1
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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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2
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Espinola-Nadurille M, Restrepo-Martínez M, Bayliss L, Flores-Montes E, Rivas-Alonso V, Vargas-Cañas S, Hernández L, Martínez-Juarez I, Gonzalez-Aguilar A, Solis-Vivanco R, Fricchione GL, Flores-Rivera J, Ramirez-Bermudez J. Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study. Psychol Med 2023; 53:4266-4274. [PMID: 35534479 DOI: 10.1017/s0033291722001027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. METHODS A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. RESULTS After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia-delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. CONCLUSIONS Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia-delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.
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Affiliation(s)
- M Espinola-Nadurille
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - M Restrepo-Martínez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - L Bayliss
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - E Flores-Montes
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - V Rivas-Alonso
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - S Vargas-Cañas
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - L Hernández
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - I Martínez-Juarez
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - A Gonzalez-Aguilar
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - R Solis-Vivanco
- Laboratory of Cognitive and Clinical Neurophysiology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - G L Fricchione
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA
| | - J Flores-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - J Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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3
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Rajakulasingam R, Lindsay D, Bayliss L, Saifuddin A. Test yourself question: right third toe swelling. Skeletal Radiol 2021; 50:239-240. [PMID: 32621062 DOI: 10.1007/s00256-020-03534-5] [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: 02/02/2023]
Affiliation(s)
- Ramanan Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - D Lindsay
- Department of Histopathology, Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - L Bayliss
- Department of Orthopaedic surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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4
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Iliadis AD, Eastwood DM, Bayliss L, Cooper M, Gibson A, Hargunani R, Calder P. Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic: The Royal National Orthopaedic Hospital experience. Bone Jt Open 2020; 1:287-292. [PMID: 33215116 PMCID: PMC7659631 DOI: 10.1302/2046-3758.16.bjo-2020-0060.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. METHODS All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge. RESULTS Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households. CONCLUSION Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process.Cite this article: Bone Joint Open 2020;1-6:287-292.
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Affiliation(s)
| | | | - Lee Bayliss
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Cooper
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | | | - Peter Calder
- Royal National Orthopaedic Hospital, Stanmore, UK
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5
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Iliadis AD, Eastwood DM, Bayliss L, Cooper M, Gibson A, Hargunani R, Calder P. Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic. Bone Jt Open 2020. [DOI: 10.1302/2633-1462.16.bjo-2020-0060.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/23/2022] Open
Abstract
Introduction In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. Methods All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge. Results Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households. Conclusion Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process. Cite this article: Bone Joint Open 2020;1-6:287–292.
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Affiliation(s)
| | | | - Lee Bayliss
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Cooper
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | | | - Peter Calder
- Royal National Orthopaedic Hospital, Stanmore, UK
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6
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Smith S, Alvand A, Locock L, Ryan S, Smith J, Bayliss L, Wilson H, Price A. Partial or total knee replacement? Identifying patients' information needs on knee replacement surgery: a qualitative study to inform a decision aid. Qual Life Res 2019; 29:999-1011. [PMID: 31848846 PMCID: PMC7142054 DOI: 10.1007/s11136-019-02381-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Abstract
Purpose For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Methods Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Results Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Conclusions Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended. Electronic supplementary material The online version of this article (10.1007/s11136-019-02381-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Ryan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Lee Bayliss
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Hannah Wilson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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7
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Abstract
This annotation briefly reviews the history of artificial intelligence and machine learning in health care and orthopaedics, and considers the role it will have in the future, particularly with reference to statistical analyses involving large datasets. Cite this article: Bone Joint J 2019;101-B:1476–1478
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Affiliation(s)
- Lee Bayliss
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Surgery, Botnar Research Centre, Oxford, UK
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8
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Espinola-Nadurille M, Bustamante-Gomez P, Ramirez-Bermudez J, Bayliss L, Rivas-Alonso V, Flores-Rivera J. Frequency of neuropsychiatric disturbances in anti-NMDA receptor encephalitis. Acta Psychiatr Scand 2018; 138:483-485. [PMID: 30367468 DOI: 10.1111/acps.12963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/06/2023]
Affiliation(s)
- M Espinola-Nadurille
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico
| | - P Bustamante-Gomez
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico
| | - J Ramirez-Bermudez
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico.,Commission of the National Institutes of Health, Mexico City, Mexico
| | - L Bayliss
- Department of Neurology, NINN, Mexico City, Mexico
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9
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Abstract
BACKGROUND Arthroscopic surgery of the knee is one of the most frequently performed orthopaedic procedures. One-third of these procedures are performed for meniscal injuries. It is essential that this commonly performed surgery be supported by robust evidence. PURPOSE To compare the effectiveness of arthroscopic surgery for meniscal injuries in all populations. STUDY DESIGN Systematic review. METHODS An online search was conducted for randomized controlled trials (RCTs) and systematic reviews (SRs) that compared treatment options for meniscal injury. The following databases (inception to April 2015) were included in the search: CENTRAL; MEDLINE; EMBASE; NHS Evidence; National Guideline Clearing House, Database of Abstracts of Reviews of Effects, Health Technology Assessment; ISRCTN; Clinicaltrials.gov ; WHO trials platform. Only studies whose participants were selected on the basis of meniscal injury were included; no restrictions were placed on patient demographics. Two independent reviewers applied AMSTAR (A Measurement Tool to Assess Systematic Reviews) criteria for SRs and the Cochrane Collaboration risk-of-bias tool for RCTs. RESULTS Nine RCTs and 8 SRs were included in the review. No difference was found between arthroscopic meniscal debridement compared with nonoperative management as a first-line treatment strategy for patients with knee pain and a degenerative meniscal tear (mean difference: Knee injury and Osteoarthritis Outcome Score, 1.6 [95% CI, -2.2 to 5.2], pain visual analog scale, -0.06 [95% CI, -0.28 to 0.15]). Some evidence was found to indicate that patients with resistant mechanical symptoms who initially fail nonoperative management may benefit from meniscal debridement No studies compared meniscal repair with meniscectomy or nonoperative management. Initial evidence suggested that meniscal transplant might be favorable in certain patient groups. CONCLUSION Further evidence is required to determine which patient groups have good outcomes from each intervention. Given the current widespread use of arthroscopic meniscal surgeries, more research is urgently needed to support evidence-based practice in meniscal surgery in order to reduce the numbers of ineffective interventions and support potentially beneficial surgery.
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Affiliation(s)
- Paul Monk
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lee Bayliss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Hilven PH, Bayliss L, Cosker T, Dijkstra PDS, Jutte PC, Lahoda LU, Schaap GR, Bramer JAM, van Drunen GK, Strackee SD, van Vooren J, Gibbons M, Giele H, van de Sande MAJ. The vascularised fibular graft for limb salvage after bone tumour surgery. Bone Joint J 2015; 97-B:853-61. [DOI: 10.1302/0301-620x.97b6.34692] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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
Vascularised fibular grafts (VFGs ) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women with mean age of 23 years (1 to 64) from four tertiary centres for orthopaedic oncology who underwent reconstruction using a VFG after resection of a tumour between 1996 and 2011. There were 52 primary and 22 secondary reconstructions. The mean follow-up was 77 months (10 to 195). In all, 69 patients (93%) had successful limb salvage; all of these united and 65 (88%) showed hypertrophy of the graft. The mean time to union differed between those involving the upper (28 weeks; 12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a greater proportion in lower limb reconstructions, non-bridging osteosynthesis, and in children. These complications resulted in revision surgery in 26 patients (35%). VFG is a successful and durable technique for reconstruction of a defect in bone after resection of a tumour, but is accompanied by a significant risk of complications, that often require revision surgery. Union was not markedly influenced by the need for chemo- or radiotherapy, but should not be expected during chemotherapy. Therefore, restricted weight-bearing within this period is advocated. Cite this article: Bone Joint J 2015;97-B:853–61.
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Affiliation(s)
- P. H. Hilven
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - L. Bayliss
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - T. Cosker
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - P. D. S. Dijkstra
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - P. C. Jutte
- University Medical Center, Hanzeplein
1 Postbus 30.001 9700 RB Groningen, The, Netherlands
| | | | - G. R. Schaap
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - J. A. M. Bramer
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - G. K. van Drunen
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - S. D. Strackee
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - J. van Vooren
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - M. Gibbons
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - H. Giele
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
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12
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Griffiths D, Gikas PD, Jowett C, Bayliss L, Aston W, Skinner J, Cannon S, Blunn G, Briggs TWR, Pollock R. Proximal humeral replacement using a fixed-fulcrum endoprosthesis. ACTA ACUST UNITED AC 2011; 93:399-403. [PMID: 21357964 DOI: 10.1302/0301-620x.93b3.24421] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation.
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Affiliation(s)
- D Griffiths
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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13
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Abstract
Chondral damage to the knee is common and, if left untreated, can proceed to degenerative osteoarthritis. In symptomatic patients established methods of management rely on the formation of fibrocartilage which has poor resistance to shear forces. The formation of hyaline or hyaline-like cartilage may be induced by implanting autologous, cultured chondrocytes into the chondral or osteochondral defect. Autologous chondrocyte implantation may be used for full-thickness chondral or osteochondral injuries which are painful and debilitating with the aim of replacing damaged cartilage with hyaline or hyaline-like cartilage, leading to improved function. The intermediate and long-term functional and clinical results are promising. We provide a review of autologous chondrocyte implantation and describe our experience with the technique at our institution with a mean follow-up of 32 months (1 to 9 years). The procedure is shown to offer statistically significant improvement with advantages over other methods of management of chondral defects.
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Affiliation(s)
- P. D. Gikas
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - L. Bayliss
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - G. Bentley
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - T. W. R. Briggs
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
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Hanna SA, Qureshi YA, Bayliss L, David LA, O'Donnell P, Judson IR, Briggs TWR. Late widespread skeletal metastases from myxoid liposarcoma detected by MRI only. World J Surg Oncol 2008; 6:62. [PMID: 18564429 PMCID: PMC2440383 DOI: 10.1186/1477-7819-6-62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 06/18/2008] [Indexed: 11/24/2022] Open
Abstract
Background Myxoid liposarcoma is the second most commonly occurring sub-type of liposarcomas. In contrast to other soft tissue sarcomas, it is known to have a tendency to spread toward extrapulmonary sites, such as soft tissues, retroperitoneum, and the peritoneal surface. Bony spread, however, is not as common. Case presentation We report an unusual case of diffuse skeletal metastases from myxoid liposarcoma occurring 13 years after treatment of the primary tumour in the left lower limb. The skeletal spread of the disease was demonstrated on MRI only after other imaging modalities (plain radiography, CT and TC99 bone scans) had failed to detect these metastases. Conclusion MRI is an extremely sensitive and specific screening tool in the detection of skeletal involvement in these types of sarcomas, and therefore, should be a part of the staging process.
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Affiliation(s)
- Sammy A Hanna
- London Bone and Soft Tissue Tumour Service, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
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Bayliss L, Connolly S, Flint R, Garthwaite E. Sensible drinking ... or elsewhere. BMJ 1996; 312:507. [PMID: 8597695 PMCID: PMC2349948 DOI: 10.1136/bmj.312.7029.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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