Aims

Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment.

Aims

The aims of this study were to evaluate the long-term outcome of surgery for bone or soft-tissue metastases from renal cell carcinoma (RCC) and to determine factors that affect prognosis.

Introduction

The aim of this study is to verify the intra-rater and inter-rater reliability of intra-operative kinematics by hand in TKA using a computer assisted image-free navigation system.

In 1999, we developed a technique for biological reconstruction after excision of a bone tumour, which involved using autografts of the bone containing the tumour treated with liquid nitrogen. We have previously reported the use of this technique in 28 patients at a mean follow up of 27 months (10 to 54).

In this study, we included 72 patients who underwent reconstruction using this technique. A total of 33 patients died and three were lost to follow-up, at a mean of 23 months (2 to 56) post-operatively, leaving 36 patients available for a assessment at a mean of 101 months 16 to 163) post-operatively. The methods of reconstruction included an osteo-articular graft in 16, an intercalary in 13 and, a composite graft with prosthesis in seven.

Post-operative function was excellent in 26 patients (72.2%), good in seven (19.4%), and fair in three (8.3%) according to the functional evaluation system of Enneking. No recurrent tumour occurred within the grafts. The autografts survived in 29 patients (80.6%), and the rates of survival at five and ten years were 86.1% and 80.6 %, respectively. Seven of 16 osteo-articular grafts (44%) failed because of fracture or infection, but all the composite and intercalary grafts survived.

The long-term outcomes of frozen autografting, particularly using composite and intercalary grafts, are satisfactory and thus represent a good method of treatment for patients with a sarcoma of bone or soft tissue.

Cite this article: Bone Joint J 2014;96-B:555–61.

We report an intertrochanteric fracture in a patient who had undergone hip arthrodesis 30 years previously. A 53-year-old man was injured in a head-on car crash and was referred to our hospital for treatment. Plain radiographs showed an intertrochanteric fracture of the right proximal femur and deformity of the right hip joint. He had undergone hip arthrodesis surgery 30 years previously at another hospital. Computed tomography scan showed marked atrophy of the gluteus and iliopsoas muscles. He preferred undergoing total hip arthroplasty (THA) to internal fixation. THA was performed using the anterolateral approach with the patient in the supine position as he had undergone hip arthrodesis through the Smith–Petersen approach, and we were concerned about damaging the gluteus muscle and dislocation if we took the posterolateral approach. The femoral head was removed using curved chisels under fluoroscopy. A cementless THA (J Taper stem, Aquala polyethylene liner; Kyocera Medical Corporation, Osaka, Japan) was inserted and fixed appropriately. Full weight-bearing using a walking frame was allowed 2 weeks after the surgery. Six months after the operation, he was able to walk independently and had good range of movement of the hip joint but continued to have weakness in the abductor muscles.

Very few cases of proximal femur fracture in a previously arthrodesed hip have been reported. Manzotti et al. reported a similar case but they performed open reduction and internal fixation. No previous reports in the literature describe THA for intertrochanteric fracture in an arthrodesed hip. The conversion of an arthrodesed hip to THA is technically challenging. It has a high risk of complications such as nerve injuries and hip instability. We were able to treat the patient successfully, but surgeons should carefully decide the treatment method depending on the case.

We describe a method of reconstruction using tumour-bearing autograft treated by liquid nitrogen in 28 patients. The operative technique consisted of en bloc excision of the tumour, removal of soft tissue, curettage of the tumour, drilling and preparation for internal fixation or prosthetic replacement before incubation for 20 minutes in liquid nitrogen, thawing at room temperature for 15 minutes, thawing in distilled water for ten minutes, and internal fixation with an intramedullary nail, plate or composite use of prosthetic replacement. Bone graft or cement was used to augment bone strength when necessary.

The limb function was rated as excellent in 20 patients (71.4%), good in three (10.7%), fair in three (10.7%), and poor in two (7.1%). At the final follow-up six patients had died at a mean of 19.8 months after the operation, while 21 remained free from disease with a mean follow-up of 28.1 months (10 to 54). One patient is alive with disease. Bony union was seen at a mean of 6.7 months after the operation in 26 patients. Complications were encountered in seven patients, including three deep infections, two fractures, and two local recurrences. All were managed successfully. Our results suggest that this is a simple and effective method of biological reconstruction.