ABSTRACT
A novel technique of using both a navigation system and an endoscope in intra-lesional curettage of benign bone tumors enables safe and adequate tumor removal via a minimal access approach. We performed curettage of benign bone tumors in five consecutive patients (4 female, 1 male, mean age 31.4 years) using a commercial CT-based navigation system supplemented by visual guidance through a shoulder arthroscope. The bone defect was filled with bone cement in four patients and with artificial bone substitute in one patient. Mean follow-up time was 8.8 months (range: 7-12 months). Mean duration of surgery was 144 min (range: 120-165 min). Mean wound length of each portal site was 19.5 mm (range: 15-25 mm). All patients could achieve a full range of joint movement and walk unaided at 4 weeks post-surgery. No local recurrence was noted.
Subject(s)
Bone Neoplasms/surgery , Chondroblastoma/surgery , Endoscopy/methods , Extremities/surgery , Giant Cell Tumor of Bone/surgery , Surgery, Computer-Assisted/methods , Adolescent , Adult , Bone Neoplasms/diagnosis , Chondroblastoma/diagnosis , Curettage/methods , Female , Giant Cell Tumor of Bone/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). METHODS: Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. RESULTS: No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI=30 kg/m2 or more), computer-assisted TKA provided better alignment than the conventional technique. CONCLUSION: Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Surgery, Computer-Assisted/methods , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Radiography , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Limb-salvage surgery, including endoprosthetic reconstruction after tumour resection, has become the standard management for local control of tumours around the knee. As the nature of surgery is technically complex and demanding, there is potential for significant morbidity arising from complications. This study describes our experience with complications following endoprosthetic reconstruction around the knee. METHODS: Retrospective analysis of consecutive resections and endoprosthetic reconstructions for tumours around the knee between 1996 and September 2005 performed at St Vincent's Hospital, Melbourne. RESULTS: Fifty consecutive cases were reviewed, with a median follow-up of 24.5 (range, 2-124) months. Median age was 41 (range, 13-79) years. Tumour types included 38 primary musculoskeletal malignancies, 8 metastatic tumours, 2 bony lymphomas and 2 benign lesions. There were eight deaths, nine cases of subsequent metastatic spread and no local recurrences. There were six cases of deep infection, two each of non-resolving nerve palsy, fracture and mechanical wear, and one each of symptomatic patellofemoral impingement, aseptic loosening and intraoperative popliteal artery trauma. Five patients required endoprosthetic revision, and three subsequent amputations were described. Excellent functional outcome and emotional acceptance was observed amongst patients that underwent revision. CONCLUSION: Resection and endoprosthetic reconstruction of tumours around the knee is both technically challenging and resource-intensive. It is imperative that morbidity from complications is limited through the minimisation of their incidence and the provision of optimal management. This series demonstrates that good patient outcomes can be achieved in specialist centres with experienced surgeons and adoption of a multidisciplinary approach.
