Aims. Osseous invasion exhibited in soft-tissue sarcoma (STS) is recognized as a prognostic risk factor. Achieving a wide margin is the default surgical approach for local control. However, for STSs where the tumour is in contact with the adjacent cortex but without clear evidence of osseous invasion, such as medullary invasion, the question of whether bone resection can provide better local control or survival than more conservative sub-periosteal excision remains controversial. The aim of this study was to assess whether bone resection for thigh STS with cortical contact of the adjacent bone results in better local control and survival compared to sub-periosteal dissection, and to investigate the prognostic factors for clinical outcomes in STS. Methods. A retrospective cohort study was conducted on 142 patients with thigh STS exhibiting cortical contact but without medullary invasion, from May 2000 to May 2020. Patients underwent either composite bone resection or sub-periosteal excision. Demographics, clinical outcomes, and functional outcomes were compared between the two groups. Additionally, Cox regression analysis was used to analyze risk factors for local recurrence. Results. The five-year overall survival, local recurrence-free survival, and metastasis-free survival among patients with bone resection was 74.0%, 65.9%, and 74.1%, respectively, compared to 72.9%, 68.3%, and 72.0%, respectively, among patients with sub-periosteal excision. The cumulative incidence of recurrence was 33.1% for patients who underwent bone and 36.4% for those with sub-periosteal excision (p = 0.681). In multivariate analysis, STS with high Fédération Nationale des Centres de Lutte Contre Le Cancer (FNCLCC) grade, invasion involving posterior intermuscular septum, medial intermuscular septum, and adductor brevis were found to be associated with poorer prognosis. The mean Musculoskeletal Tumor Society (MSTS) score in the bone resection group was 24.7, significantly lower than the 28.3 in the sub-periosteal group (p < 0.001). Conclusion. Routine bone resection failed to improve local control or survival in STS patients with cortical bone contact, but resulted in significantly impaired postoperative function. A more conservative sub-periosteal excision approach may be preferable for these cases. Cite this article: Bone Jt Open 2025;6(2):215–226

The hip joints are commonly affected in Juvenile Idiopathic Arthritis (JIA) in childhood. Common features are pain, subluxation, femoral anteversion, coxa valga, significant fixed flexion deformity and a true arthritis, with loss of articular cartilage principally from the femoral head but also the acetabulum. In children with JIA, it is accepted that a medial soft tissue release of the hips, dividing adductor longus, adductor brevis and the ilio-psoas, is a useful tool in the management of significant hip joint involvement. The principal indication for surgery is the relief of pain, but other benefits are correction of fixed flexion deformity, restoration of articular cartilage, increased abduction of the hips and, in those children who are unable to walk, frequently a transition to the potential to walk. The procedure is nearly always performed bilaterally. Our study aimed to document the restoration of articular cartilage at the hips following soft tissue release. It has been noted in the literature that there is regrowth of articular cartilage in the hip but there has been no true documentation of this and x-ray studies are unreliable as the elimination of fixed flexion deformity can prejudice accurate analysis of femoral head geometry on 2 –dimensional views. We therefore carried out MRI scanning of the hips, immediately prior to the soft tissue release and 12–18 months post-operatively. In 10 consecutive patients analysed, scans demonstrated true articular cartilage regrowth in 8 cases. We thus conclude that soft tissue release of the hips in JIA is a useful management tool, and may to some extent reverse the severe articular cartilage loss seen in these children. The next stage of our study is to analyse the articular cartilage at the time of subsequent hip arthroplasty to determine whether true hyaline cartilage is reformed or whether the reconstitute represents fibrocartilage

Objectives

Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh.