The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated.

In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes.

We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded.

There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time.

We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Aim: To review the prognosis of Pelvic Osteosarcoma in the files of the Scottish Bone Tumour Registry between 1955 and 2001.

Text: The cases of 40 consecutive patients with osteosarcoma of the pelvic ossea registered in the files of the Scottish Bone Tumour Registry between 1955 and 2001 were reviewed. 6 of these patients had underlying Paget’s disease and 2 had received previous radiotherapy to the pelvis. The median age at diagnosis was 60 years (mean 55.7 years). 12 patients had distant metastases at initial presentation (Enneking stage III). 24 patients had stage IIB ostesarcomas, 3 patients had stage IIA osteosarcomas and 1 patient had stage IB osteosarcoma. The median survival of stage IIB and stage III ostesarcoma was 9.5 months (1–39 months) and 5.5 months (0.5–16 months) respectively. The median age of survival for stage IIB tumours treated prior to the introduction of chemotherapy was 9 months (1–30 months) compared to those whose treatment included chemotherapy of 12 months (4–39 months). 5 of the 40 patients treatment regimens included surgical intervention- all had stage IIB tumours. The median survival for this group was 13 months (4–39 months).

Conclusion: Despite the introduction of modern multimodality treatment regimens the prognosis for pelvic osteosarcoma remains poor.