Aims

Hip fracture patients are at higher risk of severe COVID-19 illness, and admission into hospital puts them at further risk. We implemented a two-site orthopaedic trauma service, with ‘COVID’ and ‘COVID-free’ hubs, to deliver urgent and infection-controlled trauma care for hip fracture patients, while increasing bed capacity for medical patients during the COVID-19 pandemic.

Background

The literature quotes up to 20% dissatisfaction rates for total knee replacements (TKR). Swedish registry and national joint registry of England and Wales confirm this with high volumes of patients included. This dissatisfaction rate is used as a basis for improving/changing/modernising knee implant designs by major companies across the world.

Introduction: The Musculoskeletal Tumour Society recommends that patients with musculoskeletal tumours are treated in specialist centres. Core needle biopsy is an effective method of obtaining tissue diagnosis but a dilemma arises when the material is non-diagnostic. Our aim was to evaluate the management of non-diagnostic biopsies.

Method: We retrospectively reviewed all core needle biopsies performed between 2003 and 2009 in our regional centre. Non-diagnostic biopsies were identified and management reviewed.

Results: 4,520 core needle-biopsies were performed of which 120 (2.6%) were non-diagnostic. Of these 85 (70%) were treated definitively on the basis of existing imaging, 8 (7%) required further imaging before treatment and 27 (23%) had a repeat biopsy.

Of the 27 repeat biopsies a positive histological diagnosis was obtained in 22 patients. The remaining 5 were again non-diagnostic giving a total of 98 patients being treated definitively without a tissue diagnosis.

Of these 98 cases, 39 (40%) were treated non-operatively, 37 (38%) had curettage and 22 (22%) underwent wide excision.

In the curettage group 33 out of 37 patients had a benign tumour on final histology. Four patients turned out to have intermediate/high grade tumours and subsequently underwent wide excision.

In the wide excision group, 17 out of 22 patients had an intermediate/high grade tumour on final histology. Five patients underwent an unnecessarily wide excision of a benign lesion.

None of the patients treated non-operatively turned out to have a tumour.

Conclusion: After non-diagnostic core-needle biopsy, the patient can safely be managed without tissue diagnosis, with low error rate, provided they have been subjected to a multidisciplinary discussion.