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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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Papalia GF, Ariyaratne S, Sison J, Morris G, Vaiyapuri S, Kurisunkal V, Botchu R. An unusual cystic presentation of pelvic skeletal Ewing sarcoma: a case series. Skeletal Radiol 2024:10.1007/s00256-024-04660-0. [PMID: 38625623 DOI: 10.1007/s00256-024-04660-0] [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: 11/27/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/17/2024]
Abstract
Ewing sarcoma (ES) is the second most common primary malignant bone tumour in children and adolescents. About 14.5% of primary malignancies develop in pelvic bones, where they typically have worse prognoses than extremity or acral sarcomas. It usually presents with aggressive features on radiology scans, but may also present with different radiological characteristics. In this series, we describe rare appearances of pelvic skeletal Ewing sarcoma, with large extraosseous cystic component on imaging, defined by the presence of fluid-filled spaces in the extraosseous tumour lesion, which distinguishes it from the solid nature of conventional ES. We report 3 cases of cystic presentation of ES, with imaging features supporting diagnosis of a primary malignant bone tumour arising from the superior pubic ramus with associated massive intrapelvic solid and cystic mass. CT-guided biopsy provided diagnosis of ES, with large intrapelvic soft tissue and cystic component. These patients underwent neo-adjuvant chemotherapy and proton beam therapy with significant reduction in size of the solid components, while the cystic components remained relatively unchanged. Two patients underwent surgical resection of the tumour (navigated P3 internal hemipelvectomy and hemipelvis P2/P3 resection, respectively), and one patient died while on treatment. In both who underwent surgery, histology showed ES with margins clear and more than 99% of treatment-induced necrosis. To the authors' knowledge, this unusual presentation of pelvic ES is described for the first time in the literature as a case series, with particular reference to atypical extraosseous cystic changes, along with the clinical and radiological characteristics, and their treatment.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy.
| | - Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Jerome Sison
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - Guy Morris
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | | | - Vineet Kurisunkal
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Nischal N, Kurisunkal V, Jeys L, Davies M, Botchu R. Incidence of avascular necrosis of native femur following hip transposition surgery for periacetabular malignancies: a single-centre experience. Hip Int 2024:11207000241241288. [PMID: 38566283 DOI: 10.1177/11207000241241288] [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] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hip transposition surgery after surgical resection of large pelvic tumours is a well-established alternate to endoprosthetic reconstruction. The major goals of surgery are to ensure adequate resection margins with limb salvation, albeit with acceptable levels of morbidity. While surveillance is aimed at diagnosing local recurrence or distant metastasis primarily, other complications may occasionally be seen.The aim of this study was to assess incidence of avascular necrosis (AVN) in the preserved native femoral heads after hip transposition surgery for periacetabular malignancies, also known as hanging hip surgery. PATIENTS AND METHODS Patient records and follow-up imaging of 22 patients who had undergone hanging hip surgery from 1999 to 2020 were retrospectively analysed to assess for any probable causes of AVN. RESULTS Of the 22 patients, 5 (22.7%) had developed AVN on follow-up with a mean time of onset of about 10.5 months from surgery (5 months-2 years). A review of the patient demographics, surgical notes, preoperative management did not offer any clues as to the cause of AVN in these patients. Osteopenia was the most common radiological finding (59%) in most patients, but this also did not herald AVN onset. CONCLUSIONS The theory that loss of major vascular supply to the femoral head from capsular disruption during hip transposition surgery would lead to AVN in most patients did not hold true as AVN occurred in a small number of patients.
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Affiliation(s)
- Neha Nischal
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Holy Family Hospital, New Delhi, India
| | | | - Lee Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Mark Davies
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Cubitt C, Ariyaratne S, Vaiyapuri S, Kurisunkal V, Botchu R. An unusual case of metastatic melanoma in subcutaneous tissue presenting as a solitary cystic mass with fluid levels. J Ultrasound 2024:10.1007/s40477-023-00864-7. [PMID: 38400991 DOI: 10.1007/s40477-023-00864-7] [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: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/26/2024] Open
Abstract
Malignant melanoma is a common and often aggressive neoplasm of the skin arising from melanocytes. Metastatic melanoma is known for its diverse clinical manifestations, and can present with atypical features prior to diagnosis of the primary lesion, which can pose a diagnostic challenge. We report a rare case of metastatic melanoma in a 67 year-old male who presented with a painless, enlarging mass in the right axilla over a 4 week period. Ultrasound and magnetic resonance imaging (MRI) scans revealed a well-defined solitary, cystic appearing lesion in the right axilla with a distinct fluid-fluid level. An ultrasound guided biopsy of the lesion diagnosed a metastatic melanoma. While haemorrhagic distant metastases are a well-recognised complication of malignant melanoma, particularly in the brain and lung, soft tissue metastases presenting with fluid-fluid levels is not well described in the literature. The case highlights the importance of considering the differential of melanoma metastasis when encountered with such a lesion and importance of ultrasound guided biopsy for histopathological confirmation, as the imaging features can mimic that of a haemorrhagic soft tissue sarcoma, the management of which differs substantially from that of melanoma.
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Affiliation(s)
- Catherine Cubitt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sisith Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Sumathi Vaiyapuri
- Department of Pathology, University Hospitals Birmingham, Birmingham, UK
| | - Vineet Kurisunkal
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK
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Laitinen MK, Thorkildsen J, Morris G, Kurisunkal V, Stevenson JD, Parry MC, Jeys LM. Intraosseous conventional central chondrosarcoma does not metastasise irrespective of grade in pelvis, scapula and in long bone locations. J Bone Oncol 2023; 43:100514. [PMID: 38033413 PMCID: PMC10682821 DOI: 10.1016/j.jbo.2023.100514] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
Background Histological grade has been regarded as the most important prognostic factor in conventional central chondrosarcoma. To evaluate whether the presence of an extraosseous tumour component is associated with a decreased metastasis-free survival or disease-specific survival and alternatively to develop a simple prognostic and clinical decision-making tool. Material and methods We searched two prospectively maintained international sarcoma centre databases for primary non metastatic central conventional chondrosarcomas of all grades in pelvis, scapula or long bone location, undergoing curative treatment, diagnosed between 2000 and 2020. Pre-treatment MRI scans were reviewed for the presence of an extraosseous mass. The metastasis-free survival (MFS) and disease-specific survival (DSS) were estimated by the Kaplan-Meier method from surgery to event, death or last follow-up. Results 336 patients were identified between 2000 and 2020, undergoing surgical treatment for conventional central chondrosarcoma. 111 patients (33 %) had grade 1 tumours, 149 patients (44 %) had grade 2, and 76 patient (23 %) had grade 3 chondrosarcomas determined as the highest grade in the final resected specimen. An extraosseous soft tissue component was more frequent in higher grade tumours (p < 0.001) and present in 200 cases (60 %). None of the patients with an intraosseous tumour developed metastases or died of the disease. For patients with extraosseous tumour component, MFS was 92 % (95 % CI, 96-100) at 2-years and 74 % (95 % CI, 67-81) at 10-years and DSS was 91 % (95 % CI, 87-95) at 2-years and 75 % (95 % CI, 68-82) at 10-years. The MFS and DSS was significantly different (p < 0.001) for those patients with or without an extraosseous tumour component, irrespective of grade or anatomical location. Discussion The results of this study has shown that the metastatic potential of intraosseous conventional central chondrosarcoma is negligible. The presence of an extraosseous soft tissue component may be used for prognostication and to guide treatment pathways for patients with central cartilage tumours.
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Affiliation(s)
- Minna K. Laitinen
- Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | - Guy Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK
- Aston University Medical School. Aston University, Birmingham, UK
| | - Michael C. Parry
- Royal Orthopaedic Hospital, Birmingham, UK
- Aston University Medical School. Aston University, Birmingham, UK
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
- Faculty of Health Sciences, Aston University, Birmingham, UK
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Hegde G, Iyengar KP, Kurisunkal V, Sharma GK, Ariyaratne S, Botchu R. Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review. J Orthop 2023; 44:99-106. [PMID: 37746308 PMCID: PMC10514383 DOI: 10.1016/j.jor.2023.08.011] [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: 06/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours. Aims In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted. Material and methods A retrospective search using the keyword 'musculoskeletal system', 'neoplasms', 'biopsy', and 'interventional radiology' was performed at our tertiary care oncology orthopaedic referral centre radiology database. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS). Electronic Patient Records, histopathology laboratory records and patient characteristics were collaborated to generate this narrative experience at our centre. Results Image-guided interventional procedures have been utilised in a spectrum of primary and secondary MSK tumours. Current applications include diagnosis of bone and soft tissue MSK neoplastic lesions with biopsies, thermal, cryotherapy and Radiofrequency ablations and augmentation procedures. Conclusion Musculoskeletal (MSK) image-guided interventions have increasing applications in the diagnosis, management, treatment and monitoring of patients with MSK tumours. The emergence of newer imaging technologies with enhanced skills of interventional radiologists will allow a range of therapeutic MSK interventions in both effective control of primary lesions and palliative care of metastatic lesions.
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Affiliation(s)
- Ganesh Hegde
- Department of Musculoskeletal Radiology, Royal National Orthopedic Hospital, Stanmore, UK
| | | | - Vineet Kurisunkal
- Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Saad A, Iyengar KP, Kurisunkal V, Botchu R. Assessing ChatGPT's ability to pass the FRCS orthopaedic part A exam: A critical analysis. Surgeon 2023; 21:263-266. [PMID: 37517980 DOI: 10.1016/j.surge.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
AI technology has made significant advancements in recent years, with the notable development of ChatGPT in November 2022. Users have observed evidence of deductive reasoning, logical thinking, and coherent thought in ChatGPT's responses. This study aimed to determine if ChatGPT has the capability to pass the Orthopaedic Fellow of the Royal College of Surgeons (FRCS Orth) Part A exam. METHODS To assess ChatGPT4's ability to pass the Orthopaedic FRCS Orth Part A exam, a study was conducted using 240 mock FRCS Orth Part A questions. The study evaluated the accuracy of ChatGPT's answers and the response time for each question. Descriptive statistics were employed to analyse the chatbot's performance. RESULTS The evaluation revealed that ChatGPT4 achieved an overall score of 67.5% on Part A of the exam. However, ChatGPT4 did not meet the overall pass mark required for the FRCS Orth Part A exam. CONCLUSION This study demonstrates that ChatGPT was unable to pass the FRCS Orthopaedic examination. Several factors contributed to this outcome, including the lack of critical or high-order thinking abilities, limited clinical expertise, and the inability to meet the rigorous requirements of the exam.
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Affiliation(s)
- Ahmed Saad
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK.
| | - Karthikeyan P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK.
| | - Vineet Kurisunkal
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK.
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Saad A, Iyengar KP, Kurisunkal V, Morris G, Davies AM, Botchu R. Isolated lesions of the pubis. Clin Radiol 2023; 78:724-729. [PMID: 37453806 DOI: 10.1016/j.crad.2023.05.023] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023]
Abstract
The osseous pelvis is a well-known area of various primary and secondary bone tumours, tumour mimics, and infections. Isolated lesions of the pubis (ILP) are rare, with few case reports in the literature. Given their sparsity, such lesions may pose a great diagnostic challenge due to varied clinical presentations and imaging features. In this study, we report the largest case series of ILP. We discuss the patient demographics, differentials, surgical approaches, and management.
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Affiliation(s)
- A Saad
- Departments of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - K P Iyengar
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - V Kurisunkal
- Departments of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - G Morris
- Departments of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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Botchu R, Jalli J, Kurisunkal V, Iyengar KP. Iliotibial band friction syndrome after knee cementoplasty: a case report. J Ultrasound 2023:10.1007/s40477-023-00792-6. [PMID: 37300638 DOI: 10.1007/s40477-023-00792-6] [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: 02/22/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023] Open
Abstract
Iliotibial band pathologies can result in lateral knee pain. These are commonly seen in runners and cyclists. Lateral knee pain following knee arthroplasty can be due to distal iliotibial band enthesopathy or impingement by the femoral component. Cementoplasty is a common procedure performed during treatment of osseous lesions. We describe a case of ITB friction syndrome due to small focus of cement following cementoplasty for GCT (giant cell tumour).
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Affiliation(s)
- Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| | - Janaranjan Jalli
- Department of Radiology, Dorchester County Hospital, Dorchester, UK
| | - Vineet Kurisunkal
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
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Kurisunkal V, Morris G, Kaneuchi Y, Bleibleh S, James S, Botchu R, Jeys L, Parry MC. Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee. Bone Joint J 2023; 105-B:696-701. [PMID: 37257857 DOI: 10.1302/0301-620x.105b6.bjj-2022-0068.r2] [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] [Indexed: 06/02/2023]
Abstract
Aims Intra-articular (IA) tumours around the knee are treated with extra-articular (EA) resection, which is associated with poor functional outcomes. We aim to evaluate the accuracy of MRI in predicting IA involvement around the knee. Methods We identified 63 cases of high-grade sarcomas in or around the distal femur that underwent an EA resection from a prospectively maintained database (January 1996 to April 2020). Suspicion of IA disease was noted in 52 cases, six had IA pathological fracture, two had an effusion, two had prior surgical intervention (curettage/IA intervention), and one had an osseous metastasis in the proximal tibia. To ascertain validity, two musculoskeletal radiologists (R1, R2) reviewed the preoperative imaging (MRI) of 63 consecutive cases on two occasions six weeks apart. The radiological criteria for IA disease comprised evidence of tumour extension within the suprapatellar pouch, intercondylar notch, extension along medial/lateral retinaculum, and presence of IA fracture. The radiological predictions were then confirmed with the final histopathology of the resected specimens. Results The resection histology revealed 23 cases (36.5%) showing IA disease involvement compared with 40 cases without (62%). The intraobserver variability of R1 was 0.85 (p < 0.001) compared to R2 with κ = 0.21 (p = 0.007). The interobserver variability was κ = 0.264 (p = 0.003). Knee effusion was found to be the most sensitive indicator of IA involvement, with a sensitivity of 91.3% but specificity of only 35%. However, when combined with a pathological fracture, this rose to 97.5% and 100% when disease was visible in Hoffa's fat pad. Conclusion MRI imaging can sometimes overestimate IA joint involvement and needs to be correlated with clinical signs. In the light of our findings, we would recommend EA resections when imaging shows effusion combined with either disease in Hoffa's fat pad or retinaculum, or pathological fractures.
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Affiliation(s)
| | - Guy Morris
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Sabri Bleibleh
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Steven James
- Department of Radiology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Radiology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
- Department of Health and Life Sciences, Aston University, Birmingham, UK
| | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
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11
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Mahoney R, Khan Z, Abudu A, Kurisunkal V, Evans S, Jeys LM. Outcomes of distal radial endoprostheses for tumour reconstruction: a single centre experience over 15 years. J Hand Surg Eur Vol 2022; 47:1147-1154. [PMID: 35950216 DOI: 10.1177/17531934221116469] [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] [Indexed: 02/03/2023]
Abstract
We report a retrospective study over a 15-year period, between 2005 and 2020, evaluating clinical and functional outcomes in patients who underwent reconstruction of the distal radius with an endoprosthetic replacement following excision of both malignant and aggressive benign bone tumours. Data was collected retrospectively from a prospectively maintained electronic database, and prospectively via telephone patient consultation. Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were assessed at a minimum of 1 year postoperatively. Of nine implants, five were arthrodeses and four were arthroplasties. One patient required amputation within 6 months for proximal metastatic disease. At last follow-up, eight patients subjectively reported good function. Five patients returned to high functionally demanding jobs. Mean Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were 72% and 50/100, respectively. We conclude that distal radius endoprosthetic replacements offer acceptable functional outcomes and remain a viable option when biological reconstruction is not possible.Level of evidence: IV.
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Affiliation(s)
- Rachel Mahoney
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Health and Life Sciences, Aston University, Birmingham, UK
| | - Zeeshan Khan
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Adesegun Abudu
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Scott Evans
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Health and Life Sciences, Aston University, Birmingham, UK
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12
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Iyengar K, Mishra A, Vaish A, Kurisunkal V, Vaishya R, Botchu R. Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature. J Clin Orthop Trauma 2022; 35:102068. [PMID: 36420107 PMCID: PMC9676389 DOI: 10.1016/j.jcot.2022.102068] [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: 07/11/2022] [Revised: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings. Patients and methods A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected. Results We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort. Conclusion Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.
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Affiliation(s)
- K.P. Iyengar
- Department of Orthopaedics, Southport and Ormskirk, Southport, UK
| | - A. Mishra
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - A. Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - V. Kurisunkal
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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13
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Gulia A, Kurisunkal V, Puri A, Nayak P, Rekhi B. Clear Cell Chondrosarcoma—Oncological Outcomes in an Asian Cohort. Indian J Surg Oncol 2021; 13:282-287. [DOI: 10.1007/s13193-021-01450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
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14
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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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15
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Lex JR, Kurisunkal V, Kaneuchi Y, Fujiwara T, Sherriff J, Wigley C, Stevenson JD, Parry MC, Jeys LM. Pelvic Ewing sarcoma: Should all patients receive pre-operative radiotherapy, or should it be delivered selectively? Eur J Surg Oncol 2021; 47:2618-2626. [PMID: 34030919 DOI: 10.1016/j.ejso.2021.05.027] [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: 02/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Locally recurrent disease following surgical resection of Ewing sarcoma (ES) confers a poor prognosis. Limited evidence is available evaluating non-selective use of pre-operative radiotherapy (RT) for patients with pelvic ES and its effect on local control and survival. PATIENTS AND METHODS 49 consecutive patients with pelvic ES were identified retrospectively from a prospectively collated database. Patients either received non-selective pre-operative RT and surgery (n = 27), or selective post-operative RT (n = 22) (surgery alone (n = 11) or surgery and post-operative RT (n = 11)). RESULTS Patients who had non-selective pre-operative radiotherapy appeared to have a higher LRFS, 88.0% compared to 66.5% in the selective RT group (p = 0.096, Kaplan Meier; p = 0.028, Chi-squared). Administration of non-selective, pre-operative RT to all patients with pelvic ES elevates the LFRS to that of the good responder group (≥90% tumour necrosis and margins, p = 0.880). There was no difference in metastasis-free survival, 60.0% and 54.5% (p = 0.728) and overall survival (OS), 57.7% and 63.6% (p = 0.893). The majority of pre-operative RT patients had both good necrosis (≥90%) (p = 0.003) and widely excised tumours, 81.5% vs 59.1% (p = 0.080). Tumour volume ≥250 ml was associated with worse LRFS (p = 0.045) and post-operative complications (p = 0.017). There may be improved LRFS (p = 0.057) with pre-operative proton-beam RT compared to surgery and selective post-operative RT. CONCLUSION Pre-operative photon or proton-beam RT to all pelvic ES may improve LRFS compared to the selective delivery of post-operative RT. Radiotherapy delivered to all patients results in a greater percentage of highly necrotic tumours at surgical excision, enabling a greater proportion of patients with wide resection margins.
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Affiliation(s)
- Johnathan R Lex
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
| | - Vineet Kurisunkal
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Tomohiro Fujiwara
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Jenny Sherriff
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Catrin Wigley
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Jonathan D Stevenson
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK.
| | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK.
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK; Faculty of Health Sciences, Aston University, Birmingham, UK.
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Gulia A, Puri A, Gupta S, Kurisunkal V. 'Umbrella construct' - an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours. Shoulder Elbow 2021; 13:188-194. [PMID: 33897850 PMCID: PMC8039762 DOI: 10.1177/1758573219895988] [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: 08/28/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/15/2022]
Abstract
AIM Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique 'Umbrella construct' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. METHODS Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14-36 years). The maximum longitudinal extent of disease was 9 cm (range 5-9 cm). RESULTS The median follow-up was 54 months (range 34-122 months). The mean allograft incorporation time was 7 months (5-8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23-29). CONCLUSIONS Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.
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Affiliation(s)
- Ashish Gulia
- Ashish Gulia, Tata Memorial Hospital, Main building
OPD - 93, Dr Ernst Borges Road, Parel, Mumbai 400012, India.
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17
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Abstract
Background: Primary bone sarcomas mainly metastasize through haematogenous route and rarely through lymph nodes due to paucity of lymphatic channels in the bone (1). Nodal spread in chondrosarcoma is extremely rare and there are two reported cases in literature including one previously published by our institute (3, 5). Aims and Objectives: We present a series of chondrosarcoma cases (primary tumour located in the scapula, proximal femur, proximal humerus and pelvis), presenting with lymph node metastasis, treated at our institute. We assessed the oncological outcome of these cases and the impact of nodal metastasis on survival. Materials and Methods: Between January 2006 and December 2015, 243 patients of extremity and pelvic chondrosarcoma were operated at our institute. These cases were retrieved from a prospectively maintained database. Four (1.6%) of these patients developed lymph node metastasis. Clinical and radiological details of these cases were retrieved from electronic medical records and case files. Histopathology of the primary chondrosarcoma lesion and nodal metastasis was reconfirmed by a pathologist specializing in sarcomas. Conclusion: Lymph node metastasis though extremely rare in primary osseous chondrosarcoma, definitely affects their survival adversely. The rarity of the occurrence of lymph node metastasis in primary osseous tumors, especially chondrosarcoma highlights the need for multi institutional studies to pool knowledge and evaluate the prognostic significance and etiopathogenesis of lymph node metastasis in primary bone chondrosarcoma.
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Affiliation(s)
- Vineet Kurisunkal
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Ajay Puri
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
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18
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Gulia A, Kurisunkal V, Puri A, Purandare N, Gupta S, Rangarajan Drm V. Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma? Clin Orthop Relat Res 2020; 478:2480-2484. [PMID: 32567825 PMCID: PMC7594919 DOI: 10.1097/corr.0000000000001357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/03/2019] [Accepted: 05/21/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Staging of a bone sarcoma before initiating treatment helps orthopaedic oncologists determine the intent of treatment and predicting the prognosis. As per National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, there are no exclusive recommendations for chondrosarcoma staging. They are staged similar to other bone sarcomas even though skeletal metastases are extremely rare in chondrosarcomas. QUESTIONS/PURPOSES We asked: (1) What proportion of patients with a chondrosarcoma present with detectable only skeletal metastasis? (2) What proportion of patients with chondrosarcoma present with skeletal metastasis with or without concurrent pulmonary metastases? METHODS Between January 2006 to December 2017, 480 patients with histology-proven chondrosarcomas of the extremity, including clavicle, scapula, spine, and pelvis, presented to our institute. Fifty-three patients were excluded due to incomplete details about their staging. The remaining 427 were retrospectively analyzed and included in this study. Their clinical, radiological, and histopathological details were retrieved from patient files and electronic medical records. Of the 427 patients included, 53 had Grade 1 chondrosarcoma, 330 had Grade 2 chondrosarcoma, and 41 had Grade 3 chondrosarcoma. Grade was not available in three patients. All patients were staged with a thoracic CT scan and bone scan or a whole body fluorodeoxyglucose positron-emission tomography/CT (FDG PET/CT). Patients with a suspected or documented metastasis were reviewed again by an experienced radiologist and a nuclear medicine expert for the purpose of this study. A total of 8% (35 of 427) of patients with chondrosarcoma had isolated lung metastases at the time of initial staging. These included 9% (31 of 330) of patients with Grade 2 chondrosarcomas and 10% (4 of 41) of patients with Grade 3 chondrosarcomas. No patient with a Grade 1 chondrosarcoma had detectable lung metastases. The primary study endpoint was the number of patients who had a diagnosis of skeletal or skeletal and lung metastases as identified by the staging modalities. RESULTS Three patients with Grade 2 chondrosarcoma had only skeletal metastasis. No patients with Grade 1 or Grade 3 chondrosarcoma had detectable bone metastases. Combined lung and bone metastases were seen in only two patients with Grade 2 chondrosarcoma. CONCLUSIONS Our study found that the incidence of bony metastasis in conventional chondrosarcomas is extremely low. Considering the present results, we believe skeletal scanning may be overused in current staging algorithms. We do not have survival outcomes to know if detecting these few patients with skeletal lesions at initial presentation would be important in the absence of symptoms, but our data suggest that omitting skeletal imaging from the staging work-up of conventional chondrosarcomas should be considered. It may be reserved for patients with documented pulmonary metastases. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Ashish Gulia
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vineet Kurisunkal
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Ajay Puri
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Srinath Gupta
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Venkatesh Rangarajan Drm
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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19
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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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20
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Kurisunkal V, Botchu R, Davies AM, James SL, Jeys L. Computer assisted tumour surgery - An insight. J Orthop 2020; 22:268-273. [PMID: 32467658 DOI: 10.1016/j.jor.2020.04.013] [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: 03/25/2020] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Success in the management of bone sarcomas entails being able to achieve wide margins, which helps decrease the risk of local recurrence and provide an improvement in overall survival. The role of computer-assisted surgery has been investigated across various areas of orthopaedics, including joint replacement, cruciate ligament reconstruction, and pedicle screw placements which has led to increased interested in computer assisted tumour surgery (CATS). CATS can be used in a wide array of tumour surgeries, however its role in pelvic and sacral tumours is unparalled. Its importance lies in being able to provide radiological information to guide the surgeon at the time of surgery i.e. the distance from the tumour to the resection margin can be determined precisely based on preoperative planning and intra-operative image guidance. This minimises unnecessary bone resection, aiming to achieve good oncological and functional results which can be challenging in pelvic surgery. Most published articles on CATS have concentrated on the surgical aspects of navigation surgery. Although advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide anatomic detail about the primary tumour, the successful transfer of that information from a viewing screen to the intraoperative field can be difficult. The role of the radiologist lies in being able to provide appropriate imaging (CT, MRI) to facilitate surgical planning. This article aims at providing the radiologist a surgical insight on CATS and to facilitate optimal imaging in a patient tentatively being planned for CATS.
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Affiliation(s)
- V Kurisunkal
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - L Jeys
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
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Gulia A, Puri A, Kurisunkal V, Gupta S. Staging work up in chondrosarcoma: Is a bone scan warranted for the metastatic workup of chondrosarcoma? J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23508] [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: 11/20/2022] Open
Abstract
e23508 Background: To assess the value of a bone scan in the metastatic workup of a patient diagnosed with chondrosarcoma of bone. Methods: Retrospective analysis. 480 patients of extremity chondrosarcomas were identified with the help of nuclear imaging records and pathology department data base over a period of 12 years. Their clinical, radiological and histopathological details were retrieved from case files and electronic medical records. All cases were staged with a CT scan of thorax and bone scan or a whole body PET-CT. All reported and suspicious cases of metastasis were reviewed again by an experienced radiologist for this study. 53 patients had to be excluded from the study due to incomplete staging modalities. Results: 427 patients were available for final evaluation. Grade was not available for 3 patients. No grade I chondrosarcoma (53) had evidence of metastasis. In the remaining high grade chondrosarcomas (374), isolated lung metastasis was seen in 9% (35 cases) (grade II-31, grade III-4), combined lung and bone metastasis was seen in 0.5% (2 cases) (all grade II) and isolated bone metastasis was seen in 1 % (4 cases) (all grade II). Conclusions: The present study shows that the incidence of bony metastasis in extremity chondrosarcomas is extremely low. A non-contrast CT thorax would be adequate for staging in conventional chondrosarcomas. In light of the present results we feel bone scan may be omitted from the staging work up of conventional skeletal chondrosarcomas. It may be reserved for only symptomatic patients.
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Affiliation(s)
| | - Ajay Puri
- Tata Memorial Hospital, Mumbai, India
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Abstract
BACKGROUND With evolution of medicine, radiation therapy and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. The most common site of skeletal metastases from other primary malignant neoplasms is the spine, hence, understanding the epidemiology of metastatic spine disease and its presentation is essential for developing a diagnostic and treatment strategy which eventually results in optimum care to reduce disease-related morbidity. PURPOSE With this review article we intend to describe an evidence-based review on the presentation, diagnosis and treatment of metastatic spinal disease. METHODS We reviewed the current available literature on management of spinal metastasis and have described a step wise evaluation and management strategy of metastatic spine disease. CONCLUSION The present review article addresses various aspects and related controversies related to evaluation, staging and treatment options in the management of spinal metastasis.
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Affiliation(s)
- Vineet Kurisunkal
- Orthopaedic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Ashish Gulia
- Orthopaedic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Srinath Gupta
- Orthopaedic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Gulia A, Puri A, Prajapati A, Kurisunkal V. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma 2019; 10:1033-1037. [PMID: 31736610 PMCID: PMC6844205 DOI: 10.1016/j.jcot.2019.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/29/2019] [Revised: 09/28/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Distal radius is third most common site for occurrence of Giant cell tumor (GCT) of bone. Most of Campanacci grade II & III cases require resection. Reconstructions of these defect are challenging. Though fibular arthroplasty provides mobility at wrist but is fraught with complications of donor site morbidity and instability with wrist pain. Wrist arthrodesis with ulna translocation provides stable reconstruction but is cosmetically less appealing. We present a series of 12 cases of GCT of distal radius treated with short segment (6 cm or less) resections and wrist fusion with iliac crest grafting. We evaluated donor site morbidity, functional and oncological outcomes. OBJECTIVES To assess time to union, donor site morbidity, functional and oncological outcomes after wrist fusion with iliac crest bone grafting for distal radius resection (≤6 cm). METHODS Retrospective analysis was performed from a prospectively maintained database between January 2011 and December 2017, 12 patients (7 male and 5 female; 9 primary and 3 recurrent; all Campanacci grade III) were included. Mean age was 29 years (15-41 years) with mean resection length of 5.1 cm (4.5-6 cm). The dominant hand was involved in 6 patients. Time to union, donor site morbidity, functional and oncologiacal outcomes were evaluated. Functional outcomes were evaluated using Musculo-Skeletal Tumor Society (MSTS) score and Patient Rated Wrist Evaluation (PRWE) score. Grip strength and arc of forearm rotation were also evaluated. RESULTS All patients were available for analysis. No symptomatic donor site morbidity was observed. One patient had prominent implant following a fall and delayed union. Mean time to union for 22 osteotomy sites in rest of 11 patients (both proximal and distal) was 6 months (4-11 months). At median follow up of 45 months (18-78 months) 2 patients had soft tissue recurrence, 1 had a stable pulmonary metastasis. Local Recurrence rate was 17%. All patients returned to their pre surgery activity. Mean MSTS score was 25 (19-29) and PRWE score was 12 (6-28). Grip strength and Prono - supination measurements were available in 10 patients. Grip strength was 69% of non operated limb. Mean supination was 53° (0° to 80°) and mean protonation was 73° (40° to 80°). Mean arc of rotation was 126° (80° to 160°). CONCLUSION Reconstruction of distal radius bone defects with Iliac crest bone grafting and wrist arthrodesis retains prono-supination while maintaining wrist girth (cosmesis). The oncologic and functional outcomes make it an acceptable modality in selected cases of distal radius tumours with short resection length (≤6 cm).
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Affiliation(s)
- Ashish Gulia
- Dept of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India,Corresponding author.
| | - Ajay Puri
- Dept of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Ashwin Prajapati
- Dept of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Abstract
Understanding the epidemiology of extremity skeletal metastasis and the factors deciding the treatment decision-making are essential in developing a diagnostic and treatment strategy. This leads to optimum care and reduces disease-related burden. With the evolution of medical, radiation therapy, and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. Based on the currently available literature, we have described a step-wise evaluation and management strategy of metastatic extremity bone disease. The present review article addresses various aspects and related controversies related to evaluation, staging, and treatment options in the management of extremity bone metastasis. This article also highlights the role of multidisciplinary involvement in management of extremity skeletal metastasis.
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Affiliation(s)
- Srinath Gupta
- Department of Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vineet Kurisunkal
- Department of Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mishil Parikh
- Department of Orthopaedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Sanjay Gupta
- Division of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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