Return to sports following lower limb musculoskeletal tumor surgery-A systematic review.

BACKGROUND: Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients. PURPOSES: Identify patients returning to sports. Describe the sporting activities in which patients participate. Identify the outcome measures used to assess return to sport. Identify barriers preventing return to sports. STUDY DESIGN: Systematic review. METHODS: A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG). RESULTS: Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. CONCLUSION: There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre- and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.

Do frailty scores predict outcome after proximal femoral replacement for musculoskeletal tumours: a case series?

PURPOSE: Frailty has a negative independent relationship with morbidity and mortality. A frail individual has low resilience and adaptive capacity to stressors with unfavourable consequences. The relationship between musculoskeletal tumour patients undergoing surgery and frailty is underrepresented in literature. This study's questions are; what is the prevalence of frailty in patients undergoing surgery for musculoskeletal tumours; what is the correlation between frailty and survival plus secondary outcome measures including length of hospital stay (LOS); can clinicians use frailty scoring to support preoperative decision-making? METHODS: Patients over 60 years of age undergoing proximal femoral replacement for musculoskeletal tumours were included and classified as fit, vulnerable or frail using the modified frailty index (mFI), Rockwood and American Society of Anaesthesiologist's physical status classification (ASA) grading systems. Correlation with outcomes including survival and (LOS) was determined. RESULTS: 85 patients were identified of mean age 72.6 years. Median follow-up was 18.9 months. The prevalence of frailty ranged between 55 to 76% and the overall median survival in frail groups were 19.8 months with all scoring systems used. Frail patients classified by the Rockwood score had a greater LOS and a trend to reduced survival. CONCLUSIONS: There is a high prevalence of frailty in this cohort and frailty scores should be considered when planning surgery as part of holistic care. Moreover, a median survival greater than 18 months in frail patients supports the decision to offer surgery which may positively impact quality of life. Further research to identify the relationship between frailty and outcomes in musculoskeletal tumour patients is needed. LEVEL OF EVIDENCE: IV, Retrospective Case Series.

Hip adductor pyomyositis from Streptococcus mitis in a four-year-old child.

The unique aspect of this case study is the unusual history, presentation, ultrasonography, MRI and blood culture results, which lead to the diagnosis and treatment of adductor pyomyositis with a rare organism in a temperate country. The patient presented with a one-day history of malaise, fever, left groin pain and inability to weight bear on the left leg. There was no history of any trauma, predisposing infections or recent travel. Plain radiograph and ultrasound of the hip was normal with no effusion. Two consecutive blood cultures suggested Streptococcus mitis bacteraemia and MRI scan confirmed pyomyositis of the left hip adductors that was too small to drain. S. mitis is a normal commensal organism however it can lead to opportunistic infections particularly endocarditis. Echocardiogram revealed no cardiac complications, in particular no endocarditic vegetation. Patient was treated with intravenous benzylpenicillin for a week followed by oral phenoxymethylpenicillin for a week. Adductor pyomyositis must be considered as a differential diagnosis in a child with unusual presentation of hip pain. When an ultrasound is normal, MRI scan is warranted to confirm diagnosis. Septic screen should include blood cultures. The commonest causative organisms are the Staphylococcus family. However if S. mitis is isolated, cardiac sources of infection resulting in septic emboli must be investigated. Repeated MRI scans are required particularly if the patient does not respond to medical management. LEVEL OF EVIDENCE: IV.

Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy.

The potential benefit of arthroscopy as a treatment for knee osteoarthritis is contentious, with National Institute for Health and Care Excellence stating that, "There is uncertainty regarding the efficacy of the procedure." This is a study of a consecutive series of patients with osteoarthritis of the knee, suffering from mechanical symptoms, such as giving way, catching, and locking, and undergoing arthroscopic debridement, including chondroplasty and meniscectomy where appropriate. A total of 33 patients were reviewed at a mean period of 24 months (standard deviation 3 months) and follow-up data were obtained for 28 of these patients. Primary outcomes measured were: number of mechanical symptom episodes per week and visual analog scores for pain. Secondary outcomes measured were: Oxford, Lysholm, and Tegner knee scores together with arc of motion of the joint. Seven patients went on to have a knee replacement within 2 years. In the patient subgroup who did not require further surgery, there was statistically significant improvement in giving way (p = 0.0184) and marginally significant improvement in catching and locking (p = 0.1105 and p = 0.087, respectively). There were statistically significant improvements found in the Oxford and Lysholm scores (p < 0.0001). An average decrease of 1.9 in the VAS pain score was observed that was also statistically significant (p < 0.0007) and an average improvement of 10 degrees in the arc of motion was noted, which was marginally significant (p = 0.0687). To our knowledge, this is the first study with a primary outcome measure of mechanical symptoms experienced by patients. The results overall suggest that patient symptoms improved following arthroscopic treatment. As a result, episodes of mechanical symptoms should be important criteria for clinicians in determining the patient suitability for arthroscopic debridement.