Search

Introduction: Chondrosarcoma of the synovium is a rare and malignant form of cartilaginous tumor that originates in synovial tissue. There have only been a limited number of reported cases of malignant transformation of synovial chondromatosis (SC) into secondary chondrosarcoma (SCH), primarily in the hip and knee, in patients with resistant illness. The occurrence of chondrosarcoma in SC of the wrist is highly uncommon, as evidenced by only a single previous case study that has been documented in the literature. Case Report: This study presents a case series of two patients with primary SC who developed SCH at the wrist joint. Conclusion: Clinicians treating localized swellings of the hand and wrist should be alert to the likelihood of a sarcoma diagnosis to minimize delays to definitive therapy. Keywords: Secondary chondrosarcoma, synovitis, primary synovial chrondromatosis, secondary synovial chondromatosis, malignant transformation.

Summary Background Late-stage isolated medial knee osteoarthritis can be treated with total knee replacement (TKR) or partial knee replacement (PKR). There is high variation in treatment choice and little robust evidence to guide selection. The Total or Partial Knee Arthroplasty Trial (TOPKAT) therefore aims to assess the clinical effectiveness and cost-effectiveness of TKR versus PKR in patients with medial compartment osteoarthritis of the knee, and this represents an analysis of the main endpoints at 5 years. Methods Our multicentre, pragmatic randomised controlled trial was done at 27 UK sites. We used a combined expertise-based and equipoise-based approach, in which patients with isolated osteoarthritis of the medial compartment of the knee and who satisfied general requirements for a medial PKR were randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. The primary endpoint was the Oxford Knee Score (OKS) 5 years after randomisation in all patients assigned to groups. Health-care costs (in UK 2017 prices) and cost-effectiveness were also assessed. This trial is registered with ISRCTN (ISRCTN03013488) and ClinicalTrials.gov ( NCT01352247 ). Findings Between Jan 18, 2010, and Sept 30, 2013, we assessed 962 patients for their eligibility, of whom 431 (45%) patients were excluded (121 [13%] patients did not meet the inclusion criteria and 310 [32%] patients declined to participate) and 528 (55%) patients were randomly assigned to groups. 94% of participants responded to the follow-up survey 5 years after their operation. At the 5-year follow-up, we found no difference in OKS between groups (mean difference 1·04, 95% CI −0·42 to 2·50; p=0·159). In our within-trial cost-effectiveness analysis, we found that PKR was more effective (0·240 additional quality-adjusted life-years, 95% CI 0·046 to 0·434) and less expensive (−£910, 95% CI −1503 to −317) than TKR during the 5 years of follow-up. This finding was a result of slightly better outcomes, lower costs of surgery, and lower follow-up health-care costs with PKR than TKR. Interpretation Both TKR and PKR are effective, offer similar clinical outcomes, and result in a similar incidence of re-operations and complications. Based on our clinical findings, and results regarding the lower costs and better cost-effectiveness with PKR during the 5-year study period, we suggest that PKR should be considered the first choice for patients with late-stage isolated medial compartment osteoarthritis. Funding National Institute for Health Research Health Technology Assessment Programme.

BackgroundFifty thousand knee replacements are performed annually in the UK at an estimated cost of £150 million. Post-operative improvement depends on a number of factors including implant design and patient associated factors. To our knowledge there are no published study's comparing the results of AP glide and rotating platform designs of LCS knee arthroplasty. Therefore we feel that a study is required to investigate and compare the effects of two types of LCS total knee arthroplasty on joint proprioception and range of motion.Methods/DesignPatients will be randomised to receive either a LCS AP glide or Rotating platform prosthesis. Clinical scores (Oxford knee score, American knee society score, EuroQol), range of motion and proprioception will be assessed prior to and at 3,6, 12 and 24 months after the operation. Proprioception will be assessed in terms of absolute error angle (mean difference between the target angle and the response angle). Knee angles will be measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak that detects positions of sensors placed on the test limb. Student's t-test will be used to compare the mean of two groups.DiscussionEvidence is lacking concerning the best prosthesis to use for patients undergoing total knee replacement. This pragmatic randomised trial will test the null hypothesis that anteroposterior glide LCS knee arthroplasty does not result in better post operative knee motion and proprioception as compared to rotating platform LCS knee.Trial RegistrationISRCTN52943804

We present a case of polyarticular septic arthritis associated with radiotherapy to the pelvis. This led to rapid bilateral destruction of the hip joints. Post-irradiation osteonecrosis of the femoral head is rare with only six cases reported in the literature since 1970. The femoral head, with its tenuous blood supply, is susceptible to necrosis if its microvasculature is damaged by radiation, which can also damage osteoblasts and osteoclasts. Necrotic bone is susceptible to infection and this can lead to septic arthritis or osteitis. In November 1997 he presented to his general practitioner complaining of fever, malaise, night sweats, bilateral hip pain, a rash over his thighs and a weight loss of 6 kg over the previous two months. On examination he was noted to have an erythematous rash over his thighs and hepatosplenomegally. His hips were painful on both active and passive movement, but the range of movement was normal. He was found to have Hb 8.4g%, WCC 12.2x109/l and CRP 196. Virology screen was normal. Bone scan showed mildly increased uptake in the region of the right hip joint. X-rays demonstrated mild bilateral degeneration of the hip joints (Fig. 1). MRI scan showed reduced joint space in both hips with a mild effusion on the right. Attempted ultrasonically guided aspiration of this effusion failed. His symptoms of rash, malaise, fever and loss of weight settled spontaneously and he was discharged home. His hip pain gradually worsened and three months later he was referred to the Orthopaedic Surgery Department. He had a markedly restricted and painful range of movement in both hips with marked wasting of the quadriceps mechanism bilaterally. Xrays (Fig. 2) and computerised tomography (Fig 3, 4 & 5) revealed massive destruction of the femoral heads and acetabulae. The right hip was aspirated under image intensifier. The aspirate contained group G betahaemolytic streptococci. CASE REPORT