Magnetic Resonance Imaging Features and Prognostic Indicators of Local Recurrence after Curettage and Cementation of Atypical Cartilaginous Tumour in the Appendicular Skeleton.

: The aim of this study is to determine MRI features that may be prognostic indicators of local recurrence (LR) in patients treated with curettage and cementation of atypical cartilaginous tumours (ACTs) in the appendicular skeleton. : This study is a retrospective review of adult patients with histologically confirmed appendicular ACT. The data collected included age, sex, skeletal location and histology from curettage, the presence of LR and oncological outcomes.

A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty.

Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective.

Environmental sustainability in orthopaedic surgery : a scoping review.

Aims: In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation's total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this.

Metastatic bone disease: Early referral for multidisciplinary care.

It is estimated that more than half of all cancers develop bony metastases, exacting a substantial cost in terms of patient quality of life and healthcare expenses. Prompt diagnosis and management have been shown to reduce morbidity and costs. When a patient with a history of cancer presents with musculoskeletal pain, heightened awareness of the risk of bone metastasis should prompt immediate referral to an orthopedic specialist.

Soft tissue sarcoma: Recognizing a rare disease.

The recognition of a malignant soft tissue mass can be challenging, given the rarity of soft tissue sarcoma and the extensive overlap between benign and malignant presentations. Awareness of the signs and symptoms of soft tissue sarcoma in primary care practice ensures prompt referral to a sarcoma center for appropriate assessment and treatment to optimize outcomes.

Osteointegration of hydroxyapatite-coated collars in cemented massive endoprostheses following revision surgery.

Aims: Hydroxyapatite (HA)-coated collars have been shown to reduce aseptic loosening of massive endoprostheses following primary surgery. Limited information exists about their effectiveness in revision surgery. The aim of this study was to radiologically assess osteointegration to HA-coated collars of cemented massive endoprostheses following revision surgery.

MRI-histopathological correlation in paediatric conventional central chondrosarcoma: a report of 17 cases.

Objective: To describe the MRI features of paediatric conventional central chondrosarcoma (CC-CS) and correlate with histological grade.

Materials And Methods: A retrospective review of children/adolescents with histologically confirmed CC-CS. Data collected included age, sex, skeletal location, and histology from needle biopsy or resection, which was classified as atypical cartilaginous tumours/grade 1 CS (ACT/Gd 1 CS), high-grade chondrosarcoma (HGCS), and dedifferentiated chondrosarcoma (DD-CS).

The sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for identifying skip metastases in appendicular osteosarcoma and Ewing sarcoma.

Objective: Pre-operative whole-bone MRI is required to assess intra-osseous tumour extent and to identify skip metastases in cases of bone sarcoma. The current study aims to determine the sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for the identification of skip metastases.

Materials And Method: Review of 162 patients with long bone osteosarcoma or Ewing sarcoma who had undergone whole-bone MRI to assess intra-osseous tumour length and identify skip metastases.

Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent.

Aims: The aim of this study is to assess outcomes of patients ≤12 years who undergo Stanmore noninvasive extendible endoprosthetic replacement of the distal femur (DF NIEPR).

Patients And Methods: A total of 101 children (mean age 9.6 years) were included.

Mixed methods evaluation of the Getting it Right First Time programme - improvements to NHS orthopaedic care in England: study protocol.

Background: Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. The Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. We will examine whether the planned changes have delivered improvements in the quality of care and patient outcomes.

Towards the prediction of fragility fractures with Raman spectroscopy.

Fragility fractures, those fractures which result from low level trauma, have a large and growing socio-economic cost in countries with aging populations. Bone-density-based assessment techniques are vital for identifying populations that are at higher risk of fracture, but do not have high sensitivity when it comes to identifying individuals who will go on to have their first fragility fracture. We are developing Spatially Offset Raman Spectroscopy (SORS) as a tool for retrieving chemical information from bone non-invasively .

Functional outcome following primary total knee arthroplasty cannot be predicted using the initial post-operative radiograph.

Obtaining standardised post-operative radiographs following total knee arthroplasty is common practice. Little is known regarding how measurements taken from the initial post-operative radiograph correlate to functional outcome. The initial post-operative radiographs for 110 primary total knee arthroplasties were reviewed retrospectively.

Hydroxyapatite-coated collars reduce radiolucent line progression in cemented distal femoral bone tumor implants.

Background: Aseptic loosening of massive bone tumor implants is a major cause of prosthesis failure. Evidence suggests that an osteointegrated hydroxyapatite (HA)-coated collar would reduce the incidence of aseptic loosening around the cemented intramedullary stem in distal femoral bone tumor prostheses. Because these implants often are used in young patients with a tumor, such treatment might extend the longevity of tumor implants.

Functional adaptation of long bone extremities involves the localized "tuning" of the cortical bone composition; evidence from Raman spectroscopy.

In long bones, the functional adaptation of shape and structure occurs along the whole length of the organ. This study explores the hypothesis that adaptation of bone composition is also site-specific and that the mineral-to-collagen ratio of bone (and, thus, its mechanical properties) varies along the organ's length. Raman spectroscopy was used to map the chemical composition of long bones along their entire length in fine spatial resolution (1 mm), and then biochemical analysis was used to measure the mineral, collagen, water, and sulfated glycosaminoglycan content where site-specific differences were seen.

Evidence from Raman spectroscopy of a putative link between inherent bone matrix chemistry and degenerative joint disease.

Objective: Osteoarthritis (OA) is a common debilitating disease that results in degeneration of cartilage and bone in the synovial joints. Subtle changes in the molecular structure of the subchondral bone matrix occur and may be associated with cartilage changes. The aim of this study was to explore whether the abnormal molecular changes observed in the matrix of OA subchondral bone can be identified with Raman spectroscopy.

Repair of osteochondral defects in joints--how to achieve success.

Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes.

The effect of smoking on fracture healing and on various orthopaedic procedures.

Ten percent of all fractures lead to problems with healing. Smoking is said to be a cause. There are 13.

Smartphones in orthopaedics.

With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques.

Review article: Plica syndrome of the knee.

Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed.

Pre-operative Embolization of Primary and Secondary Bone Tumours is Safe and Effective: a Retrospective Study.

Background: The surgical treatment of bone tumours can result in large peri-operative blood loss, due to their large sizes and hypervascularity. Pre-operative embolisation has been successfully used to downgrade vascularity, thus reducing peri-operative blood loss and its associated complications.

Methods: Pre-operative embolisation was successfully undertaken on twenty-six patients with a variety of primary and secondary bone tumours.

Destructive synovial hemangioma of the hip resembling pigmented villonodular synovitis.

We report a case of synovial hemangioma of the hip causing joint destruction severe enough to warrant arthroplasty in a 32-year-old man who presented with a 2-year history of hip pain and worsening limp. Plain radiographs demonstrated advanced degenerative changes of the hip articular surface. Magnetic resonance imaging revealed changes consistent with pigmented villonodular synovitis throughout the joint and erosion of the acetabular bone.

Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis.

Background: Nonbacterial osteitis (NBO), a term referring to sterile bone lesions with nonspecific histopathological features of inflammation, may be either unifocal or multifocal, acute (< or =6 months) or chronic, and recurrent. Only when the condition is chronic, recurrent, and multifocal is it appropriate to use the term chronic recurrent multifocal osteomyelitis (CRMO). We present our clinical experience as the largest reported series of children with NBO to date.