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  • Online-Ressource  (8)
  • British Editorial Society of Bone & Joint Surgery  (8)
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  • British Editorial Society of Bone & Joint Surgery  (8)
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  • 1
    Online-Ressource
    Online-Ressource
    Osteosarcoma of the pelvis
    British Editorial Society of Bone & Joint Surgery ; 2016
    In:  The Bone & Joint Journal Vol. 98-B, No. 4 ( 2016-04), p. 555-563
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 98-B, No. 4 ( 2016-04), p. 555-563
    Kurzfassung: Osteosarcoma of the pelvis is a particularly difficult tumour to treat as it often presents late, may be of considerable size and/or associated with metastases when it presents, and is frequently chondroid in origin and resistant to chemotherapy. The aim of this study was to review our experience of managing this group of patients and to identify features predictive of a poor outcome. Patients and Methods Between 1983 and 2014, 121 patients, (74 females and 47 males) were treated at a single hospital: 74 (61.2%) patients had a primary osteosarcoma and 47 (38.8%) had an osteosarcoma which was secondary either to Paget’s disease (22; 18.2%) or to previous pelvic irradiation (25; 20.7%). The mean age of those with a primary osteosarcoma was 29.3 years (nine to 76) and their mean follow-up 2.9 years (0 to 29). The mean age of those with a secondary sarcoma was 61.9 years (15 to 85) and their mean follow-up was one year (0 to 14). A total of 22 patients with a primary sarcoma (52.4%) and 20 of those with a secondary sarcoma (47.6%) had metastases at the time of presentation. Results The disease-specific survival at five years for all patients was 27.2%. For those without metastases at the time of diagnosis, the five-year survival was 32.7%. Factors associated with a poor outcome were metastases at diagnosis and secondary tumours. In primary osteosarcoma, sacral location, surgical margin and a diameter 〉 10 cm were associated with a poor outcome. Conclusion In this, the largest single series of patients with an osteosarcoma of the pelvis treated in a single hospital, those with secondary tumours and those with metastases at presentation had a particularly poor outcome. For those with a primary sarcoma, sacral location, an intralesional margin and a diameter of 〉 10 cm were poor prognostic indicators. Cite this article: Bone Joint J 2016;98-B:555–63.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.98B4.36583
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2016
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels
    British Editorial Society of Bone & Joint Surgery ; 2019
    In:  The Bone & Joint Journal Vol. 101-B, No. 8 ( 2019-08), p. 1024-1031
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 101-B, No. 8 ( 2019-08), p. 1024-1031
    Kurzfassung: The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 〉 5 mm; type 2 ≤ 5 mm, 〉 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p 〈 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.101B8.BJJ-2018-0963.R1
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2019
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    The role of grade in local recurrence and the disease-specific survival in chondrosarcomas
    British Editorial Society of Bone & Joint Surgery ; 2018
    In:  The Bone & Joint Journal Vol. 100-B, No. 5 ( 2018-05), p. 662-666
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 100-B, No. 5 ( 2018-05), p. 662-666
    Kurzfassung: The purpose of this study was to describe the effect of histological grade on disease-specific survival in patients with chondrosarcoma. Patients and Methods A total of 343 patients with a chondrosarcoma were included. The histological grade was assessed on the initial biopsy and on the resection specimen. Where the histology showed a mixed grade, the highest grade was taken as the definitive grade. When only small focal areas showed higher grade, the final grade was considered as both. Results The concordance between the highest preoperative biopsy grading and the highest final grading of the resection specimen in total was only 43% (146/343). In 102 specimens (30%), a small number of cells or focal areas of higher grade were observed in contrast to the main histology. The disease-specific survival, stratified according to the predominant histological grade, showed greater variation than when stratified according to the highest grade seen in the resection specimen. Conclusion The diagnostic biopsy in chondrosarcoma is unreliable in assessing the definitive grade and the malignant potential of the tumour. When categorizing the grade of the resection specimen, the prognosis for local recurrence and disease-specific survival should be based on the highest grade seen, even when seen in only a few cells. Cite this article: Bone Joint J 2018;100-B:662–6.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.100B5.BJJ-2017-1243.R1
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2018
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Ewing’s sarcoma : only patients with 100% of necrosis after chemotherapy should be classified as having a good response
    British Editorial Society of Bone & Joint Surgery ; 2016
    In:  The Bone & Joint Journal Vol. 98-B, No. 8 ( 2016-08), p. 1138-1144
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 98-B, No. 8 ( 2016-08), p. 1138-1144
    Kurzfassung: The purpose of this study was to review a large cohort of patients and further assess the correlation between the histological response to chemotherapy in patients with Ewing’s sarcoma with the overall (OS) and event-free survival (EFS). Patients and Methods All patients treated for Ewing’s sarcoma between 1980 and 2012 were reviewed. Of these, 293 patients without metastases at the time of diagnosis and treated with chemotherapy and surgery were included. Patients were grouped according to the percentage of necrosis after chemotherapy: Group I: 0% to 50%, Group II: 51% to 99% and Group III: 100%. Results The mean age at diagnosis was 16 years (1 to 62) and the mean follow-up was 9.1 years (six months to 32.6 years). The OS and EFS for the series were 75% and 65% at five years. There were significant differences in survival between the groups of necrosis: 0% to 50% (OS: 49% and EFS: 45% at five years, respectively) compared with 51% to 99% (OS: 72% and EFS: 59% at five years, respectively) and 100% (OS: 94% and EFS: 81% at five years, respectively) (p  〈  0.001). There were no significant differences in survival between patients treated between 1980 and 1989 compared with those treated between 1990 and 1999, and those treated between 2000 and 2012 (p = 0.55). Conclusion Only patients with 100% necrosis after chemotherapy should be classified as having a good response to chemotherapy because they have significantly better rates of survival compared with those with any viable tumour in the surgical specimen. Cite this article: Bone Joint J 2016;98-B:1138–44.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.98B8.37346
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2016
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Predictors of time to revision and clinical outcomes following revision of metal-on-metal hip replacements for adverse reaction to metal debris
    British Editorial Society of Bone & Joint Surgery ; 2014
    In:  The Bone & Joint Journal Vol. 96-B, No. 12 ( 2014-12), p. 1600-1609
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 96-B, No. 12 ( 2014-12), p. 1600-1609
    Kurzfassung: We undertook a retrospective cohort study to determine clinical outcomes following the revision of metal-on-metal (MoM) hip replacements for adverse reaction to metal debris (ARMD), and to identify predictors of time to revision and outcomes following revision. Between 1998 and 2012 a total of 64 MoM hips (mean age at revision of 57.8 years; 46 (72%) female; 46 (72%) hip resurfacings and 18 (28%) total hip replacements) were revised for ARMD at one specialist centre. At a mean follow-up of 4.5 years (1.0 to 14.6) from revision for ARMD there were 13 hips (20.3%) with post-operative complications and eight (12.5%) requiring re-revision. The Kaplan–Meier five-year survival rate for ARMD revision was 87.9% (95% confidence interval 78.9 to 98.0; 19 hips at risk). Excluding re-revisions, the median absolute Oxford hip score (OHS) following ARMD revision using the percentage method (0% best outcome and 100% worst outcome) was 18.8% (interquartile range (IQR) 7.8% to 48.3%), which is equivalent to 39/48 (IQR 24.8/48 to 44.3/48) when using the modified OHS. Histopathological response did not affect time to revision for ARMD (p = 0.334) or the subsequent risk of re-revision (p = 0.879). Similarly, the presence or absence of a contralateral MoM hip bearing did not affect time to revision for ARMD (p = 0.066) or the subsequent risk of re-revision (p = 0.178). Patients revised to MoM bearings had higher rates of re-revision (five of 16 MoM hips re-revised; p = 0.046), but those not requiring re-revision had good functional results (median absolute OHS 14.6% or 41.0/48). Short-term morbidity following revision for ARMD was comparable with previous reports. Caution should be exercised when choosing bearing surfaces for ARMD revisions. Cite this article: Bone Joint J 2014;96-B:1600–9.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.96B12.33473
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2014
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    The prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma
    British Editorial Society of Bone & Joint Surgery ; 2015
    In:  The Bone & Joint Journal Vol. 97-B, No. 12 ( 2015-12), p. 1698-1703
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 97-B, No. 12 ( 2015-12), p. 1698-1703
    Kurzfassung: The aim of this study was to evaluate the prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma. A total of 80 patients with a primary parosteal osteosarcoma were included in this retrospective study. There were 51 females and 29 males with a mean age of 29.9 years (11 to 78). The mean follow-up was 11.2 years (1 to 40). Overall survival was 91.8% at five years and 87.8% at ten years. Local recurrence occurred in 14 (17.5%) patients and was associated with intralesional surgery and a large volume of tumour. On histological examination, 80% of the local recurrences were dedifferentiated high-grade tumours. A total of 12 (14.8%) patients developed pulmonary metastases, of whom half had either a dedifferentiated tumour or a local recurrence. Female gender and young age were good prognostic factors. Local recurrence was a poor prognostic factor for survival. Medullary involvement or the use of chemotherapy had no impact on survival. The main goal in treating a parosteal osteosarcoma must be to achieve a wide surgical margin, as inadequate margins are associated with local recurrence. Local recurrence has a significant negative effect on survival, as 80% of the local recurrences are high-grade dedifferentiated tumours, and half of these patients develop metastases. The role of chemotherapy in the treatment of parosteal osteosarcoma is not as obvious as it is in the treatment of conventional osteosarcoma. The mainstay of treatment is wide local excision. Cite this article: Bone Joint J 2015;97-B:1698–1703.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.97B12.35749
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2015
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 7
    Online-Ressource
    Online-Ressource
    Bone sarcomas arising in patients with neurofibromatosis type 1
    British Editorial Society of Bone & Joint Surgery ; 2009
    In:  The Journal of Bone and Joint Surgery. British volume Vol. 91-B, No. 9 ( 2009-09), p. 1223-1226
    Details
    In: The Journal of Bone and Joint Surgery. British volume, British Editorial Society of Bone & Joint Surgery, Vol. 91-B, No. 9 ( 2009-09), p. 1223-1226
    Kurzfassung: We identified eight patients of 2900 with a primary malignant bone tumour who had coexisting neurofibromatosis type 1. This was a much higher incidence than would be expected by chance. The patients had a mean age of 22.4 years (9 to 54): five were male. Two patients subsequently developed a second bone sarcoma, one of which was radiation induced. Four of the primary tumours were osteosarcomas, four were spindle-cell sarcomas and one a Ewing’s sarcoma. All the patients were treated with chemotherapy and surgery: six of the eight appear to be cured. This study suggests a possible relationship between neurofibromatosis type 1 and the development of a bone sarcoma, the increased risk being estimated at eight times that of the normal population. We recommend that further research into this possible link should be considered.
    Materialart: Online-Ressource
    ISSN: 0301-620X , 2044-5377
    URL: Article
    DOI: 10.1302/0301-620X.91B9.22299
    RVK:
    XA 52200.B
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2009
    ZDB Id: 2697480-0
    ZDB Id: 2039886-4
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 8
    Online-Ressource
    Online-Ressource
    Does osteofibrous dysplasia progress to adamantinoma and how should they be treated?
    British Editorial Society of Bone & Joint Surgery ; 2017
    In:  The Bone & Joint Journal Vol. 99-B, No. 3 ( 2017-03), p. 409-416
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 99-B, No. 3 ( 2017-03), p. 409-416
    Kurzfassung: The aim of this study was to identify any progression between benign osteofibrous dysplasia (OFD), OFD-like adamantinoma and malignant adamantinoma, and to investigate the rates of local recurrence, metastases and survival, in order to develop treatment algorithms for each. Patients and Methods A single institution retrospective review of all patients presenting with OFD, OFD-like adamantinoma and adamantinoma between 1973 and 2012 was undertaken. Complete data were available for 73 patients (42 with OFD; ten with an OFD-like adamantinoma and 21 with an adamantinoma). The mean follow-up was 10.3 years (3 to 25) for OFD, 9.2 years (3.0 to 26.3) for OFD-like and 11.6 years (0.25 to 33) for adamantinoma. Results The mean age at diagnosis for OFD was 13.5 years (1 to 49), 10.5 years (6 to 28) for OFD-like and 34 years (14 to 86) for adamantinoma. A total of 24 of the 42 patients with OFD (57%) have not required any treatment and have been managed with observation. A total of 18 of the 42 patients with OFD underwent surgery, 13 with curettage and five with resection. In all, three patients developed recurrence following curettage (23%) but none following resection. All these patients were cured with further limited surgery. A total of six patients initially diagnosed with OFD were subsequently found to have OFD-like adamantinoma. Of the ten patients initially diagnosed with OFD-like adamantinoma, three (30%) were managed with observation alone and seven underwent surgery, two with curettage and five with resection. Local recurrence arose in two patients, one each after curettage and resection. No patients with either OFD or an OFD-like adamantinoma developed metastases or had progression to adamantinoma. All patients with an adamantinoma were treated by surgery, three with curettage, six with amputation and 12 with excision. In all, two of the three treated with curettage developed local recurrence, requiring further surgery. Late development of both local recurrence and metastases led to a ten year disease specific survival of 93% which had dropped to 39% by 20 years. Conclusion We found no evidence of progression from OFD to adamantinoma. Conservative management with observation or curettage is often successful for patients with OFD and OFD-like adamantinoma. Resection with clear margins is required for patients with adamantinoma. Late tumour recurrence is not uncommon in adamantinoma and prolonged follow-up should be considered. Cite this article: Bone Joint J 2017;99-B:409–16.
    Materialart: Online-Ressource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.99B3.38050
    Sprache: Englisch
    Verlag: British Editorial Society of Bone & Joint Surgery
    Publikationsdatum: 2017
    ZDB Id: 2697480-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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