ABSTRACT
The aim of this study was to investigate if the risk of pathological fracture can be predicted with the proportion of body weight that can be put through the affected leg in patients with metastatic bone disease of the lower limb. A prospective observational study was conducted in patients with metastatic disease in the lower limb. Receiver Operator Characteristic curves were used to identify the optimum threshold level of single stance weight bearing to predict fracture and compared to the Mirels score. Patients who underwent surgery could weight bear significantly less than those who did not have surgical intervention. The optimum threshold to predict pathological fracture was 85% of total body weight. No patient below the threshold level of 85% single stance body weight sustained a pathological fracture. The use of single stance body weight can be a useful in conjunction with the Mirels score to predict pathological fracture. If less than 85% of total body weight can be put through the affected limb, the risk of fracture increases, and consideration of treatment is suggested.
Subject(s)
Bone Neoplasms/pathology , Fractures, Bone/pathology , Lower Extremity/pathology , Adolescent , Adult , Body Weight/physiology , Female , Humans , Male , Prospective Studies , ROC Curve , Risk Assessment , Young AdultABSTRACT
INTRODUCTION: Pigmented villonodular synovitis (PVNS) is normally treated by arthroscopic or open surgical excision. We present our initial experience with radiofrequency thermo-ablation (RF ablation) of PVNS located in an inaccessible location in the knee. MATERIALS: Review of all patients with histologically proven PVNS treated with RF ablation and with at least 2-year follow-up. RESULTS: Three patients met inclusion criteria and were treated with RF ablation. Two of the patients were treated successfully by one ablation procedure. One of the three patients had a recurrence which was also treated successfully by repeat RF ablation. There were no complications and all patients returned to their previous occupations following RF ablation. CONCLUSION: In this study we demonstrated the feasibility of performing RF ablation to treat PVNS in relatively inaccessible locations with curative intent. We have also discussed various post-ablation imaging appearances which can confound the assessment for residual/recurrent disease.
Subject(s)
Catheter Ablation/methods , Knee Joint/surgery , Synovitis, Pigmented Villonodular/diagnosis , Synovitis, Pigmented Villonodular/surgery , Adult , Female , Humans , Knee Joint/diagnostic imaging , Knee Joint/pathology , Magnetic Resonance Imaging/methods , Male , Pilot Projects , Tomography, X-Ray Computed/methods , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery. MATERIALS AND METHODS: Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablation. RESULTS: Twelve patients were diagnosed with chondroblastoma. Out of these, 8 patients (6 male, 2 female, mean age 17 years) with chondroblastoma (mean size 2.7 cm) underwent RF ablation. Multitine expandable electrodes were used in all patients. The number of probe positions needed varied from 1 to 4 and lesions were ablated at 90 °C for 5 min at each probe position. The tumours were successfully treated and all patients became asymptomatic. There were no recurrences. There were 2 patients with knee complications, 1 with minor asymptomatic infraction of the subchondral bone and a second patient with osteonecrosis/chondrolysis. CONCLUSION: Radiofrequency ablation appears to be a safe and effective alternative to surgical treatment with a low risk of recurrence and complications for most chondroblastomas. RF ablation is probably superior to surgery when chondroblastomas are small (less than 2.5 cm) with an intact bony margin with subchondral bone and in areas of difficult surgical access.
Subject(s)
Bone Neoplasms/surgery , Catheter Ablation/adverse effects , Catheter Ablation/methods , Chondroblastoma/surgery , Neoplasm Recurrence, Local/prevention & control , Osteonecrosis/etiology , Adolescent , Adult , Bone Neoplasms/complications , Bone Neoplasms/diagnosis , Chondroblastoma/complications , Chondroblastoma/diagnosis , Female , Humans , Male , Neoplasm Recurrence, Local/diagnosis , Osteonecrosis/prevention & control , Treatment Outcome , Young AdultABSTRACT
Objective. To evaluate rise in impedance during percutaneous radiofrequency thermocoagulation (PRFTC) of osteoid osteomas as a predictor of local recurrence. Design and Patients. A prospective study of 23 patients (24 PRFTC procedures) with minimum of 2.25-year followup (average 3.3 years). Average age 19.6 years (range 4-44), sex ratio 15 : 8 (male : female), 16 nondiaphyseal, 7 diaphyseal. Results. In 19 procedures, an increase in impedance was measured-no recurrences have occurred in this group to date. In 5 procedures, no increase in impedance was seen (3 non-diaphyseal, 2 diaphyseal), and 1 recurrence has been seen in this group to date. This difference is statistically significant with a P value of .05.
ABSTRACT
Periarticular bone metastasis may be treated with endoprosthetic reconstruction. The extensive surgery required may not, however, be appropriate for all patients. Our aim was to establish whether locking plates provide good functional outcomes and a durable construct when used in the management of metastatic disease. Prospective data collection was performed. Twenty one patients underwent surgery for periarticular metastatic tumours. The median duration of followup for surviving patients is one year. There have been no cases of implant failure and no requirement for revision surgery. Pain relief was excellent or good in the majority of patients. Patients who had sustained a fracture prior to fixation had restoration of their WHO performance status. All patients had a dramatic improvement in their MSTS scores. The median pre-operative score was 15% (0%-37%) improving to a median score of 80% (75%-96%) post operatively. Locking plates were found to provide reliable fixation and excellent functional restoration in selected patients suffering from periarticular metastatic bone disease.