The NZ Standards of Service Provision for Sarcoma patients were developed by the NZ Sarcoma working group and published by the Ministry of Health (MOH) in 2013. Although not formally enacted by the MOH we aimed to determine the impact of these published standards and referral pathways on disease-specific survival of patients with soft-tissue sarcoma in NZ. The Middlemore Musculoskeletal Tumour Unit database was searched. Patients referred for treatment in our centre with a diagnosis of soft tissue sarcoma in the five-year period before (n=115) and after (n=155) were included. We excluded patients with bone sarcomas and retroperitoneal soft tissue sarcomas. The rate of referral after inappropriate treatment reduced after implementation of the Standards (24% vs 12%, p=0.010). The number of patients referred with tumours larger than 50mm decreased (74.8% vs 72.3%, p=0.021) and fewer had metastases at diagnosis (11.3% vs 3.2%, p=0.017). Mortality was lower in the group after introduction of the Standards (45% vs 30%, p=0.017). The estimated disease-specific survival curve between the two groups shows a trend towards increased survival in the post-standards group, although not reaching statistical significance. Local recurrence rate and metastasis rate after definitive treatment were similar between the two groups. Patients had a shorter duration of symptoms before referral in the post-Standards group although this was not statistically significant. Since implementation of the Standards, patients have been referred more promptly, with fewer inappropriate treatments. The time to mortality curve indicates a trend towards improved disease-specific survival. We conclude that the pathway for investigation and referral for this condition has become clearer, supporting the ongoing use of the Sarcoma Standards, and that these should be formally implemented by the MOH.
The aim of this study was to assess arthritis of the basal joint of the thumb quantitatively using bone single-photon emission CT/CT (SPECT/CT) and evaluate its relationship with patients’ pain and function. We retrospectively reviewed 30 patients (53 hands) with symptomatic basal joint arthritis of the thumb between April 2019 and March 2020. Visual analogue scale (VAS) scores for pain, grip strength, and pinch power of both hands and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores were recorded for all patients. Basal joint arthritis was classified according to the modified Eaton-Glickel stage using routine radiographs and the CT scans of SPECT/CT, respectively. The maximum standardized uptake value (SUVmax) from SPECT/CT was measured in the four peritrapezial joints and the highest uptake was used for analysis.Aims
Methods
The present study investigated the five-year interval changes in pseudotumours and measured serum metal ions at long-term follow-up of a previous report of 28 mm diameter metal-on-metal (MoM) total hip arthroplasty (THA). A total of 72 patients (mean age 46.6 years (37 to 55); 43 men, 29 women; 91 hips) who underwent cementless primary MoM THA with a 28 mm modular head were included. The mean follow-up duration was 20.3 years (18 to 24). All patients had CT scans at a mean 15.1 years (13 to 19) after the index operation and subsequent follow-up at a mean of 20.2 years (18 to 24). Pseudotumour volume, type of mass, and new-onset pseudotumours were evaluated using CT scanning. Clinical outcomes were assessed by Harris Hip Score (HHS) and the presence of groin pain. Serum metal ion (cobalt (Co) and chromium (Cr)) levels were measured at the latest follow-up.Aims
Patients and Methods
Oriental people habitually adopt formal sitting and squatting postures, the extreme flexion of the knees allowing of this. The influence exercised by pressure and posture are, therefore, found at the posterior side of knee joint. However, we don't have many report about articular cartilage of posterior femoral condyle. The purpose of this study was to reveal the accurate prevalence and related factors to the presence of degenerative changing of the articular cartilage of posterior femoral condyle in cadaveric knee joints.Introduction
Objectives
Total knee arthroplasty (TKA) has been proven to be the most effective treatment for patients with severe or “end-stage” joint disease. Although infection is not a frequent complication of total knee arthroplasty, it is certainly one of the most dreaded. The purpose of this study was to identify related factors associated with septic arthritis. 2202 primary total knee arthroplasties were done in 1257 patients between 1995 and 2006. Of these knee arthroplasties, 2022 knees in 1146 patients were available for follow-up. Revision arthroplasty procedures and infected knees were excluded. 252 knees in 147 males, 1770 knees in 999 females were done. Their mean age at the time of primary TKA was 70.6 (range, 26–91) years. The mean follow-up period post primary TKA was 48 (range, 3–145) months. The medical records were reviewed to extract the following information: age, gender, body mass index, preoperative CRP, preoperative ESR, preoperative TP, duration of surgery, operative blood loss, total blood loss, duration of surgical drain, duration of antibiotic prophylaxis, primary diagnoses, smoking, diabetes mellitus, steroid or DMARDs therapy, previous operation around the knee joint, previous arthroscopic surgery, previous except arthroscopic surgery, previous operation of high tibial osteotomy (HTO) or open reduction internal fixation (ORIF), residue of internal fixation material, bone graft, patella replacement, and bone cement. Proportions were compared using the chi-square or two-tailed Fisher’s exact test, as appropriate. Continuous variables were compared by the student’s t-test. Logistic regression analysis (stepwise) of selected variables from univariate analysis was performed to identify factors independently associated with the development of infection following total knee arthroplasty. During the study period, 17 infected knee arthroplasties in 17 patients were identified. The infections occurred in 8 males and 9 females, with a medial age of 69.5 years. The results of univariate analysis indicating those variables statistically associated with infection are : gender (p <
0.0001), smoking (p = 0.02), previous operation around the knee joint (p = 0.001), previous except arthroscopic surgery(p <
0.0001), previous operation of ORIF (p <
0.0001), residue of internal fixation material (p <
0.0001). Logistic regression analysis indicated that the four predictors of infection following total knee arthroplasty were gender (odds ratio [OR], 0.2; 95% confidence interval [CI95], 0.1 to 0.6; P=0.005), previous operation of ORIF (OR, 7.9; CI95, 1.1 to 57.1; P=0.041), residue of internal fixation material (OR, 26.0; CI95, 4.5 to 151.0; P<
0.001), body mass index (OR, 1.2; CI95, 1.0 to 1.3; P=0.007). We conclude that the risk factors of infection after TKA were previous operation of ORIF, gender, residue of internal fixation, and body mass index.
A number of causes have been advanced to explain the destructive discovertebral (Andersson) lesions that occur in ankylosing spondylitis, and various treatments have been proposed, depending on the presumed cause. The purpose of this study was to identify the causes of these lesions by defining their clinical and radiological characteristics. We retrospectively reviewed 622 patients with ankylosing spondylitis. In all, 33 patients (5.3%) had these lesions, affecting 100 spinal segments. Inflammatory lesions were found in 91 segments of 24 patients (3.9%) and traumatic lesions in nine segments of nine patients (1.4%). The inflammatory lesions were associated with recent-onset disease; a low modified Stoke ankylosing spondylitis spine score (mSASSS) due to incomplete bony ankylosis between vertebral bodies; multiple lesions; inflammatory changes on MRI; reversal of the inflammatory changes and central bony ankylosis at follow-up; and a good response to anti-inflammatory drugs. Traumatic lesions were associated with prolonged disease duration; a high mSASSS due to complete bony ankylosis between vertebral bodies; a previous history of trauma; single lesions; nonunion of fractures of the posterior column; acute kyphoscoliotic deformity with the lesion at the apex; instability, and the need for operative treatment due to that instability. It is essential to distinguish between inflammatory and traumatic Andersson lesions, as the former respond to medical treatment whereas the latter require surgery.
We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary intramedullary nail. In a retrospective case-matched series assembled from 176 patients with tibial lengthening, we matched 52 patients (26 pairs, group A with nail and group B without) according to the following criteria in order of importance: 1) difference in amount of lengthening (± 2 cm); 2) percentage difference in lengthening (± 5%); 3) difference in patient’s age (± seven years); 4) aetiology of the shortening, and 5) level of difficulty in obtaining the correction. The outcome was evaluated using the external fixator index, the healing index and an outcome score according to the criteria of Paley. It was found that some complications were specific to group A or B respectively, but others were common to both groups. The outcome was generally better in lengthenings with a nail, although there was a higher incidence of rectifiable equinus deformity in these patients.
One hundred fifty one total hip arthroplasty (THA) with metal on metal hip system of without cement were followed at a mean of 5. 5 years (range 2. 6 years to 7 years). Original diseases were 134 hip in 123 cases with osteoarthritis and 17 hips in 13 with rheumatoid arthritis. The average Harris hip score of before the operation was 45. 3 points and at the follow-up time the average score was 88. 5 points. Radiographic findings in the incidence of partial radiolucent line around the component: in the acetabular component, no radiolucent line was observed, in the femoral component, marginal lucent lines were 8. 6% (13 hips). Cortical hypertrophy was observed in high ratio of 27. 2%(41 hips). There was no loosening and tilt of component over 5 degrees observed in any patient. Postoperative dislocation of the hip was observed 9 hips (6. 0%). Cobalt concentrations and chromium concentration in the serum were measured in cases in metal on metal total hip, metal on poly arthroplasty and in controls without implants. Serum was assayed using graphite furnaces atomic absorption spectrophotometer. No patients were seen of elevation in serum cobalt and chromium concentrations. The authors conclude that THA with metal on metal system has presented excellent results for mid term follow-up in our hospital.
In patients with severe acetabular deficiency due to rheumatic arthritis (RA), the mid-term result of THA including a bone graft in the acetabular bed were analyzed. A total of 32 patients with 40 joints, comprising of 30 females and 2 males, were reviewed in this study. These patients had severe acetabular deficiency and were receiving THA for RA, including a bone graft in the acetabular bed. The average age at surgery was 58. 3 years and the average follow-up period was 6. 2 years. These patients had suffered from RA for 21 years on an average. The acetabular bed was filled with the chip bone and covered with the slice bone, followed by strong pressurization of the implanted bone and fixation of the cup with a screw. The patients were evaluated clinically using the Harris hip score, and radiologically using the Gruen radiographic analysis and the Sotelo-Garza and Charnley classification. In the clinical evaluation using score, the mean score improved from 39. 7 preoperatively to 82. 3 postoperatively. An improvement in pain, walking ability, ROM and ADL were observed. In the radiological evaluation using the Gruen analysis, more radiolucent lines tended to appear in the zone 1, of which none was progressive or indicated loosening. On the femoral side, more partially radiolucent lines of 1 mm or less tended to appear in the zone 4, of which none indicated osteolysis or loosening. The mean thickness of acetabular bed improved from 4. 3 mm preoperatively to 13. 5 mm postoperatively. During the follow-up period, no collapse of the implanted bone, dislocation of the cup or loosening was observed. Treatment with the bone graft method using slice bone and chip bone are used for acetabular deficiency in rheumatic hip joint in our department, this methods is considered to be an effective treatment, because it has provided a good initial fixation of cup and a good graft survival.
It is frequently difficult to diagnose and treat of malignant sacral bone tumors. This tumor is diagnosed with lumbar disc hernia, instability coccygitis, hemorrhoids. We reviewed the surgical treatment of primary malignant (14) and secondary (metastatic) sacral tumors (11) in 25 patients from 1983 to 2000. Primary tumors consisted of chordoma in 11 patients, chordoma with spindle cell sarcoma, malignant peripheral nerve sheath tumor (MPNST), giant cell tumor of bone in 1 patient each. The secondary tumors consisted of invading carcinoma in 7 patients, metastatic carcinoma in 4 patients. Location of the sacral tumor was showed total sacrum in 2 patients, below S2 in 18, S3 in 2 and S4 in 3. Preserving nerves were L5 in 1 patient, S1 in 17, S2 in 2, S3 in 3, and 2 performed curettage. Posterior approach was used in 8 patients, and an anterior and posterior combined approach in 17. Sacrectomy only in 7 patients, and sacrectomy and colostomy in 8, including with rectum was performed in 8, and 2 patients had extensive curettage and bone graft or hydroxyapatite (HA) transplantation. Six tumor excisions were used modified T-saw which pass through the sacral canal preserving nerve roots. Surgical margin of chordoma in primary sacral tumors had wide in 10, wide excision with partial contamination in 2, except curettage in 1. MPNST had curettage and giant cell tumor of bone had marginal in 1 each. Secondary sacral tumors had wide in 9, marginal in 2. Adjuvant therapy was used radiation therapy in 3 patients and chemotherapy in 2 and ethanol in 1. Musculocutaneous flap was reconstracted tensor fascia lata flap and gluteal muscle flap in 2 patients. Interval between initial chief complaints and diagnosis of chordoma detected from 6 months to 10 years, avarage 5 years 3 months by rectal examination, radiogram, genital ultra echo and MRI; invading carcinoma from 2 months to 3 years, avarage 8 months, and metastatic carcinoma from 2 months to 4 months, average 3 months. Six of 12 patients of chordoma in primary sacral tumors are alive from 6 months to 18 years, average 4 years 6 months; remaining patients were died 6 month to 8 years, average 3 years 2 months, except 2 patient died with infection. The patient with a MPNST died after 2 years 6 months, and a giant cell tumor of bone had no recurrence or lung metastases in 10 years. One of 11 patients of secondary sacral tumor (initial surgery) is alive in 14 years 6 months, remaining 10 patients died 3 months to 4 years 6 months, average 1 year 10 months, except 2 patients died with infection. Complications were much bleeding, infection, skin slough, nerve injury. We recommend better surgical method that anterior and posterir approach use above S3, and posterior approach blow S4, A modified T-saw performed an osteotomy of the pars lateral of the sacrum, proved to be easier and faster than osteotomies performed using the old method.
