, standing pelvic tilt, flexed-seated
pelvic tilt, standing lumbar lordotic angle, flexed-seated lumbar
lordotic angle, and lumbar flexion. Changes in pelvic tilt from
supine-to-standing positions and supine-to-flexed-seated positions
were determined. A change in pelvic tilt of 13° between positions was
deemed unfavourable as it alters functional anteversion by 10° and
effectively places the acetabular component outside the safe zone
of orientation.Aims
Patients and Methods
The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities. Between 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.Aims
Patients and Methods
A high rate of suicide has been reported in patients who sustain
fractures, but the association remains uncertain in the context
of other factors. The aim of this study was to examine the association
between fractures and the risk of suicide in this contextual setting. We performed a case-control study of patients aged 40 years or
older who died by suicide between 2000 and 2011. We included patients’
demographics, physical and mental health problems, and socioeconomic
factors. We performed conditional logistic regression to evaluate
the associations between fractures and the risk of suicide.Aims
Patients and Methods
We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips).Aims
Patients and Methods
Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age. A prospective cohort study was conducted. Patients were recruited into three age groups: less than 65 years (n = 65), 65 to 74 years (n = 68), and 75 years and older (n = 67). There were 200 patients enrolled in the study, of whom 115 were female and 85 were male, with a mean age of 69.9 years (sd 9.5, 42 to 92). They were assessed preoperatively, and at three, 12 and, 24 months postoperatively. Stem migration was assessed using Einzel-Bild-Röntgen-Analyse (EBRA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), EuroQol-5 domains questionnaire (EQ-5D), short form-36 questionnaire (SF-36,) and patient satisfaction were used to assess outcome. The Lower Extremity Activity Scale (LEAS), Timed Up and Go (TUG) test, and activPAL monitor (energy expelled, time lying/standing/walking and step count) were used to assess activity. The BMD was assessed in Gruen and Charnley zones.Objectives
Patients and Methods
The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study.Aims
Patients and Methods
Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems. We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).Aims
Patients and Methods
The aim of this study was to establish the incidence of developmental dysplasia of the hip (DDH) diagnosed after one-year of age in England, stratified by age, gender, year, and region of diagnosis. A descriptive observational study was performed by linking primary and secondary care information from two independent national databases of routinely collected data: the United Kingdom Clinical Practice Research Datalink and Hospital Episode Statistics. The study examined all children from 1 January 1990 to 1 January 2016 who had a new first diagnostic code for DDH aged between one and eight years old.Aims
Patients and Methods
The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We hypothesize that FAI patients will experience less flexion at the lumbar spine and more flexion at the hip whilst changing from standing to sitting positions than subjects without FAI. This increase in hip flexion may contribute to symptomatology in FAI. Male subjects were prospectively enrolled to the study (n = 20). Mean age was 31 years old (22 to 41). All underwent clinical examination, plain radiographs, and dynamic imaging using EOS. Subjects were categorized into three groups: non-FAI (no radiographic or clinical FAI or pain), asymptomatic FAI (radiographic and clinical FAI but no pain), and symptomatic FAI (patients with both pain and radiographic FAI). FAI was defined as internal rotation less than 15° and alpha angle greater than 60°. Subjects underwent standing and sitting radiographs in order to measure spine and femoroacetabular flexion.Aims
Patients and Methods
