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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 101 - 101
1 Sep 2012
Maempel J Coathup M Calleja N Cannon S Briggs T Blunn G
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Background

Extendable proximal femoral replacements(PFR) are used in children with bone tumours in proximity to the proximal femoral physis, previously treated by hip disarticulation. Long-axis growth is preserved, allowing limb salvage. Since 1986, survival outcomes after limb salvage and amputation have been known to be equal.

Method

Retrospective review of all patients <16years undergoing extendable PFR at Royal National Orthopaedic Hospital (UK) between 04/1996 and 01/2006, recording complications, failures, procedures undertaken and patient outcomes.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 51 - 51
1 Sep 2012
Maempel J Coathup M Calleja N Briggs T Cannon S Blunn G
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Background

Extendable partial femoral replacements (EPFR) permit limb salvage in children with bone tumours in proximity to the physis. Older designs were extended through large incisions or minimally invasive surgery. Modern EPFR are lengthened non-invasively. Lengthening improves functional score (Futani, 2006) but has been associated with complications including infection (Jeys, 2005). This study is the first to look specifically at the relationship between EPFR lengthening and complications.

Method

Retrospective review of 51 paediatric (<16 years) oncology patients undergoing primary (1 °) EPFR (minimally/noninvasive) between 06/1994 and 01/2006. Exclusions: 1 patient with 5cm extension without medical intervention and 5 patients with incomplete data.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 99 - 99
1 Sep 2012
Maempel J Coathup M Calleja N Maempel FZ Briggs T Cannon S Blunn G
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Background/Aims

The development of extendable prostheses has permitted limb salvage surgery in paediatric patients with bone tumours in proximity to the physis. Prostheses are extended to offset limb length discrepancy as the child grows. Aseptic loosening (AL) is a recognised complication. The implant stem must fit the narrow paediatric medullary canal and remain fixed while withstanding growth and increasing physical demands. Novel designs incorporate a hydroxyapatite (HA) coated collar that manufacturers claim improves bony ongrowth and stability, providing even stress distribution in stem and shoulder regions and providing a bone-implant seal, resulting in decreased AL and prolonged survival. This study aims to assess whether there is a relationship between bony ongrowth onto a HA collar and AL. Hypothesis: Bone ongrowth onto the HA collar of extendable prostheses is associated with more stable fixation and less AL despite patient growth.

Methods

Retrospective review of 51 primary partial femoral extendable prostheses implanted over 12 years from 1994–2006 (followed up to death at a mean of 2.5±2.2 years or last clinical encounter at a mean of 8.6 years) and 24 subsequent revisions, to ascertain failure rate and mode, together with a cohort study reviewing bony ongrowth onto the HA coated collar in 10 loose and 13 well fixed partial femoral, humeral and tibial implants. Patient growth was measured as a change in bone:implant-width ratio.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 236 - 236
1 Sep 2005
Spiteri V Maempel F Spiteri M Calleja N
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Study Design: Retrospective cohort study.

Objectives: The aim of the study was to determine the incidence, sex distribution, age at diagnosis and any relationship this may have to handedness in 10–16 year olds with idiopathic scoliosis.

Design: A total of 611 patients with scoliosis were reviewed.

Subjects: 344 patients were diagnosed as having idiopathic idiopathic scoliosis. Those between the ages of 10–16, with a Bunnell angle greater than 5 degrees were included in the study.

Outcome Measures: Incidence in females was 0.69 % and 0.15 % in males. The female:male ratio was 5:1.

Results: Age at diagnosis was earlier in females, and typically occurred eighteen months following menarche. The incidence of left-handedness in 10–16 year olds in the general population was found to be 10%. This was the same in the scoliotic group.

Conclusions: The data showed that there was no significant relationship between handedness and the typical idiopathic pattern. However, there was a significant relationship between left handed individuals and the atypical curves (p= 0.0003, CI 1.56–6.63)