Much controversy surrounds synovial sarcomas, including prognostic indicators and optimal treatment. This paper reviews these subjects on the 65 cases of synovial sarcoma on the hospital’s database.

At 40 months 3 cases were excluded. 2 on review of the diagnosis and 1 had definitive treatment elsewhere. At 80 months 5 additional patients were lost to follow up.

The Kaplan-Meier 5 year survival rate for all patients in this review was 52.1%. Excluding patients who presented with metastases, this figure rose to 60.1%. All deaths were due to metastatic disease. Univariate analysis showed age of patient and size of tumour to be significant prognostic indicators for survival. Size of tumour only, was a significant predictor of metastatic spread using univariate analysis. Multivariate analysis showed only tumour size to be a significant indicator of survival and metastatic spread.

The local recurrence rate at 5 years was 22.3%. No convincing clinical features were shown to influence the local recurrence rate.

Adjuvant therapy was not shown to influence outcome significantly.

At 80 months follow up the 5 year survival rate increased to 54.9% (SE = 6.9%) and without metastases 61.7% (SE = 7.2%). The significance of established prognostic indicators did not change at final follow up.

The amputation rate was 21%. 3 patients had limb preserving surgery using an endoprosthetic replacement.

Tumour size and metastases appear to be the only consistent prognostic indicators of survival. Endoprosthetic replacement surgery should be considered a surgical option for synovial sarcomas involving bone. Doubling the follow up did not statistically affect survivorship data.

Over a 16-year period, 135 custom-made distal femoral prostheses, based on a fully constrained Stanmore-type knee replacement, were used in the treatment of primary malignant or aggressive benign tumours. Survivorship analysis showed a cumulative success rate of 72% at five years and 64% at seven years. Intact prostheses in 91% of the surviving patients gave good or excellent functional results. Deep infection was the major complication, occurring in 6.8% of cases; clinical aseptic loosening occurred in 6.0%. Revision surgery was carried out for loosening and infection, and the early results are encouraging. We conclude that prosthetic replacement of the distal femur can meet the objectives of limb salvage surgery.

We reviewed 34 hindquarter amputations performed for malignant tumours around the hip from 1971 to 1988, classifying them as palliative or curative according to the resection margins or the presence of disseminated disease at the time of surgery. There were three peri-operative deaths, 12 palliative and 19 curative procedures. Ten patients died of disseminated disease within a year of surgery, eight of whom had had a palliative operation. Three patients died between one and five years after palliative surgery. One died of unrelated disease at nine years. Seventeen patients are disease free an average of 31 months from surgery, 16 after curative procedures. The median survival after palliative amputations was six months and the 5-year survival rate for curative cases was 83%.

Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient.

A series of 81 patients has been reviewed to determine the value of endoprosthetic replacement of the proximal femur and hip in the treatment of bone tumours. Standard statistical methods were used to evaluate the survival of the replacements and the patients. Taking removal of the prosthesis, irrespective of the cause, as the criterion for failure the survival of the replacements was found to be 63 per cent after 10 years. If deaths are regarded as failures, then the survival value falls to 48 per cent. The survival of patients with chondrosarcoma and osteoclastoma treated by endoprosthetic replacement compares favourably with survival after amputation or excision of the tumour.