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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Test Yourself question: Incidental hip lesion on PET-CT. Skeletal Radiol 2024; 53:1195-1197. [PMID: 38032363 DOI: 10.1007/s00256-023-04532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Correction to: Test Yourself question: Incidental hip lesion on PET‑CT. Skeletal Radiol 2024; 53:1199. [PMID: 38095687 DOI: 10.1007/s00256-023-04540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Macdonald J, Baird C, Jeys L, Parry M, Stevenson J. Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease. Indian J Surg Oncol 2024; 15:428-436. [PMID: 38741639 PMCID: PMC11088586 DOI: 10.1007/s13193-024-01917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/01/2024] [Indexed: 05/16/2024] Open
Abstract
Management of periacetabular metastatic bone disease (MBD) is challenging, specifically if associated with bone loss or fracture. The aim of this study was to evaluate the complications and outcomes after undergoing peri-acetabular reconstruction using an 'ice-cream cone' pedestal cup endoprostheses for the most severe cases of (impending) pathological acetabular fractures. Fifty cases with severe periacetabular disease were identified. Acetabular defects were classified using the Metastatic Acetabular Classification (MAC). Pre- and post-operative mobility was assessed using the Eastern Cooperative Oncology Group (ECOG) Performance Status. Pain levels were assessed using a verbal rating scale. Surgical complications and patient survival were analysed; the Prognostic Immune Nutritional Index (PINI) was applied retrospectively to survival. There were 32 females and 18 males with a median age of 65 (41-88). Median post-operative follow-up was 16 months (IQR 5.5-28.5 months). Thirty-nine had complete, and 11, impending pathological fractures. The observed five-year survival was 19%, with a median survival of 16 months (IQR 5.8-42.5 months). Significantly worse survival was observed with PINI scores < 3.0 (p = 0.003). Excluding three perioperative deaths, 13 complications occurred in 12 patients: Implant failure in six patients (four aseptic loosening, one dislocation and one infection). At the final follow-up, mobility and pain levels were improved in 85% and 100%, respectively. Reconstruction of significant pelvic MBD with the 'ice-cream cone' reduces pain and improves mobility. Whilst the mortality rate is high, it remains a reasonable option for bed-bound, immobile patients. We advocate the use of an 'ice-cream cone' prosthesis for selected patients balancing the reported risks with the observed benefits. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-024-01917-x.
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Affiliation(s)
- J. Macdonald
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - C. Baird
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L. Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- School of Life Sciences, Aston University, Birmingham, UK
| | - M. Parry
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Medical School, Aston University, Birmingham, UK
| | - J. Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Medical School, Aston University, Birmingham, UK
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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Test yourself answer: incidental hip lesion on PET-CT. Skeletal Radiol 2024; 53:1229-1231. [PMID: 38063891 DOI: 10.1007/s00256-023-04530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Jeys LM, Thorkildsen J, Kurisunkal V, Puri A, Ruggieri P, Houdek MT, Boyle RA, Ebeid W, Botello E, Morris GV, Laitinen MK, Abudu A, Ae K, Agarwal M, Ajit Singh V, Akiyama T, Albergo JI, Alexander J, Alpan B, Aoude A, Asavamongkolkul A, Aston W, Baad-Hansen T, Balach T, Benevenia J, Bergh P, Bernthal N, Binitie O, Boffano M, Bramer J, Branford White H, Brennan B, Cabrolier J, Calvo Haro JA, Campanacci DA, Cardoso R, Carey Smith R, Casales Fresnga N, Casanova JM, Ceballos O, Chan CM, Chung YG, Clara-Altamirano MA, Cribb G, Dadia S, Dammerer D, de Vaal M, Delgado Obando J, Deo S, Di Bella C, Donati DM, Endo M, Eralp L, Erol B, Evans S, Eward W, Fiorenza F, Freitas J, Funovics PT, Galli Serra M, Ghert M, Ghosh K, Gomez Mier LC, Gomez Vallejo J, Griffin A, Gulia A, Guzman M, Hardes J, Healey J, Hernandez A, Hesla A, Hongsaprabhas C, Hornicek F, Hosking K, Iwata S, Jagiello J, Johnson L, Johnston A, Joo MW, Jutte P, Kapanci B, Khan Z, Kobayashi H, Kollender Y, Koob S, Kotrych D, Le Nail LR, Legosz P, Lehner B, Leithner A, Lewis V, Lin P, Linares F, Lozano Calderon S, Mahendra A, Mahyudin F, Mascard E, Mattei JC, McCullough L, Medellin Rincon MR, Morgan-Jones R, Moriel Garcesco DJ, Mottard S, Nakayama R, Narhari P, O'Toole G, Vania O, Olivier A, Omar M, Ortiz-Cruz E, Ozger H, Ozkan K, Palmerini E, Papagelopoulos P, Parry M, Patton S, Petersen MM, Powell G, Puhaindran M, Raja A, Rajasekaran RB, Repsa L, Ropars M, Sambri A, Schubert T, Shehadeh A, Siegel G, Sommerville S, Spiguel A, Stevenson J, Sys G, Temple T, Traub F, Tsuchiya H, Valencia J, Van de Sande M, Vaz G, Velez Villa R, Vyrva O, Wafa H, Wan Faisham Numan WI, Wang E, Warnock D, Werier J, Wong KC, Norio Y, Zhaoming Y, Zainul Abidin S, Zamora T, Zumarraga JP, Abou-Nouar G, Gebert C, Randall RL. Controversies in orthopaedic oncology. Bone Joint J 2024; 106-B:425-429. [PMID: 38689572 DOI: 10.1302/0301-620x.106b5.bjj-2023-1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
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Affiliation(s)
- Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | | | - Ajay Puri
- Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Walid Ebeid
- Orthopedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Keisuke Ae
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Toru Akiyama
- Saitama Medical Center, JIchi Medical University, Saitama, Japan
| | - Jose I Albergo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | - Peter Bergh
- Sahlgren University Hospital, Gothenburg, Sweden
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Michele Boffano
- Orthopaedic Oncology Unit, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Jos Bramer
- Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | | | | | - Rodrigo Cardoso
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
| | | | - Nicolas Casales Fresnga
- National Orthopaedic and Trauma Institute Republic University Montevideo Montevideo, Montevideo, Uruguay
| | - Jose M Casanova
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Chung M Chan
- National University Hospital, Singapore, Singapore
| | - Yang-Guk Chung
- Seoul St. Mary's Hospital/The Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | - Levent Eralp
- Complex Extremity Reconstruction Unit, Acibadem Hospital Group, Istanbul, Turkey
| | - Bulent Erol
- Marmara University Orthopedics and Traumatology, Istanbul, Turkey
| | | | - Will Eward
- Duke University, Durham, North Carolina, USA
| | | | - Joao Freitas
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Marcos Galli Serra
- Hospital Universitario Austral / Orthopedic Oncology Unit Buenos, Aires, Argentina
| | | | | | | | | | | | - Ashish Gulia
- Homi Bhabha Cancer Hospital & Research Centre, Vishakhapatnam, India
| | | | | | - John Healey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Asle Hesla
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Keith Hosking
- Life Orthopaedic Hospital / Groote Schuur, Cape Town, South Africa
| | | | | | - Luke Johnson
- South Australian Bone & Soft Tissue Tumour Unit, Flinders Medical Centre, Adelaine, Australia
| | | | - Min Wook Joo
- The Catholic University of Korea, Seoul, South Korea
| | - Paul Jutte
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Zeeshan Khan
- Rehman Medical Institute and Medical College, Peshawar, Pakistan
| | | | | | | | - Daniel Kotrych
- Pomeranian Medical University of Szczecin, Szczecin, Poland
| | | | | | - Burkhard Lehner
- Orthopedic University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Peng Lin
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | | | | | | | | | | | | | | | | | | | - Sophie Mottard
- Maisonneuve Rosemont Hospital, Université de Montréal, Montreal, Canada
| | | | | | - Gary O'Toole
- St. Vincent's University Hospital Dublin, Dublin, Ireland
| | - Oliveira Vania
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | | | | | | | - Harzem Ozger
- Istanbul University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | - Sam Patton
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michael M Petersen
- Rigshospitalet/University of Copenhagen/Department of Orthopedics, Copenhagen, Denmark
| | | | | | | | | | | | | | - Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | - Ahmad Shehadeh
- Orthopaedic Unit, King Hussein Cancer Center, Amman, Jordan
| | - Geoffrey Siegel
- Michigan Medicine / University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Gwen Sys
- Ghent University Hospital, Ghent, Belgium
| | | | - Frank Traub
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | | | - Oleg Vyrva
- Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Hazem Wafa
- Leuven University Hospitals, Leuven, Belgium
| | | | - Edward Wang
- University of the Philippines Musculoskeletal Tumor Unit, Manila, Phillipines
| | | | | | - Kwok-Chuen Wong
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ye Zhaoming
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | - Tomas Zamora
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Zumarraga
- Hospital Metropolitano / Departamento de Ortopedia y Traumatología, Quito, Ecuador
| | | | | | - R L Randall
- University of California, Sacramento, California, USA
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Shihabul Hassan M, Stevenson J, Gandikota G, Veeratterapillay A, Bhamidipaty K, Botchu R. Current updates in MSK infection imaging: A narrative review. J Clin Orthop Trauma 2024; 51:102396. [PMID: 38585385 PMCID: PMC10998214 DOI: 10.1016/j.jcot.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.
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Affiliation(s)
- M. Shihabul Hassan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J. Stevenson
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | - G. Gandikota
- Department of Radiology, University of North Carolina, USA
| | | | | | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Stevenson J, Siddiqi MA, Sheehy V, Kendrick B, Whitwell D, Taylor A, Blunn G, Mohammad HR, Kamath AF, Thoma S. Early radiological outcomes of a fully porous bridging collar in lower-limb endoprosthetic reconstructions: a case-matched retrospective series to assess osseointegration. Arthroplasty 2024; 6:17. [PMID: 38429812 PMCID: PMC10908216 DOI: 10.1186/s42836-023-00230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/26/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Limb-salvage surgery involving the utilization of endoprosthetic replacements is commonly employed following segmental bone resection for primary and secondary bone tumors. This study aimed to evaluate whether a fully porous bridging collar promotes early osseous integration in endoprosthetic replacements. METHODS We undertook a retrospective review of all lower-limb endoprostheses utilizing a fully porous endosteal bridging collar design. We matched this cohort with a conventional extra-osteal non-porous fully hydroxyapatite-coated grooved collar cohort according to surgical indication, implant type, resection length, age, and follow-up time. At 6, 12, and 24 months post-implantation, radiographs were assessed for the number of cortices with or without osseointegration on orthogonal radiographs. Each radiograph was scored on a scale of -4 to + 4 for the number of cortices bridging the ongrowth between the bone and the collar of the prosthesis. Implant survival was estimated using the Kaplan-Meier method, and the mean number of osseointegrated cortices at each time point between the collar designs was compared using a paired t-test. RESULTS Ninety patients were retrospectively identified and analyzed. After exclusion, 40 patients with porous bridging collars matched with 40 patients with conventional extra-osteal non-porous collars were included in the study (n = 80). The mean age was 63.4 years (range 16-91 years); there were 37 males and 43 females. The groups showed no difference in implant survival (P = 0.54). The mean number of cortices with radiographic ongrowth for the porous bridging collar and non-porous collar groups was 2.1 and 0.3, respectively, at 6-month (P < 0.0001), 2.4 and 0.5, respectively, at 12-month (P = 0.044), and 3.2 and -0.2, respectively, at 24-month (P = 0.18) radiological follow-up. CONCLUSION These findings indicate that fully porous bridging collars increased the number of cortices, with evidence of bone ongrowth between 6 and 24 months post-implantation. By contrast, extra-osteal collars exhibited reduced evidence of ongrowth between 6 and 24 months post-implantation. In the medium term, the use of a fully porous bridging collar may translate to a reduced incidence of aseptic loosening.
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Affiliation(s)
- Jonathan Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
- Aston University Medical School, Aston University, Birmingham, B4 7ET, UK.
| | - M Ather Siddiqi
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - Vicky Sheehy
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - Ben Kendrick
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - Duncan Whitwell
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - Adrian Taylor
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, St. Michaels Building, White Swan Road, Portsmouth, PO1 2DT, UK
| | - Hasan R Mohammad
- Bart's Bone Joint Health, Bart's and the London School of Medicine and Dentistry, Blizard Institute, 4 Newark St., London, E1 2AT, UK
| | - Atul F Kamath
- Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, 9500 Euclid Avenue A40, Cleveland, OH, 44195, USA
| | - Sofia Thoma
- Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Bavan L, Eastley N, Stevenson J, Mifsud M, Bayliss L, Mahmoud S, Baker G, Cusick L, Nail R, Rankin K, Crooks S, Cool P, Williams D, Kandarakis G, Duncan R, Kothari A. Aneurysmal bone cysts: A UK wide tumor center experience. J Surg Oncol 2024; 129:601-608. [PMID: 37965813 DOI: 10.1002/jso.27499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVES This multicenter retrospective series of consecutive extra-spinal aneurysmal bone cysts aims to identify risk factors for treatment failure. METHODS Aneurysmal bone cysts treated within seven collaborating centers with over 12-months follow-up were eligible for inclusion. Survival analyses were performed to identify variables associated with recurrence using log-rank tests and Cox proportional hazard regression. RESULTS One hundred and fifteen (M:F 60:55) patients were included. Median age at presentation was 13 years and median follow-up was 27 months. Seventy-five patients underwent surgical curettage and 27% of these required further intervention for recurrence. Of the 30 patients who underwent biopsy with limited percutaneous curettage as initial procedure, 47% required no further treatment. Patients under 13 years (log-rank p = 0.006, HR 2.3, p = 0.011) and those treated who had limited curettage (log-rank p = 0.001, HR 2.7, p = 0.002) had a higher risk of recurrence/persistence. CONCLUSIONS There is a high risk of recurrence following surgical treatment for aneurysmal bone cysts and this risk is higher in young patients. However, the cyst heals in a substantial number of patients who have a limited curettage at the time of biopsy.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jonathan Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
| | | | - Lee Bayliss
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Shady Mahmoud
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gavin Baker
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca Nail
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Kenneth Rankin
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Sophie Crooks
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Derfel Williams
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | | | | | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Stevenson J, Cool P, Ashford R. Poor adherence to national guidance in the management of patients with metastatic bone disease. Bone Joint J 2024; 106-B:6-8. [PMID: 38160679 DOI: 10.1302/0301-620x.106b1.bjj-2023-0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Cite this article: Bone Joint J 2024;106-B(1):6–8.
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Affiliation(s)
- Jonathan Stevenson
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
| | - Paul Cool
- Oncology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
- Keele University, Keele, UK
| | - Robert Ashford
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Joint Reconstruction and Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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McCulloch RA, Martin A, Young BC, Kendrick BJ, Alvand A, Jeys L, Stevenson J, Palmer AJ. Frequent microbiological profile changes are seen in subsequent-revision hip and knee arthroplasty for prosthetic joint infection. J Bone Jt Infect 2023; 8:229-234. [PMID: 38127488 PMCID: PMC10726023 DOI: 10.5194/jbji-8-229-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
A proportion of patients with hip and knee prosthetic joint infection (PJI) undergo multiple revisions with the aim of eradicating infection and improving quality of life. The aim of this study was to describe the microbiology cultured from multiply revised hip and knee replacement procedures to guide antimicrobial therapy at the time of surgery. Patients and methods: Consecutive patients were retrospectively identified from databases at two specialist orthopaedic centres in the United Kingdom between 2011 and 2019. Patient were included who had undergone repeat-revision total knee replacement (TKR) or total hip replacement (THR) for infection, following an initial failed revision for infection. Results: A total of 106 patients were identified. Of these patients, 74 underwent revision TKR and 32 underwent revision THR. The mean age at first revision was 67 years (SD 10). The Charlson comorbidity index was ≤ 2 for 31 patients, 3-4 for 57 patients, and ≥ 5 for 18 patients. All patients underwent at least two revisions, 73 patients received three, 47 patients received four, 31 patients received five, and 21 patients received at least six. After six revisions, 90 % of patients had different organisms cultured compared with the initial revision, and 53 % of organisms were multidrug resistant. The most frequent organisms at each revision were coagulase-negative Staphylococcus (36 %) and Staphylococcus aureus (19 %). Fungus was cultured from 3 % of revisions, and 21 % of infections were polymicrobial. Conclusion: Patients undergoing multiple revisions for PJI are highly likely to experience a change in organism, with 90 % of patients having a different organism cultured by their sixth revision. It is therefore important to administer empirical antibiotics at each subsequent revision, taking into account known drug resistance from previous cultures. Our results do not support the routine use of empirical antifungals.
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Affiliation(s)
- Robert A McCulloch
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Alex Martin
- The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK
| | - Bernadette C Young
- The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK
| | - Benjamin J Kendrick
- The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK
| | - Abtin Alvand
- The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK
| | - Lee Jeys
- The Royal Orthopaedic Hospital, Bristol Road, Northfield, Birmingham, B31 2AP, UK
| | - Jonathan Stevenson
- The Royal Orthopaedic Hospital, Bristol Road, Northfield, Birmingham, B31 2AP, UK
| | - Antony J Palmer
- The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK
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11
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Stevenson J, Cool P, Ashford R. Poor adherence to national guidance in the management of patients with metastatic bone disease. Bone Joint J 2023; 105-B:xxx. [PMID: 37846573 DOI: 10.1302/0301-620x.105b.bjj-2023-0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Jonathan Stevenson
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
| | - Paul Cool
- Oncology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
- Keele University, Keele, UK
| | - Robert Ashford
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Joint Reconstruction and Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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12
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Archer JE, Chauhan GS, Dewan V, Osman K, Thomson C, Nandra RS, Ashford RU, Cool P, Stevenson J. The British Orthopaedic Oncology Management (BOOM) audit. Bone Joint J 2023; 105-B:1115-1122. [PMID: 37777202 DOI: 10.1302/0301-620x.105b10.bjj-2023-0443.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in the UK. Methods A prospective, multicentre, national collaborative audit was designed and delivered by a trainee-led collaborative group. Data were collected over three months (1 April 2021 to 30 June 2021) for all patients presenting with MBD. A data collection tool allowed investigators at each hospital to compare practice against guidelines. Data were collated and analyzed centrally to quantify compliance from 84 hospitals in the UK for a total of 1,137 patients who were eligible for inclusion. Results A total of 846 patients with pelvic and appendicular MBD were analyzed, after excluding those with only spinal metastatic disease. A designated MBD lead was not present in 39% of centres (33/84). Adequate radiographs were not performed in 19% of patients (160/846), and 29% (247/846) did not have an up-to-date CT of thorax, abdomen, and pelvis to stage their disease. Compliance was low obtaining an oncological opinion (69%; 584/846) and prognosis estimations (38%; 223/846). Surgery was performed in 38% of patients (319/846), with the rates of up-to-date radiological investigations and oncology input with prognosis below the expected standard. Of the 25% (215/846) presenting with a solitary metastasis, a tertiary opinion from a MBD centre and biopsy was sought in 60% (130/215). Conclusion Current practice in the UK does not comply with national guidelines, especially regarding investigations prior to surgery and for patients with solitary metastases. This study highlights the need for investment and improvement in care. The recent publication of British Orthopaedic Association Standards for Trauma (BOAST) defines auditable standards to drive these improvements for this vulnerable patient group.
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Affiliation(s)
- James E Archer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Govind S Chauhan
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Varun Dewan
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Khabab Osman
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Calum Thomson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajpal S Nandra
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert U Ashford
- Joint Reconstruction and Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Paul Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
- Medical School, Keele University, Keele, UK
| | - Jonathan Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
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13
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Orchard L, Van M, Abbas J, Malik R, Stevenson J, Tolley N. Mixed-reality technology for clinical communication: objective assessment of the HoloLens 2 as a clinical communication device in a simulated on-call scenario. J Laryngol Otol 2023; 137:1165-1169. [PMID: 36992658 DOI: 10.1017/s0022215123000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario. METHOD This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively. RESULTS Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision. CONCLUSION This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.
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Affiliation(s)
- L Orchard
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - M Van
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - J Abbas
- Human Factors Academy, Manchester University NHS Trust, University of Manchester, Manchester, UK
| | - R Malik
- Medical School, Imperial College London, London, UK
| | - J Stevenson
- Infomation Technology, Imperial College Healthcare NHS Trust, London, UK
| | - N Tolley
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
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Fraterrigo G, Schileo E, Simpson D, Stevenson J, Kendrick B, Taddei F. Does a novel bridging collar in endoprosthetic replacement optimise the mechanical environment for osseointegration? A finite element study. Front Bioeng Biotechnol 2023; 11:1120430. [PMID: 37342508 PMCID: PMC10277679 DOI: 10.3389/fbioe.2023.1120430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction: Limb-salvage surgery using endoprosthetic replacements (EPRs) is frequently used to reconstruct segmental bone defects, but the reconstruction longevity is still a major concern. In EPRs, the stem-collar junction is the most critical region for bone resorption. We hypothesised that an in-lay collar would be more likely to promote bone ongrowth in Proximal Femur Reconstruction (PFR), and we tested this hypothesis through validated Finite Element (FE) analyses simulating the maximum load during walking. Methods: We simulated three different femur reconstruction lengths (proximal, mid-diaphyseal, and distal). For each reconstruction length one in-lay and one traditional on-lay collar model was built and compared. All reconstructions were virtually implanted in a population-average femur. Personalised Finite Element models were built from Computed Tomography for the intact case and for all reconstruction cases, including contact interfaces where appropriate. We compared the mechanical environment in the in-lay and on-lay collar configurations, through metrics of reconstruction safety, osseointegration potential, and risk of long-term bone resorption due to stress-shielding. Results: In all models, differences with respect to intact conditions were localized at the inner bone-implant interface, being more marked in the collar-bone interface. In proximal and mid-diaphyseal reconstructions, the in-lay configuration doubled the area in contact at the bone-collar interface with respect to the on-lay configuration, showed less critical values and trends of contact micromotions, and consistently showed higher (roughly double) volume percentages of predicted bone apposition and reduced (up to one-third) percentages of predicted bone resorption. In the most distal reconstruction, results for the in-lay and on-lay configurations were generally similar and showed overall less favourable maps of the bone remodelling tendency. Discussion: In summary, the models corroborate the hypothesis that an in-lay collar, by realising a more uniform load transfer into the bone with a more physiological pattern, creates an advantageous mechanical environment at the bone-collar interface, compared to an on-lay design. Therefore, it could significantly increase the survivorship of endo-prosthetic replacements.
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Affiliation(s)
- Giulia Fraterrigo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy
| | - Enrico Schileo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy
| | | | - Jonathan Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
- Aston University Medical School, Aston University, Birmingham, United Kingdom
| | - Ben Kendrick
- Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculo-skeletal Science, University of Oxford, Oxford, England
| | - Fulvia Taddei
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy
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15
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Rajgor H, Dong H, Nandra R, Parry M, Stevenson J, Jeys L. Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require multiple operations: a case control study. Arch Orthop Trauma Surg 2023; 143:987-994. [PMID: 35980459 DOI: 10.1007/s00402-022-04594-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty. MATERIALS AND METHODS A retrospective analysis was performed of 32 patients who underwent re-revision knee arthroplasty, having already undergone at least one previous two-stage exchange for PJI with a minimum follow-up of two-years for alive patients. Outcomes were compared to a matched control of two-stage revisions for PJI of a primary knee replacement also containing 32 patients. Outcomes investigated were eradication of infection, re-operation, mortality and limb-salvage rate. RESULTS Successful eradication of infection was achieved in 50% of patients following re-revision surgery, compared with 91% following two-stage exchange of primary knee replacement for PJI (p < 0.001). Fourteen (44%) patients required further re-operation compared with three (9%) patients in the primary group (p = 0.006). Amputation was performed in one case (3%) with thirteen patients (92%) who had infection controlled by debridement, antibiotics and implant retention (DAIR), further revision surgery or arthrodesis. Two patients died with infection (6%) and the long-term rate for infection control was 91%. The mean number of procedures following surgery for the re-revision group was 2.8 (0-9) compared with 0.13 (0-1) for the primary two-stage group (p < 0.001). Five-year patient survival was 90.6% (95% CI 77.1-100). The limb-salvage rate for the re-revision cohort was 97%. CONCLUSION Outcomes for re-revision knee arthroplasty for PJI have higher re-operation and failure rates, but no worse mortality than in revisions of primary knee replacements. Failures can successfully be managed by further operation.
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Affiliation(s)
- Harshad Rajgor
- Trauma and Orthopaedic Registrar, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Huan Dong
- Trauma and Orthopaedic Registrar, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Raj Nandra
- Trauma and Orthopaedic Registrar, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Michael Parry
- Consultant Orthopaedic Oncology and Arthroplasty Surgeon, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Senior Clinical Lecturer, Aston University Medical School, Aston University, Birmingham, UK
| | - Jonathan Stevenson
- Consultant Orthopaedic Oncology and Arthroplasty Surgeon, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK. .,Senior Clinical Lecturer, Aston University Medical School, Aston University, Birmingham, UK.
| | - Lee Jeys
- Consultant Orthopaedic Oncology and Arthroplasty Surgeon, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Professor of Life Sciences, Aston University, Birmingham, UK
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16
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Ali K, Mensah E, McDermott A, Stevenson J, Hamer V, Parekh N, Schiff R, Nyangoma S, Fowler-Davis S, Cammen T, Davies JG, Rajkumar C. 1285 IMPLEMENTATION OF A MEDICINE MANAGEMENT PLAN TO REDUCE MEDICATION-RELATED HARM IN OLDER PEOPLE POST-HOSPITAL DISCHARGE - AN RCT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS.
Method
Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records.
Data Analysis
Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP.
Conclusion
This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites.
Reference
1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.
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Affiliation(s)
- K Ali
- Brighton and Sussex Medical School
| | | | | | | | | | - N Parekh
- Brighton and Sussex Medical School
| | - R Schiff
- Guys and St Thomas’s NHS Foundation
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17
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Al-Aqeel M, Adlan A, Stevenson J. 626 What Is the Influence of Negative Pressure Wound Therapy (NPWT) on High-Risk Wounds in Pelvic Oncology? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
Hindquarter amputation (HQA) has a high incidence of postoperative wound complications. We aim to use the HQA procedure as a model to investigate the potential advantages of negative pressure wound therapy (NPWT) on wound healing complications in high-risk pelvic oncology wounds.
Method
We conducted a retrospective analysis of all patients undergoing hindquarter amputation at a single tertiary centre between January 2009 and November 2020. Patients were divided into groups who had and hadn't undergone neoadjuvant radiotherapy (RT) to the pelvic tumour.
Results
One hundred six patients were included in the study. 43.4% had NPWT. There was no difference in the incidence of reoperation in the patient group without neo-adjuvant RT between NPWT and conventional dressings (odds ratio [OR], 1.01; p=0.983, 95% confidence interval [CI], 0.365–2.8). However, the use of NPWT decreased the incidence of reoperation among the patients who had NPWT who had received radiotherapy [OR], 0.087; p=0.033, 95% CI, 0.009–0.818). The incidence of wound complications has declined with the increasing use of NPWT between 2009–2020.
Conclusions
The application of NPWT reduces the incidence of wound complications in high-risk pelvic oncology wounds. We demonstrated a reduction in the incidence of reoperation due to wound complications in patients who received NPWT following HQA.
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Affiliation(s)
- M Al-Aqeel
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - A Adlan
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - J Stevenson
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
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18
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Lyskjær I, Davies C, Strobl A, Hindley J, James S, Lalam RK, Cross W, Hide G, Rankin KS, Jeys L, Tirabosco R, Stevenson J, O’Donnell P, Cool P, Flanagan AM. Circulating tumour DNA is a promising biomarker for risk stratification of central chondrosarcoma with IDH1/2 and GNAS mutations. Mol Oncol 2021; 15:3679-3690. [PMID: 34528398 PMCID: PMC8637565 DOI: 10.1002/1878-0261.13102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Chondrosarcoma (CS) is a rare tumour type and the most common primary malignant bone cancer in adults. The prognosis, currently based on tumour grade, imaging and anatomical location, is not reliable, and more objective biomarkers are required. We aimed to determine whether the level of circulating tumour DNA (ctDNA) in the blood of CS patients could be used to predict outcome. In this multi-institutional study, we recruited 145 patients with cartilaginous tumours, of which 41 were excluded. ctDNA levels were assessed in 83 of the remaining 104 patients, whose tumours harboured a hotspot mutation in IDH1/2 or GNAS. ctDNA was detected pre-operatively in 31/83 (37%) and in 12/31 (39%) patients postoperatively. We found that detection of ctDNA was more accurate than pathology for identification of high-grade tumours and was associated with a poor prognosis; ctDNA was never associated with CS grade 1/atypical cartilaginous tumours (ACT) in the long bones, in neoplasms sited in the small bones of the hands and feet or in tumours measuring less than 80 mm. Although the results are promising, they are based on a small number of patients, and therefore, introduction of this blood test into clinical practice as a complementary assay to current standard-of-care protocols would allow the assay to be assessed more stringently and developed for a more personalised approach for the treatment of patients with CS.
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Affiliation(s)
- Iben Lyskjær
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
- Medical Genomics Research GroupUniversity College LondonUCL Cancer InstituteLondonUK
| | - Christopher Davies
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Anna‐Christina Strobl
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Joanna Hindley
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Steven James
- Department of Musculoskeletal ImagingRoyal Orthopaedic HospitalBirminghamUK
| | - Radhesh K. Lalam
- Department of RadiologyRoyal National Orthopaedic HospitalStanmoreUK
| | - William Cross
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
| | - Geoff Hide
- North of England Bone and Soft Tissue Tumour ServiceFreeman HospitalNewcastleUK
| | - Kenneth S. Rankin
- North of England Bone and Soft Tissue Tumour ServiceFreeman HospitalNewcastleUK
- Newcastle Centre for CancerNewcastle UniversityUK
| | - Lee Jeys
- Orthopaedic DepartmentRoyal Orthopaedic Hospital NHS Foundation TrustBirminghamUK
| | - Roberto Tirabosco
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Jonathan Stevenson
- Department of Orthopaedic Oncology and ArthroplastyRoyal Orthopaedic Hospital NHS Foundation TrustBirminghamUK
| | | | - Paul O’Donnell
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
- Department of RadiologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Paul Cool
- Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
- Keele UniversityUK
| | - Adrienne M. Flanagan
- Research Department of PathologyUniversity College LondonUCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
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Fujiwara T, Tsuda Y, Stevenson J, Parry M, Jeys L. Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection? J Bone Oncol 2021; 31:100401. [PMID: 34815929 PMCID: PMC8592885 DOI: 10.1016/j.jbo.2021.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While extra-articular resection (EAR) of the knee and shoulder joint is associated with poorer clinical outcomes, the oncological and functional risks of EAR of the hip joint are unknown. We aimed to compare these risks between EAR of the hip joint and intra-articular resection (IAR). METHODS We conducted a comparative study of 75 patients who underwent en-bloc tumour resection and limb-salvage reconstruction for bone sarcomas of the peri-acetabulum between 1996 and 2016. We divided patients into two groups for analyses; EAR (n = 21) and IAR (n = 54). RESULTS There was no statistical difference in oncological outcomes; the 5-year cumulative incidence of disease-specific death was 34% and 35% in the EAR and IAR groups, respectively (p = 0.943), and the 5-year cumulative incidence of LR was 26% and 34%, respectively (p = 0.482). The most common complications were dislocation (28%) and deep infection (28%); there was equally no difference between the groups. The mean Musculoskeletal Tumour Society score was 66% and 65% in the EAR and IAR groups, respectively (p = 0.795), and were significantly lower in patients with deep infection (52% vs. 69%; p = 0.013). In a sub-analysis on the outcomes in patients who underwent PI-uninvolved PII-resection for chondrosarcoma, no major differences in oncologic and functional outcomes were confirmed. CONCLUSION Patients undergoing EAR and limb-salvage reconstructions of the hip joint have undistinguishable oncological, clinical and functional outcomes compared to those undergoing IAR and reconstructions. If preoperative imaging suggests articular tumour involvement, there appears to be no detrimental effect of undertaking EAR to optimise local control.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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20
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McCulloch R, Adlan A, Evans S, Parry M, Stevenson J, Jeys L. Outcomes of the gastrocnemius flap performed by orthopaedic surgeons in salvage revision knee arthroplasty. J Bone Jt Infect 2021; 6:425-432. [PMID: 36561206 PMCID: PMC9720735 DOI: 10.5194/jbji-6-425-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. Patients and methods: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50-84) and were followed up for a mean of 50.4 months (range 2-128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was recurrent infection. Results: Flap survival was 100 % with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48 % (13 of 27 infected cases). Using limb salvage as the outcome, 77 % (23 of 30 patients) retained the limb. Infection recurrence occurred in 48 % (10 patients) in the type B3 cohort and 67 % (4 patients) in the type C3 cohort ( p = 0.65 ). Conclusions: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.
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Affiliation(s)
| | - Amirul Adlan
- Royal Orthopaedic Hospital, Bristol Road South, Northfield,
Birmingham, B31 2AP, UK
| | - Scott Evans
- Royal Orthopaedic Hospital, Bristol Road South, Northfield,
Birmingham, B31 2AP, UK
| | - Michael Parry
- Royal Orthopaedic Hospital, Bristol Road South, Northfield,
Birmingham, B31 2AP, UK
| | - Jonathan Stevenson
- Royal Orthopaedic Hospital, Bristol Road South, Northfield,
Birmingham, B31 2AP, UK
| | - Lee Jeys
- Royal Orthopaedic Hospital, Bristol Road South, Northfield,
Birmingham, B31 2AP, UK,Aston Medical School, Aston University, Birmingham,
UK,School of Life and Health Sciences, Aston University, Birmingham,
UK
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21
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Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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22
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Ortega Franco A, Adamson-Raieste A, Rahman R, Pihlak R, Peters N, Scott JA, Aruketty S, Thomson C, Dransfield S, Henshaw A, Ward A, Cutts T, Carter L, Thistlethwaite F, Cook N, Graham D, Stevenson J, Krebs M. 44P Value of comprehensive genomic profiling in pre-screening patients for NTRK fusion in STARTRK2 trial: Single centre experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer RJ, Abudu S. Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system : what has been the impact of national policies in the UK? Bone Joint J 2021; 103-B:1541-1549. [PMID: 34465152 DOI: 10.1302/0301-620x.103b9.bjj-2020-2554.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
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Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Birmingham, UK
| | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert J Grimer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Seggy Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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24
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Kurisunkal V, Laitinen MK, Kaneuchi Y, Kapanci B, Stevenson J, Parry MC, Reito A, Fujiwara T, Jeys LM. Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis? Bone Joint J 2021; 103-B:1150-1154. [PMID: 34058869 DOI: 10.1302/0301-620x.103b6.bjj-2020-1869.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis. METHODS We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm. RESULTS The disease--specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001). CONCLUSION Obtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis. Cite this article: Bone Joint J 2021;103-B(6):1150-1154.
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Affiliation(s)
| | - Minna K Laitinen
- Dept of Orthopaedic and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Bilal Kapanci
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Aleksi Reito
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | | | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Dept of Health and Life Sciences, Aston University, Birmingham, UK
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25
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Abstract
AIMS Chondrosarcoma is the second most common primary sarcoma of bone: conventional chondrosarcoma accounts for 85% of all cases. Conventional chondrosarcoma may be central or peripheral. Most studies group central and peripheral chondrosarcomas together, although there is growing evidence that their clinical behaviour and prognosis differ. The aims of this study were to analyze any differences in characteristics between central and peripheral chondrosarcomas and to investigate the incidence and role of different syndromes. METHODS Data from two international tertiary referral sarcoma centres between January 1995 and December 2018 were retrospectively reviewed. The study population consisted of 714 patients with surgically treated conventional chondrosarcoma of the pelvis and limbs. RESULTS In patients with Ollier's disease and Mafucci's syndrome, 12/20 (60%) and 2/5 (60%) of malignancies, respectively, were in the limbs, most frequently in the proximal humerus, proximal tibia, and in the hands and feet. In patients with hereditary multiple exostosis (HME), 20/29 (69.0%) of chondrosarcomas were in the pelvis and scapula, specifically in the ilium in 13/29 (44.8%) and the scapula in 3/29 (10.3%). In central chondrosarcoma, survival of patients with Ollier's disease and non-syndromic patients was the same (p = 0.805). In peripheral chondrosarcoma, survival among HME patients was similar (p = 0.676) in patients with tumours of the pelvis and limbs. CONCLUSION Both central and peripheral chondrosarcoma have specific characteristics. HME is frequently seen in patients with a peripheral chondrosarcoma, in whom tumours are commonly located in the ilium and scapula. The incidence of Ollier's disease is uncommon in patients with a central chondrosarcoma. Disease-specific survival is equal in different subtypes after adjustment for histological grade. The local recurrence-free survival is the same for different locations and subtypes after adjustment for surgical margin. Cite this article: Bone Joint J 2021;103-B(5):984-990.
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Affiliation(s)
- Minna K Laitinen
- Department of Orthopaedics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Scott Evans
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Stevenson
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| | - Vaiyapuri Sumathi
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Gilber Kask
- Department of Orthopaedics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lee M Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Michael C Parry
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
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26
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Sinclair C, Schnobrich M, Stevenson J, Kouba J. 108 A preliminary investigation of anti-Müllerian hormone as a biomarker for fertility in mares. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Agrawal Y, Vasudev A, Sharma A, Cooper G, Stevenson J, Parry MC, Dunlop D. Morbidity and mortality in patients undergoing lower limb arthroplasty surgery during the initial surge of the COVID-19 pandemic in the UK at a single-speciality orthopaedic hospital. Bone Jt Open 2021; 2:323-329. [PMID: 34003027 PMCID: PMC8168543 DOI: 10.1302/2633-1462.25.bjo-2021-0001.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims The COVID-19 pandemic posed significant challenges to healthcare systems across the globe in 2020. There were concerns surrounding early reports of increased mortality among patients undergoing emergency or non-urgent surgery. We report the morbidity and mortality in patients who underwent arthroplasty procedures during the UK first stage of the pandemic. Methods Institutional review board approval was obtained for a review of prospectively collected data on consecutive patients who underwent arthroplasty procedures between March and May 2020 at a specialist orthopaedic centre in the UK. Data included diagnoses, comorbidities, BMI, American Society of Anesthesiologists grade, length of stay, and complications. The primary outcome was 30-day mortality and secondary outcomes were prevalence of SARS-CoV-2 infection, medical and surgical complications, and readmission within 30 days of discharge. The data collated were compared with series from the preceding three months. Results There were 167 elective procedures performed in the first three weeks of the study period, prior to the first national lockdown, and 57 emergency procedures thereafter. Three patients (1.3%) were readmitted within 30 days of discharge. There was one death (0.45%) due to SARS-CoV-2 infection after an emergency procedure. None of the patients developed complications of SARS-CoV-2 infection after elective arthroplasty. There was no observed spike in complications during in-hospital stay or in the early postoperative period. There was no statistically significant difference in survival between pre-COVID-19 and peri-COVID-19 groups (p = 0.624). We observed a higher number of emergency procedures performed during the pandemic within our institute. Conclusion An international cohort has reported 30-day mortality as 28.8% following orthopaedic procedures during the pandemic. There are currently no reports on clinical outcomes of patients treated with lower limb reconstructive surgery during the same period. While an effective vaccine is developed and widely accepted, it is very likely that SARS-CoV2 infection remains endemic. We believe that this report will help guide future restoration planning here in the UK and abroad. Cite this article: Bone Jt Open 2021;2(5):323–329.
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Affiliation(s)
- Yuvraj Agrawal
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Akash Sharma
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - George Cooper
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Michael C Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - David Dunlop
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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28
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Fujiwara T, Medellin Rincon MR, Sambri A, Tsuda Y, Clark R, Stevenson J, Parry MC, Grimer RJ, Jeys L. Limb-salvage reconstruction following resection of pelvic bone sarcomas involving the acetabulum. Bone Joint J 2021; 103-B:795-803. [PMID: 33789467 DOI: 10.1302/0301-620x.103b4.bjj-2020-0665.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. METHODS The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). RESULTS The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). CONCLUSION Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795-803.
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Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Andrea Sambri
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rhys Clark
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Michael C Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert J Grimer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Lee Jeys
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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29
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Shaw RJ, Yang Q, Barnes A, Hatch D, Crowley MJ, Vorderstrasse A, Vaughn J, Diane A, Lewinski AA, Jiang M, Stevenson J, Steinberg D. Self-monitoring diabetes with multiple mobile health devices. J Am Med Inform Assoc 2021; 27:667-676. [PMID: 32134447 DOI: 10.1093/jamia/ocaa007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the use of multiple mobile health technologies to generate and transmit data from diverse patients with type 2 diabetes mellitus (T2DM) in between clinic visits. We examined the data to identify patterns that describe characteristics of patients for clinical insights. METHODS We enrolled 60 adults with T2DM from a US healthcare system to participate in a 6-month longitudinal feasibility trial. Patient weight, physical activity, and blood glucose were self-monitored via devices provided at baseline. Patients also responded to biweekly medication adherence text message surveys. Data were aggregated in near real-time. Measures of feasibility assessing total engagement in device submissions and survey completion over the 6 months of observation were calculated. RESULTS It was feasible for participants from different socioeconomic, educational, and racial backgrounds to use and track relevant diabetes-related data from multiple mobile health devices for at least 6 months. Both the transmission and engagement of the data revealed notable patterns and varied by patient characteristics. DISCUSSION Using multiple mobile health tools allowed us to derive clinical insights from diverse patients with diabetes. The ubiquitous adoption of smartphones across racial, educational, and socioeconomic populations and the integration of data from mobile health devices into electronic health records present an opportunity to develop new models of care delivery for patients with T2DM that may promote equity as well.
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Affiliation(s)
- Ryan J Shaw
- School of Nursing, Duke University, Durham, North Carolina, USA.,Center for Applied Genomics & Precision Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Q Yang
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A Barnes
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - D Hatch
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - M J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina, USA
| | - A Vorderstrasse
- College of Nursing, New York University, New York, New York, USA
| | - J Vaughn
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A Diane
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - M Jiang
- Department of Biostatistics & Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA
| | - J Stevenson
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - D Steinberg
- School of Nursing, Duke University, Durham, North Carolina, USA
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30
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Mclachlan S, Chakravorty M, Odone J, Stevenson J, Minshul J, Schiff R. 28 Medication Compliance Aids and Acute Hospitals. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
An estimated 64 million Medication Compliance Aids (MCAs) are dispensed by pharmacies in England each year as a method of reasonable adjustment to improve medication adherence (NICE 2009) and support medicines administration by carers (RPS 2013). Complexities exist when implementing medication changes for patients using MCAs, particularly at hospital discharge or outpatient appointments, where practices seem to vary. This National Survey is the first to determine the current policy and service provision of MCAs by acute hospitals in England.
Methods
An electronic survey was emailed to Chief Pharmacists via the Regional Medicines Information Services in Spring 2019. Initial non-responders were contacted by email and telephone.
Results
51% (73/144) of acute hospital trusts in England responded. 77% (56/73) dispensed medication in MCAs at discharge. Of these, 62.5% would initiate MCAs and 61% supplied a different length of MCA vs non-MCA prescription (see table).
41 hospitals had designated staff completing MCAs. The median time to complete an MCA was 59.5 minutes (range 10–200). The median time from prescription receipt in pharmacy to MCA arrival on ward was 144.5 minutes (range 60–1,440).
Of the 17 hospitals not providing MCAs, the majority would, upon discharge, contact the community pharmacy that provided the MCA pre-admission to update any medication changes and request the provision of a new supply of medicines.
Conclusion
Despite the ubiquitous nature of the MCA, there is no standard approach to the supply of these devices from acute hospitals across England. When hospitals do provide MCAs their preparation is time consuming, often requiring additional staff. A national approach to MCAs might help patients and carers, and reduce medication-related problems and costs.
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Affiliation(s)
- S Mclachlan
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - M Chakravorty
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - J Odone
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - J Stevenson
- Institute of Pharmaceutical Science, King’s College London
- Pharmacy Department, Guy’s and St. Thomas’ NHS Foundation Trust
| | - J Minshul
- London Medicines Information Service, NHS Specialist Pharmacy
| | - R Schiff
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
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31
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Fujiwara T, Stevenson J, Parry M, Le Nail LR, Tsuda Y, Grimer R, Jeys L. Pelvic reconstruction using an ice-cream cone prosthesis: correlation between the inserted length of the coned stem and surgical outcome. Int J Clin Oncol 2021; 26:1139-1146. [PMID: 33721114 DOI: 10.1007/s10147-021-01882-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acetabular reconstruction using an ice-cream cone prosthesis has been a reliable reconstruction option following pelvic tumour resection. However, it remains unknown which factor determines the success of this procedure. We aimed to determine risk factors for complications and functional loss in acetabular reconstruction using an ice-cream cone prosthesis. PATIENTS AND METHODS Fifty-four patients with malignant bone tumours who underwent acetabular reconstruction using an ice-cream cone prosthesis between 2004 and 2016 were studied. The bone-stem ratio was calculated as the ratio of the inserted length into the bone per the entire stem length. RESULTS A total of 26 (48%) patients had at least one complication and 11 patients (20%) required surgical interventions. The complication rates were 71% and 40% with a bone-stem ratio ≤ 50% and > 50%, respectively (p = 0.026), and the bone-stem ratio significantly stratified the risk of complications (≤ 50%: OR, 4.67 versus > 50%; p = 0.048). The mean MSTS score at the final follow-up was 60% (range 23-97%): the scores were significantly lower in patients with complications/leg-length discrepancy (52%) than in those without (79%; p = 0.002). The mean score with a bone-stem ratio ≤ 50% was significantly lower than the score with a ratio > 50%, especially in patients who underwent non-navigated reconstructions (33% versus 64%; p = 0.001). CONCLUSION The inserted length of the coned stem into residual bone was predictive of complications and functional outcome. Surgical indication for this procedure should be considered with the size of the remaining ilium to stabilise the prosthesis with a coned stem longer than half length.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Jonathan Stevenson
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Michael Parry
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Louis-Romée Le Nail
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Lee Jeys
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Abstract
METHODS A multicentre retrospective study was carried out at two tertiary sarcoma centres. A database search identified all patients with a CS treated between January 1995 and January 2018. There were 810 CSs of which 76 (9.4%) were located in the fingers, toes, metacarpals, and metatarsal bones. RESULTS The median age of the study population was 55 years (36 to 68) with a median follow-up of 52 months (22 to 87) months. Overall, 70% of the tumours were in the hand (n = 54) and 30% in the foot (n = 22). Predictors for LR were margin (p = 0.011), anatomical location (p = 0.017), and method of surgical management (p = 0.003). Anatomical location (p = 0.026), histological grade between 1 and 3 (p = 0.004) or 2 and 3 (p = 0.016), and surgical management (p = 0.001) were significant factors for LR-free survival. Disease-specific survival was affected by histological grade (p < 0.001), but not by LR (p = 0.397). CONCLUSION Intralesional curettage of a low-grade CS is associated with an increased risk of LR, but LR does not affect disease-specific survival. Therefore, for low-grade CSs of the hands and feet, surgical management should aim to preserve function. In grade 2 CS, our study did not show any decreased disease-specific survival after recurrence; however, we suggest a more aggressive surgical approach to these tumours to prevent local recurrence, especially in the metacarpal and metatarsal bones. In high-grade tumours, the incidence of progressive disease is high and, therefore, the treatment of the primary tumour should be aggressive where possible, and patients observed closely for the development of metastatic disease. Cite this article: Bone Joint J 2021;103-B(3):562-568.
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Affiliation(s)
- Gilber Kask
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Helsinki, Finland
| | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonathan Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| | | | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Science, Aston University, Birmingham, UK
| | - Michael C Parry
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
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Rao S, Arnold S, Carbone D, Salgia R, Tsao A, Niu J, Aggarwal C, Dragnev K, Awad M, Gainor J, Gubens M, Velcheti V, Telliho L, Akala O, Chartash E, Stevenson J. P75.03 KEYNOTE-U01: A Phase 2 Umbrella Study of Investigational Agents Plus Pembrolizumab-Based Therapy for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsoi KM, Lowe M, Tsuda Y, Lex JR, Fujiwara T, Almeer G, Gregory J, Stevenson J, Evans SE, Botchu R, Jeys LM. How Are Indeterminate Pulmonary Nodules at Diagnosis Associated with Survival in Patients with High-Grade Osteosarcoma? Clin Orthop Relat Res 2021; 479:298-308. [PMID: 32956141 PMCID: PMC7899536 DOI: 10.1097/corr.0000000000001491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pulmonary metastases are a poor prognostic factor in patients with osteosarcoma; however, the clinical significance of subcentimeter lung nodules and whether they represent a tumor is not fully known. Because the clinician is faced with decisions regarding biopsy, resection, or observation of lung nodules and the potential impact they have on decisions about resection of the primary tumor, this remains an area of uncertainty in patient treatment. Surgical management of the primary tumor is tailored to prognosis, and it is unclear how aggressively patients with indeterminate pulmonary nodules (IPNs), defined as nodules smaller than 1 cm at presentation, should be treated. There is a clear need to better understand the clinical importance of these nodules. QUESTIONS/PURPOSES (1) What percentage of patients with high-grade osteosarcoma and spindle cell sarcoma of bone have IPNs at diagnosis? (2) Are IPNs at diagnosis associated with worse metastasis-free and overall survival? (3) Are there any clinical or radiologic factors associated with worse overall survival in patients with IPN? METHODS Between 2008 and 2016, 484 patients with a first presentation of osteosarcoma or spindle cell sarcoma of bone were retrospectively identified from an institutional database. Patients with the following were excluded: treatment at another institution (6%, 27 of 484), death related to complications of neoadjuvant chemotherapy (1%, 3 of 484), Grade 1 or 2 on final pathology (4%, 21 of 484) and lack of staging chest CT available for review (0.4%, 2 of 484). All patients with abnormalities on their staging chest CT underwent imaging re-review by a senior radiology consultant and were divided into three groups for comparison: no metastases (70%, 302 of 431), IPN (16%, 68 of 431), and metastases (14%, 61 of 431) at the time of diagnosis. A random subset of CT scans was reviewed by a senior radiology registrar and there was very good agreement between the two reviewers (κ = 0.88). Demographic and oncologic variables as well as treatment details and clinical course were gleaned from a longitudinally maintained institutional database. The three groups did not differ with regard to age, gender, subtype, presence of pathological fracture, tumor site, or chemotherapy-induced necrosis. They differed according to local control strategy and tumor size, with a larger proportion of patients in the metastases group presenting with larger tumor size and undergoing nonoperative treatment. There was no differential loss to follow-up among the three groups. Two percent (6 of 302) of patients with no metastases, no patients with IPN, and 2% (1 of 61) of patients with metastases were lost to follow-up at 1 year postdiagnosis but were not known to have died. Individual treatment decisions were determined as part of a multidisciplinary conference, but in general, patients without obvious metastases received (neo)adjuvant chemotherapy and surgical resection for local control. Patients in the no metastases and IPN groups did not differ in local control strategy. For patients in the IPN group, staging CT images were inspected for IPN characteristics including number, distribution, size, location, presence of mineralization, and shape. Subsequent chest CT images were examined by the same radiologist to reevaluate known nodules for interval change in size and to identify the presence of new nodules. A random subset of chest CT scans were re-reviewed by a senior radiology resident (κ = 0.62). The association of demographic and oncologic variables with metastasis-free and overall survival was first explored using the Kaplan-Meier method (log-rank test) in univariable analyses. All variables that were statistically significant (p < 0.05) in univariable analyses were entered into Cox regression multivariable analyses. RESULTS Following re-review of staging chest CTs, IPNs were found in 16% (68 of 431) of patients, while an additional 14% (61 of 431) of patients had lung metastases (parenchymal nodules 10 mm or larger). After controlling for potential confounding variables like local control strategy, tumor size, and chemotherapy-induced necrosis, we found that the presence of an IPN was associated with worse overall survival and a higher incidence of metastases (hazard ratio 1.9 [95% CI 1.3 to 2.8]; p = 0.001 and HR 3.6 [95% CI 2.5 to 5.2]; p < 0.001, respectively). Two-year overall survival for patients with no metastases, IPN, or metastases was 83% [95% CI 78 to 87], 65% [95% CI 52 to 75] and 45% [95% CI 32 to 57], respectively (p = 0.001). In 74% (50 of 68) of patients with IPNs, it became apparent that they were true metastatic lesions at a median of 5.3 months. Eighty-six percent (43 of 50) of these patients had disease progression by 2 years after diagnosis. In multivariable analysis, local control strategy and tumor subtype correlated with overall survival for patients with IPNs. Patients who were treated nonoperatively and who had a secondary sarcoma had worse outcomes (HR 3.6 [95% CI 1.5 to 8.3]; p = 0.003 and HR 3.4 [95% CI 1.1 to 10.0]; p = 0.03). The presence of nodule mineralization was associated with improved overall survival in the univariable analysis (87% [95% CI 39 to 98] versus 57% [95% CI 43 to 69]; p = 0.008), however, because we could not control for other factors in a multivariable analysis, the relationship between mineralization and survival could not be determined. We were unable to detect an association between any other nodule radiologic features and survival. CONCLUSION The findings show that the presence of IPNs at diagnosis is associated with poorer survival of affected patients compared with those with normal staging chest CTs. IPNs noted at presentation in patients with high-grade osteosarcoma and spindle cell sarcoma of bone should be discussed with the patient and be considered when making treatment decisions. Further work is required to elucidate how the nodules should be managed. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Kim M Tsoi
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Martin Lowe
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Yusuke Tsuda
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Johnathan R Lex
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Tomohiro Fujiwara
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Ghassan Almeer
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Gregory
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Stevenson
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Scott E Evans
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Rajesh Botchu
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Lee M Jeys
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
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Tsoi K, Tan D, Stevenson J, Evans S, Jeys L, Botchu R. Indeterminate pulmonary nodules are not associated with worse overall survival in Ewing Sarcoma. J Clin Orthop Trauma 2021; 16:58-64. [PMID: 33717939 PMCID: PMC7920159 DOI: 10.1016/j.jcot.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Lung metastases are a negative prognostic factor in Ewing sarcoma, however, the incidence and significance of sub-centimetre pulmonary nodules at diagnosis is unclear. The aims of this study were to (1): determine the incidence of indeterminate pulmonary nodules (IPNs) in patients diagnosed with Ewing sarcoma (2); establish the impact of IPNs on overall and metastasis-free survival and (3) identify patient, oncological and radiological factors that correlate with poorer prognosis in patients that present with IPNs on their staging chest CT. MATERIALS & METHODS Between 2008 and 2016, 173 patients with a first presentation of Ewing sarcoma of bone were retrospectively identified from an institutional database. Staging and follow-up chest CTs for all patients with IPN were reviewed by a senior radiologist. Clinical and radiologic course were examined to determine overall- and metastasis-free survival for IPN patients and to identify demographic, oncological or nodule-specific features that predict which IPN represent true lung metastases. RESULTS Following radiologic re-review, IPN were found in 8.7% of patients. Overall survival for IPN patients was comparable to those with a normal staging chest CT (2-year overall survival of 73.3% [95% CI 43.6-89] and 89.4% [95% CI 81.6-94], respectively; p = 0.34) and was significantly better than for patients with clear metastases (46.0% [95% CI 31.9-59]; p < 0.0001). Similarly, there was no difference in metastasis-free survival between 'No Metastases' and 'IPN' patients (p = 0.16). Lung metastases developed in 40% of IPN patients at a median 9.6 months. Reduction of nodule size on neoadjuvant chemotherapy was associated with worse overall survival in IPN patients (p = 0.0084). CONCLUSION IPN are not uncommon in patients diagnosed with Ewing sarcoma. In this study, we were unable to detect a difference in overall- or metastasis-free survival between patients with IPN at diagnosis and patients with normal staging chest CTs.
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Affiliation(s)
- K.M. Tsoi
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - D. Tan
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Stevenson
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK,Aston University Medical School, Birmingham, UK
| | - S. Evans
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - L.M. Jeys
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK,Aston University Medical School, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Abstract
AIMS Malignancy and surgery are risk factors for venous thromboembolism (VTE). We undertook a systematic review of the literature concerning the prophylactic management of VTE in orthopaedic oncology patients. METHODS MEDLINE (PubMed), EMBASE (Ovid), Cochrane, and CINAHL databases were searched focusing on VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, or wound complication rates. RESULTS In all, 17 studies published from 1998 to 2018 met the inclusion criteria for the systematic review. The mean incidence of all VTE events in orthopaedic oncology patients was 10.7% (1.1% to 27.7%). The rate of PE was 2.4% (0.1% to 10.6%) while the rate of lethal PE was 0.6% (0.0% to 4.3%). The overall rate of DVT was 8.8% (1.1% to 22.3%) and the rate of symptomatic DVT was 2.9% (0.0% to 6.2%). From the studies that screened all patients prior to hospital discharge, the rate of asymptomatic DVT was 10.9% (2.0% to 20.2%). The most common risk factors identified for VTE were endoprosthetic replacements, hip and pelvic resections, presence of metastases, surgical procedures taking longer than three hours, and patients having chemotherapy. Mean incidence of VTE with and without chemical prophylaxis was 7.9% (1.1% to 21.8%) and 8.7% (2.0% to 23.4%; p = 0.11), respectively. No difference in the incidence of bleeding or wound complications between prophylaxis groups was reported. CONCLUSION Current evidence is limited to guide clinicians. It is our consensus opinion, based upon logic and deduction, that all patients be considered for both mechanical and chemical VTE prophylaxis, particularly in high-risk patients (pelvic or hip resections, prosthetic reconstruction, malignant diagnosis, presence of metastases, or surgical procedures longer than three hours). Additionally, the surgeon must determine, in each patient, if the risk of haemorrhage outweighs the risk of VTE. No individual pharmacological agent has been identified as being superior in the prevention of VTE events. Cite this article: Bone Joint J 2020;102-B(12)1743:-1751.
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Affiliation(s)
- Johnathan R Lex
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada.,Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Scott Evans
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.,Medical School, Keele University, Keele, UK
| | - Jonathan Gregory
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert U Ashford
- Joint Reconstruction and Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Kenneth S Rankin
- Translational and Clinical Sciences Institute, Newcastle University, Newcastle, UK.,North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals NHS Foundation Trust, Newcastle, UK
| | - Tom Cosker
- Orthopaedic Oncology, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Amit Kumar
- Orthopaedics Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Craig Gerrand
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Jonathan Stevenson
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Medical School, Aston University, Birmingham, UK
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Thaker S, Almeer G, Stevenson J, Azzopardi C, Botchu R. Imaging of the lesions in the lateral muscle compartment of the forearm, alias mobile wad of Henry: Demographics, radiological anatomy and surgical relevance. Clin Imaging 2020; 69:374-379. [PMID: 33075596 DOI: 10.1016/j.clinimag.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mobile wad of Henry (MOH) is a preferred surgical term used to describe the lateral compartment muscles of the forearm consisting of brachioradialis, extensor carpi radialis longus and brevis. The lesions in this compartment are uncommon. In this paper, we describe the largest series of the MOH lesions including their demographics, imaging appearances and importance of surgical anatomy whilst managing MOH lesions via radiological or surgical interventions. METHODS A retrospective search of oncology database for lesions in MOH at our tertiary orthopaedic oncology institute was performed for the last 12 years (2007-2019) after obtaining institutional review board approval. We further analyse data to obtain further clarity of various neoplasms occurring at this particular anatomical site. RESULTS We identified 28 patients with MOH lesions with an age range of 8 to 84 years and a male predominance. Imaging-wise, majority of lesions were benign following characteristics of lipomatous tumours, lipomas being the commonest. Other relatively uncommon benign lesions were nodular fasciitis, myositis ossificans and brachioradialis muscle injury; whereas aggressive MOH soft tissue neoplasms included synovial sarcoma and fibrohistiocytoma. CONCLUSION Although majority of MOH lesions are benign, one needs to be aware of spectrum containing uncommon benign and aggressive MOH lesions. When posed with dilemma, the MOH lesions require multidisciplinary approach with close collaboration of the radiologist, the surgeon and the pathologist to decide further management.
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Affiliation(s)
- Siddharth Thaker
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ghassan Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Stevenson
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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Fujiwara T, Stevenson J, Parry M, Tsuda Y, Kaneuchi Y, Jeys L. The adequacy of resection margin for non-infiltrative soft-tissue sarcomas. Eur J Surg Oncol 2020; 47:429-435. [PMID: 32723608 DOI: 10.1016/j.ejso.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There remains no consensus on what constitutes an adequate margin of resection for non-infiltrative soft-tissue sarcomas (STSs). We aimed to investigate the role of resection margins in millimetres for non-infiltrative STSs. METHODS 502 patients who underwent surgical resection for a localized, non-infiltrative, high-grade STSs were studied. The prognostic significance of margin width was analysed and compared with the conventional R- and R+1-classification of surgical margins. RESULTS The overall local recurrence (LR) rate was 13%; 9% and 27% with negative and positive margins, respectively (p < 0.001). In patients with negative margins, the LR rates were greater than 10% in patients with margins ≤5.0 mm but reduced to less than 4% with margins >5.0 mm. When classified by the R- (or R+1)-classification, the 5-year cumulative LR incidence was 8%, 23% (16%), and 31% for R0, R1, and R2, respectively, which did not stratify the LR risk with negative margins. On the other hand, an accurate risk stratification was possible by metric distance; the 5-year cumulative incidence of LR was 29%, 10%, and 1% with 0 mm, 0.1-5.0 mm, and >5.0 mm, respectively (p < 0.001). This classification also stratified the LR risk in patients with or without adjuvant radiotherapy. CONCLUSION While a negative margin is essential to optimize local control in patients with non-infiltrative STSs, surgical margin width greater than 5 mm minimises the risk of local failure regardless of the use of adjuvant radiotherapy.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | | | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yoichi Kaneuchi
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
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Fujiwara T, Kaneuchi Y, Stevenson J, Parry M, Kurisunkal V, Clark R, Tsuda Y, Laitinen M, Grimer R, Jeys L. Navigation-assisted pelvic resections and reconstructions for periacetabular chondrosarcomas. Eur J Surg Oncol 2020; 47:416-423. [PMID: 32788097 DOI: 10.1016/j.ejso.2020.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Survival in patients with chondrosarcomas has not improved over 40 years. Although emerging evidence has documented the efficacy of navigation-assisted surgery, the prognostic significance in chondrosarcomas remains unknown. We aimed to assess the clinical benefit of navigation-assisted surgery for pelvic chondrosarcomas involving the peri-acetabulum. METHODS We studied 50 patients who underwent limb-sparing surgery for periacetabular chondrosarcomas performed with navigation (n = 13) without it (n = 37) at a referral musculoskeletal oncology centre between 2000 and 2015. RESULTS The intralesional resection rates in the navigated and non-navigated groups were 8% (n = 1) and 19% (n = 7), respectively; all bone resection margins were clear in the navigated group. The 5-year cumulative incidence of local recurrence was 23% and 56% in the navigated and non-navigated groups, respectively (p = 0.035). There were no intra-operative complications related to use of navigation. There was a trend toward better functional outcomes in the navigated group (mean MSTS score, 67%) than the non-navigated group (mean MSTS score, 60%; p = 0.412). At a mean follow-up of 63 months, the 5-year disease-specific survival was 76% and 53% in the navigated and non-navigated group, respectively (p = 0.085), whilst the 5-year progression-free survival was 62% and 28% in the navigated and non-navigated group, respectively (p = 0.032). CONCLUSION This study confirmed improved local control and progression-free survival with the use of computer navigation in patients with limb-salvage surgery for periacetabular chondrosarcomas, although the advancement in other treatment modalities is required for improvement of disease-specific survival.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yoichi Kaneuchi
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Vineet Kurisunkal
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rhys Clark
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Minna Laitinen
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Taghavi K, Goddard L, Evans SM, Hobson A, Beasley SW, Sankaran S, Kukkady A, Stevenson J, Stringer MD. Contemporary management of Hirschsprung disease in New Zealand. ANZ J Surg 2020; 90:1037-1040. [PMID: 32483885 DOI: 10.1111/ans.15923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to report the contemporary management of Hirschsprung disease (HD) in New Zealand. METHODS We undertook a national multi-centre retrospective review of all newly diagnosed cases of HD during a 16-year period (2000-2015). Demographics, genetic and syndromic associations, family history, radiology and histology results and surgical interventions were analysed. RESULTS A total of 246 cases (males:females 4:1) were identified, an incidence of 1:3870 live births. Short-segment disease was present in 81.7%, long-segment disease in 8.5%, total colonic aganglionosis in 6.5% and unknown in 3.3%. HD was diagnosed by 4 weeks' corrected gestational age in 67%. Thirty cases (12%) also had Trisomy 21. Fifty-three (21.5%) patients required a repeat rectal biopsy for definitive diagnosis. A contrast enema was performed in 55% and identified the transition zone with 69% accuracy. Primary pull-through surgery was undertaken in 59% (65% of short-segment cases) at a median age of 27 days; others were initially managed by a defunctioning stoma. The commonest definitive procedure was a Soave-Boley endorectal pull-through (79%) (or similar variant). During a median follow-up of 7.4 years, six (2.5%) survivors underwent a redo pull-through, 13 (5.5%) an appendicostomy, 16 (6.8%) a defunctioning stoma and 10 never had a definitive procedure. Total colonic aganglionosis was significantly more likely to be fatal (12.5% versus 0.5%, P < 0.0005) or associated with a permanent end stoma (27.5% versus 4.5%, P < 0.0005). CONCLUSIONS Most New Zealand born infants with short-segment HD are currently managed by primary pull-through, usually in the first months of life.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Surgery and Urology, Starship Children's Health, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Lucy Goddard
- Department of Paediatric Surgery and Urology, Starship Children's Health, Auckland, New Zealand
| | - Stephen M Evans
- Department of Paediatric Surgery and Urology, Starship Children's Health, Auckland, New Zealand
| | - Andrew Hobson
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Spencer W Beasley
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Sasikumar Sankaran
- Department of Paediatric Surgery, Waikato Hospital, Waikato, New Zealand
| | - Askar Kukkady
- Department of Paediatric Surgery, Waikato Hospital, Waikato, New Zealand
| | - Jonathan Stevenson
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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Fujiwara T, Sree DV, Stevenson J, Kaneuchi Y, Parry M, Tsuda Y, Le Nail L, Medellin RM, Grimer R, Jeys L. Acetabular reconstruction with an ice‐cream cone prosthesis following resection of pelvic tumors: Does computer navigation improve surgical outcome? J Surg Oncol 2020; 121:1104-1114. [DOI: 10.1002/jso.25882] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Tomohiro Fujiwara
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
- Department of Orthopaedic SurgeryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Deepak V. Sree
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Jonathan Stevenson
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Yoichi Kaneuchi
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Michael Parry
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Yusuke Tsuda
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Louis‐Romée Le Nail
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Ricardo M. Medellin
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Robert Grimer
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Lee Jeys
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
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Fujiwara T, Tsuda Y, Evans S, Stevenson J, Parry M, Jeys L, Abudu A. Extra-articular resection for bone sarcomas involving the hip joint. J Surg Oncol 2020; 121:258-266. [PMID: 31743447 DOI: 10.1002/jso.25769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/06/2019] [Indexed: 01/24/2023]
Abstract
AIM The aim of this study was to determine the oncologic, functional, and clinical outcomes after the extra-articular resection and limb-salvage reconstruction of the hip joint. METHODS A retrospective study of 34 patients who underwent extra-articular resection of the hip joint for bone sarcomas between 1996 and 2016 was conducted. The primary tumor site was pelvis in 26 patients (76%) and femur in eight (24%). RESULTS The surgical margins achieved were clear in 31 (91%) patients, and seven (21%) patients developed local recurrence; mostly occurring in pelvic tumors (n = 6). The 3-year overall survival was 63% with a median follow-up of 38 months (range, 5-219), which showed no statistical difference in tumor location. The most common complication was deep infection (n = 7) and dislocation (n = 7), mostly seen in pelvic tumors. Implant failure was seen in two patients with pelvic tumors, while no failure was noted in patients with femoral tumors. The median Musculoskeletal Tumour Society score was 69%; 67% for pelvic tumors and 73% for femoral tumors (P = .535). CONCLUSION Despite complex surgery, extra-articular resection of the hip joint can achieve oncologically and functionally acceptable outcomes. While tumors of the pelvis are associated with a higher incidence of infection and local recurrence after resection, resection of tumors involving the femur are well tolerated.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Fujiwara T, Stevenson J, Parry M, Tsuda Y, Tsoi K, Jeys L. What is an adequate margin for infiltrative soft-tissue sarcomas? Eur J Surg Oncol 2020; 46:277-281. [DOI: 10.1016/j.ejso.2019.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/24/2019] [Accepted: 10/05/2019] [Indexed: 01/18/2023] Open
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Fujiwara T, Tsuda Y, Stevenson J, Parry M, Jeys L. Sacral chordoma: do the width of surgical margin and the use of photon/proton radiotherapy affect local disease control? Int Orthop 2019; 44:381-389. [PMID: 31863159 DOI: 10.1007/s00264-019-04460-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Chordoma is a rare but highly aggressive primary bone sarcoma that arises commonly from the sacrum. While en bloc resection has been the mainstay of the treatment, the role of resection margin in millimetres with/without adjuvant radiotherapy (RT) has been unknown. We investigated the prognostic impact of surgical margin width, adjuvant RT, and their combined factor for sacral chordoma. METHODS Forty-eight patients who underwent surgical treatment between 1996 and 2016 were studied. Of these, 11 patients (23%) received adjuvant RT; photon RT in 7 (15%) and proton RT in 4 (8%). Margins were microscopically measured in millimetres from the resection surface to the closest tumour on histologic slides. RESULTS The five year and ten year disease-specific survival was 88% and 58%, respectively, and the local recurrence (LR) rate was 48%. The LR rate with 0-mm, < 1.5-mm, and ≥ 1.5-mm margin was 50% (group 1), 50% (group 2: RT-, 61%; group 3: RT+, 14%), and 0% (group 4), respectively. We observed a significantly lower LR rate in patients with adjuvant photon/proton RT (18%) than without it (57%; p = 0.026), and no LR was observed after post-operative proton RT. The combined factor of margin with RT clearly stratified the LR risk: patients of group 1 (positive margin) and 2 (< 1.5-mm margin, RT-) had approximately 7.5× LR risk (p = 0.049) compared with those of group 3 (< 1.5-mm margin, RT+) and 4 (≥ 1.5-mm margin). CONCLUSION This study identified the lowest risk of local failure in tumour resection with ≥ 1.5-mm margin or negative but < 1.5-mm margin with the use of adjuvant photon/proton radiotherapy for sacral chordoma. Early results of adjuvant proton RT demonstrated excellent local control.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK. .,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Southam S, Ayub M, Krebs M, Rothwell D, Graham D, Stevenson J. Application of variant interpretation software to decipher pathogenicity of mutations for a molecular tumour board (MTB). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yang P, Gilg M, Evans S, Totti F, Stevenson J, Jeys L, Parry M. Survival of osteosarcoma patients following diagnosis of synchronous skip metastases. J Orthop 2019; 18:121-125. [PMID: 32021017 DOI: 10.1016/j.jor.2019.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 11/15/2022] Open
Abstract
Background We aim to investigate the prognostic implications of synchronous skip metastases in osteosarcoma by presenting the largest single centre series to date. Methods Retrospective study of 21 osteosarcoma patients with skip metastases treated between 1983 and 2004. Results No statistical difference in overall survival was demonstrated when comparing presence of lung metastases to those without (p = 0.859). No statistical difference was found in overall survival according to age group (<18yrs vs >18yrs; p = 0.126), or to percentage chemotherapy-induced bone necrosis (<90% vs >90%; p = 0.056). Conclusions The presence of skip metastases confers a very poor prognosis as an independent variable. Level of evidence III.
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Affiliation(s)
- Peiming Yang
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | | | - Scott Evans
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | | | | | - Lee Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
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Murphy L, Laurent J, Mathews K, Stevenson J, Thiele S, Vissing J, Walter M, Woods L, Straub V. P.389Global FKRP registry. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Randall A, Stevenson J, Heaney S, Notaras S, Hoffman A, Choi P, Brown M, Sud K. SUN-103 PREVALENCE OF MALNUTRITION & NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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RANDALL A, Stevenson J, Heaney S, Notaras S, Hoffman A, Choi P, Brown M, Sud K. SUN-102 NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nandra R, Matharu G, Stevenson J, Parry M, Grimer R, Jeys L. Long-term outcomes after an initial experience of computer-navigated resection of primary pelvic and sacral bone tumours. Bone Joint J 2019; 101-B:484-490. [PMID: 30929483 DOI: 10.1302/0301-620x.101b4.bjj-2018-0981.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. Patients and Methods This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, using computer navigation, between 2010 and 2012. The mean age of the patients at the time of presentation was 51 years (10 to 77). The rates of local recurrence and mortality were calculated using the Kaplan–Meier method. Results Bone resection margins were all clear and there were no bony recurrences. At a mean follow-up for all patients of 59 months (12 to 93), eight patients (34.8%) developed soft-tissue local recurrence, with a cumulative rate of local recurrence at six-years of 35.1% (95% confidence interval (CI) 19.3 to 58.1). The cumulative all-cause rate of mortality at six-years was 26.1% (95% CI 12.7 to 49.1). Conclusion Despite the positive early experience with navigated-assisted resection, local recurrence rates remain high. With increasing knowledge of the size of soft-tissue margins required to reduce local recurrence and the close proximity of native structures in the pelvis, we advise against compromising resection to preserve function, and encourage surgeons to reduce local recurrence by prioritizing wide resection margins of the tumour. Cite this article: Bone Joint J 2019;101-B:484–490.
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Affiliation(s)
- R. Nandra
- West Midlands Deanery, Birmingham, UK
| | | | - J. Stevenson
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - M. Parry
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - R. Grimer
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - L. Jeys
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
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