Aims. Patients with soft-tissue sarcoma (STS) who undergo unplanned excision (UE) are reported to have worse outcomes than those who undergo planned excision (PE). However, others have reported that patients who undergo UE may have similar or improved outcomes. These discrepancies are likely to be due to differences in characteristics between the two groups of patients. The aim of the study is to compare patients who underwent UE and PE using propensity score matching, by analyzing data from the Japanese Bone and Soft Tissue Tumor (BSTT) registry. Methods. Data from 2006 to 2016 was obtained from the BSTT registry. Only patients with STS of the limb were included in the study. Patients with distant metastasis at the initial presentation and patients with dermatofibrosarcoma protuberans and well-differentiated liposarcoma were excluded from the study. Results. A total of 4,483 patients with STS of the limb were identified before propensity score matching. There were 355 patients who underwent UE and 4,128 patients who underwent PE. The five-year disease-specific survival (DSS) rate was significantly better in the patients who received additional excision after UE than in those who underwent PE. There was no significant difference in local recurrence-free survival (LRFS) between the two groups. After propensity score matching, a new cohort of 355 patients was created for both PE and UE groups, in which baseline covariates were appropriately balanced. Reconstruction after tumour excision was frequently performed in patients who underwent additional excision after UE. There were no significant differences in DSS and LRFS between the patients who underwent PE and those who had an additional excision after UE. Conclusion. Using propensity score matching, patients with STS of the limb who underwent additional excision after UE did not experience higher mortality and local failure than those who underwent PE. Reconstruction may be necessary when additional excision is performed. Cite this article: Bone Joint J 2021;103-B(12):1809–1814

Aims. Treatment of high-grade limb bone sarcoma that invades a joint requires en bloc extra-articular excision. MRI can demonstrate joint invasion but is frequently inconclusive, and its predictive value is unknown. We evaluated the diagnostic accuracy of direct and indirect radiological signs of intra-articular tumour extension and the performance characteristics of MRI findings of intra-articular tumour extension. Methods. We performed a retrospective case-control study of patients who underwent extra-articular excision for sarcoma of the knee, hip, or shoulder from 1 June 2000 to 1 November 2020. Radiologists blinded to the pathology results evaluated preoperative MRI for three direct signs of joint invasion (capsular disruption, cortical breach, cartilage invasion) and indirect signs (e.g. joint effusion, synovial thickening). The discriminatory ability of MRI to detect intra-articular tumour extension was determined by receiver operating characteristic analysis. Results. Overall, 49 patients underwent extra-articular excision. The area under the curve (AUC) ranged from 0.65 to 0.76 for direct signs of joint invasion, and was 0.83 for all three combined. In all, 26 patients had only one to two direct signs of invasion, representing an equivocal result. In these patients, the AUC was 0.63 for joint effusion and 0.85 for synovial thickening. When direct signs and synovial thickening were combined, the AUC was 0.89. Conclusion. MRI provides excellent discrimination for determining intra-articular tumour extension when multiple direct signs of invasion are present. When MRI results are equivocal, assessment of synovial thickening increases MRI’s discriminatory ability to predict intra-articular joint extension. These results should be interpreted in the context of the study’s limitations. The inclusion of only extra-articular excisions enriched the sample for true positive cases. Direct signs likely varied with tumour histology and location. A larger, prospective study of periarticular bone sarcomas with spatial correlation of histological and radiological findings is needed to validate these results before their adoption in clinical practice. Cite this article: Bone Jt Open 2024;5(10):944–952

We investigated whether our policy of routine re-excision of the tumour bed after an unplanned excision of a soft-tissue sarcoma was justified. Between April 1982 and December 2005, 2201 patients were referred to our hospital with the diagnosis of soft-tissue sarcoma, of whom 402 (18%) had undergone an unplanned excision elsewhere. A total of 363 (16.5%) were included in this study. Each patient was routinely restaged and the original histology was reviewed. Re-excision was undertaken in 316 (87%). We analysed the patient, tumour and treatment factors in relation to local control, metastasis and overall survival. Residual tumour was found in 188 patients (59%). There was thus no residual disease in 128 patients of whom 10% (13) went on to develop a local recurrence. In 149 patients (47%), the re-excision specimen contained residual tumour, but it had been widely excised. Local recurrence occurred in 30 of these patients (20%). In 39 patients (12%), residual tumour was present in a marginal resection specimen. Of these, 46% (18) developed a local recurrence. A final positive margin in a high-grade tumour had a 60% risk of local recurrence even with post-operative radiotherapy. Metastases developed in 24% (86). The overall survival was 77% at five years. Survival was related to the grade of the tumour and the finding of residual tumour at the time of re-excision. We concluded that our policy of routine re-excision after unplanned excision of soft-tissue sarcoma was justified in view of the high risk of finding residual tumour

We measured the tension in the interosseous membrane in six cadaveric forearms using an in vitro forearm testing system with the native radial head, after excision of the radial head and after metallic radial head replacement. The tension almost doubled after excision of the radial head during simulated rotation of the forearm (p = 0.007). There was no significant difference in tension in the interosseous membrane between the native and radial head replacement states (p = 0.09). Maximal tension occurred in neutral rotation with both the native and the replaced radial head, but in pronation if the radial head was excised. Under an increasing axial load and with the forearm in a fixed position, the rate of increase in tension in the interosseous membrane was greater when the radial head was excised than for the native radial head or replacement states (p = 0.02). As there was no difference in tension between the native and radial head replacement states, a radial head replacement should provide a normal healing environment for the interosseous membrane after injury or following its reconstruction. Load sharing between the radius and ulna becomes normal after radial head Replacement. As excision of the radial head significantly increased the tension in the interosseous membrane it may potentially lead to its attritional failure over time. Cite this article: Bone Joint J 2013;95-B:1383–7

Aims . This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton’s neuroma. Patients and Methods. Between May 2006 and April 2013, we prospectively studied 99 consecutive patients (111 feet) who were to undergo excision of a Morton’s neuroma. There were 78 women and 21 men with a mean age at the time of surgery of 56 years (22 to 78). Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF-12) and a supplementary patient satisfaction survey three months pre-operatively and six months post-operatively. Results. Statistically significant differences were found between the mean pre- and post-operative MOXFQ and the physical component of the SF-12 scores (p = 0.00081 and p = 0.00092 respectively). Most patients reported their overall satisfaction as excellent (n = 49, 49.5%) or good (n = 29, 29.3%), but ten patients were dissatisfied, reporting poor (n = 8, 8.1%) or very poor (n = 2, 2.0%) results. Only 63 patients (63%) were pain-free at follow-up: in eight patients (8.1%), the MOXFQ score worsened. There was no statistically significant difference in outcome between surgery on single or multiple sites. However, the MOXFQ scores were significantly worse after revision surgery (p = 0.004). Conclusions. The patient-reported outcomes after resection of a symptomatic Morton’s neuroma are acceptable but may not be as good as earlier studies suggest. Surgery at several sites can be undertaken safely but caution should be exercised when considering revision surgery. Cite this article: Bone Joint J 2016;98-B:1376–81

1. The late results in nineteen cases of total excision of the carpal scaphoid bone for ununited fracture have been reviewed. 2. The results are least satisfactory when there is clinical evidence of arthritis on the dorsal aspect of the wrist, or subluxation of the os magnum and semilunar. In other cases good results usually can be expected. 3. The operation must be done carefully without injury to the neighbouring bones and ligaments. Total excision is preferable to excision of the proximal pole alone

Operation on the hips of patients with myelomeningocele is often followed by stiffness or ankylosis. Excision of the upper end of the femur for this condition frequently fails because of extensive new bone formation. Twelve excisions in eight patients are reported. Six of these patients had recently had spinal fusion operations; the consequent loss of ability to compensate for hip stiffness by spinal flexion had made sitting difficult or impossible. Excision or even re-excision of the upper femur failed in most cases. Careful assessment of hip mobility before spinal operations in these patients is essential and osteotomy rather than excision of the upper femur is advised

1. Seventy-seven operations on the patella have been reviewed. 2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella. 3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of ossification in the quadriceps tendon. 4. Patello-femoral arthritis after partial excision of the patella may be due to faulty realignment of the patellar ligament and consequent tilting of the patellar remnant towards the femoral condyles

1. Twenty-eight patients subjected to excision of the coccyx for coccygeal pain during the last ten years have been reviewed. 2. No constant means of selection appears to have been used in recommending these patients for operation, and, in retrospect, no factor in the history or examination emerges as reliable for making such selection in the future. 3. Operation may be recommended as likely to provide a cure in about 45 per cent and to give worthwhile relief in another 45 per cent of cases. 4. When conservative treatment has succeeded, operation will not, of course, be required, but failure of conservative treatment is not an essential pre-requisite in recommending operation. 5. If more care were taken to eliminate the markedly psychoneurotic patients the worthwhile results of operation could probably be increased even above 90 per cent. 6. Excision of the coccyx is certainly a useful operation and should not be discarded

The results of excision of the head of the radius in forty-four elbows affected by rheumatoid arthritis are presented. Relief of pain was obtained in 90 per cent and an increase in the range of flexion and extension was seen in 70 per cent. Involvement of the humero-ulnar joint seen radiologically is no contra-indication to the operation; simple excision of the radial head often gives gratifying results; In our experience the relief of pain and increased range of movement have greatly reduced the need for total replacement arthroplasty

A study of excision arthroplasty (Girdlestone's pseudarthrosis) for infected total hip replacements is presented. Twenty-two patients were reviewed with a minimum follow-up of one year. Reduction in pain was significant but the functional results were poor. Factors contributing to poor function were old age, poor medical condition and arthritis of the contralateral hip; these were in addition to the gross instability resulting from the pseudarthrosis. The patients were easily fatigued and dependent on external supports; calipers were found to be unacceptable. The symptoms after excision arthroplasty are compared with those before the original hip replacement

Between June 2005 and March 2008, 14 patients with a Campanacci grade-3 giant-cell tumour of the distal radius were treated by en bloc resection and reconstruction by ulnar translocation with arthrodesis of the wrist. The mean length of radius resected was 7.9 cm (5.5 to 15). All the patients were followed to bony union and 12 were available at a mean follow-up of 26 months (10 to 49). The mean time to union was four months (3 to 7) at the ulnocarpal junction and five months (3 to 8) at the ulnoradial junction. All except one patient had an excellent range of pronation and supination. The remaining patient developed a radio-ulnar synostosis. The mean Musculoskeletal Tumor Society score was 26 (87%, range 20 to 28). Three patients had a soft-tissue recurrence, but with no bony involvement. They underwent a further excision and are currently well and free from disease. Ulnar translocation provides a local vascularised bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. It avoids the need for a microvascular procedure while retaining rotation of the forearm and good function of the hand

Aims. Children treated for osteosarcoma around the knee often have a substantial leg-length discrepancy at skeletal maturity. The aim of this study was to investigate the results of staged skeletal reconstruction after a leg lengthening procedure using an external fixator in these patients. Patients and Methods. We reviewed 11 patients who underwent staged reconstruction with either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control group of 11 patients who had undergone wide excision and concurrent reconstruction with an arthroplasty were matched for gender, location, and size of tumour. We investigated the change in leg-length discrepancy, function as assessed by the Musculoskeletal Tumor Society Scale (MSTS) score and complications. Results. A mean 5.2 cm (1.7 to 8.9) of lengthening was achieved. The mean MSTS scores significantly improved after staged reconstruction (p = 0.003) but were still worse than those of the control group (p = 0.049). However, the MSTS scores of the arthroplasty subgroup were comparable with those of the controls, although the extensor lag was greater and the range of movement was less. The patient group experienced more complications, but all of these resolved. Conclusion. Approximately 5 cm of lengthening and significant functional improvement can be achieved by staged reconstruction and lengthening, without major complications. Although it has limitations, this method of treatment seems to be a satisfactory surgical option for growing children with a significant leg-length discrepancy after excision of an osteosarcoma around the knee. Cite this article: Bone Joint J 2017;99-B:401–8

Reports of excision of the clavicle in the nineteenth century literature are reviewed, and certain operative complications discussed. Osteomyelitis was the most common indication, and was described first in this country by Syme in 1833. The first successful excision of the entire clavicle was performed by McCreary of Kentucky in 1813. The removal of tumour-bearing clavicles provided memorable challenges at a time when anaesthetics were not available, blood transfusion unknown and antibiotic therapy non-existent

The results of ten excision arthroplasties of the elbow for rheumatoid disease are described. The operation may afford good relief of pain and a useful increase both of hinge motion and of forearm rotation. Instability is not a serious problem unless the patient has to bear weight on crutches. To increase stability after arthroplasty it appears that Kirschner wire fixation is advisable as well as a plaster cast. For advanced rheumatoid disease unilateral excision arthroplasty has a definite value, especially for patients confined to a wheelchair

1. The supraspinatus group of lesions constitutes one of the two common causes of the painful shoulder. 2. Most, but not all, of these lesions resolve either spontaneously or after conservative treatment. 3. When conservative treatment fails symptoms can be relieved by excision of the acromion process, provided that sufficient bone is removed to relieve all pressure on the tendon throughout a full range of shoulder movement. 4. Excision of the acromion is contra-indicated if there is doubt as to the diagnosis or if there is true limitation of shoulder movement

We randomly selected 39 patients undergoing excision of the trapezium for osteoarthritis of the first carpometacarpal joint into two groups, with mobilisation either at one or at four weeks after operation. The patients were reviewed at a median of six months (6 to 8). The clinical details, the severity of the disease and the preoperative clinical measurements of both groups were similar. Excision of the trapezium resulted in significant improvement in objective and subjective function. Comparison of the outcomes of the two groups showed no differences except that patients found early mobilisation significantly more convenient. Although there was no significant difference in the range of movement between the groups, there was a small loss of movement at the metacarpophalangeal joint in the late mobilisation group. Our findings show that simple excision of the trapezium is an effective procedure for patients with carpometacarpal osteoarthritis of the thumb and that prolonged splintage is neither necessary nor desirable

1. Twenty-four cases of excision of the lunate bone in Kienböck's disease have been reviewed. 2. In general, the results have been favourable, with 88 per cent excellent or good and 12 per cent fair or poor. 3. Abnormal contact between the triquetrum and the styloid process of the ulna appeared in many cases, but this contact did not appear to prejudice the results. 4. Excision after prolonged symptoms of the disease gave disappointing results

Thirty patients with chronic pyogenic or tuberculous arthritis of the hip treated by Girdlestone's excision arthroplasty were reviewed two to seven years after operation. There was marked or complete relief of pain in 29, control of infection in 27, squatting and sitting cross-legged was possible in 27, and 16 were able to stand on the operated limb. Overall results were good in 16, fair in nine, and poor in five. Tuberculous disease was not reactivated and the use of traction for 12 weeks and a weight-relieving caliper for 12 months after operation helped to reduce the shortening to an average of 3.8 centimetres. Excision arthroplasty is considered a sound operation to restore the ability to squat and sit cross-legged