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11. Correspondence

Author

Grimer, Robert J., Carter, Simon R., Tillman, Roger M., Bell, Robert S., Davis, Aileen M., Wunder, Jay S., Buconjic, Tom, McGoveran, Bruce, and Gross, Allan E.

Published
1998

14. Modular endoprosthetic replacement for metastatic tumours of the proximal femur

Author

Carter Simon R, Grimer Robert J, Chandrasekar Coonoor R, Tillman Roger M, and Abudu Adesegun T

Subjects
Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background and aims Endoprosthetic replacements of the proximal femur are commonly required to treat destructive metastases with either impending or actual pathological fractures at this site. Modular prostheses provide an off the shelf availability and can be adapted to most reconstructive situations for proximal femoral replacements. The aim of this study was to assess the clinical and functional outcomes following modular tumour prosthesis reconstruction of the proximal femur in 100 consecutive patients with metastatic tumours and to compare them with the published results of patients with modular and custom made endoprosthetic replacements. Methods 100 consecutive patients who underwent modular tumour prosthetic reconstruction of the proximal femur for metastases using the METS system from 2001 to 2007 were studied. The patient, tumour and treatment factors in relation to overall survival, local control, implant survival and complications were analysed. Functional scores were obtained from surviving patients. Results and conclusion There were 45 male and 55 female patients. The mean age was 60.2 years. The indications were metastases. Seventy five patients presented with pathological fracture or with failed fixation and 25 patients were at a high risk of developing a fracture. The mean follow up was 15.9 months [range 0–77]. Three patients died within 2 weeks following surgery. 69 patients have died and 31 are alive. Of the 69 patients who were dead 68 did not need revision surgery indicating that the implant provided single definitive treatment which outlived the patient. There were three dislocations (2/5 with THR and 1/95 with unipolar femoral heads). 6 patients had deep infections. The estimated five year implant survival (Kaplan-Meier analysis) was 83.1% with revision as end point. The mean TESS score was 64% (54%–82%). We conclude that METS modular tumour prosthesis for proximal femur provides versatility; low implant related complications and acceptable function lasting the lifetime of the patients with metastatic tumours of the proximal femur.

Published
2008
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16. Bone defects following curettage do not necessarily need augmentation

Author

Hirn, Martti, de Silva, Uday, Sidharthan, Sujith, Grimer, Robert J, Abudu, Adesegun, Tillman, Roger M, and Carter, Simon R

Subjects
Research Article
Abstract

Background and purpose The natural pattern of bone healing in large bony defects following curettage alone as treatment of benign bone tumors around the knee is not well reported. We analyzed the outcome in 146 patients. Patients and methods 146 patients with over 18 months of follow-up who underwent curettage without bone substitute filling or bone grafting for a benign tumor in the distal femur or upper tibia were included. The mean diameter of the defects following curettage was 5.7 (1.3–11) cm and the estimated average volume was 63 (1–240) cm3. The plain radiographs before and following curettage were reviewed to establish the size of the initial defect and the rate of reconstitution and infilling of the bone. The time to full weight bearing and any complications were recorded. Results There was a variable rate of infilling; some defects completely reconstituted to a normal appearance while some never filled in. In 88% of the cases, no further intervention after curettage was required and the mean time to full weight bearing was 6 weeks. The risk of subsequent fracture or the late development of osteoarthritis was strongly related to the size of the cyst at diagnosis, with cysts of > 60 cm3 (about 5 cm in diameter) having a much higher incidence of complications. Interpretation This study demonstrates the natural healing ability of bone without any adjuvant filling. It could be used as a baseline for future studies using any sort of filling with autograft, allograft, or bone substitute.

Published
2009

18. Tumour Transfer to Bone Graft Donor Site: A Case Report and Review of the Literature of the Mechanism of Seeding

Author

Dias, Richard G., Abudu, Adesegun, Carter, Simon R., Grimer, Robert J., and Tillman, Roger M.

Subjects
Article Subject
Abstract

Purpose. Transmission of malignant tumour cells to a bone graft donor site is a rare complication of bone grafting.We report a case of seeding of malignant fibrous histiocytoma from the femur to a pelvic bone graft donor site.Discussion. We review the literature, discuss the possible mechanism of tumour transfer and offer advice aimed at avoiding this complication.

Published
2000
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19. Malignant Chondroblastoma of the Os Calcis

Author

Elek, Emil M., Grimer, Robert J., Mangham, David C., Davies, A. Mark, Carter, Simon R., and Tillman, Roger M.

Subjects
Article Subject, respiratory system
Abstract

Patient. We describe a case of chondroblastoma of the os calcis which metastasized to the tibia, soft tissues and lung. A complete response of the lung lesions was noted with chemotherapy.Discussion. Review of the published literature shows that metastatic chondroblastoma only arises following local recurrence of the tumour.

Published
1998
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32. Clear Cell Chondrosarcoma of Bone

Author

Ayoub, Khalid S., primary, Grimer, Robert J., additional, Carter, Simon R., additional, Mangham, David C., additional, Davies, A. M., additional, and Tillman, Roger M., additional

Published
1999
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42. Surgery.

Author

Jeys, Lee M., Grimer, Robert J., Carter, Simon R., Tillman, Roger M., Bickels, Jacob, Wittig, James C., Kollender, Yehuda, Kellar-Graney, Kristen L., Meller, Isaac, Malawer, Martin Miles, Maman, Eran, Mansour, Kari L., Wodajo, Felasfa, van Ruth, Serge, van Coevorden, Frits, Kroon, Bin B.R., Eilber, Fritz Christian, and Rosen, Gerald

Subjects
SURGERY, PROSTHETICS
Abstract

Focuses on the developments in surgery. Risk of amputation following endoprosthetic replacement; Types of reconstruction used in total scapular resection; Recommendation of extensile axillary exposure in the management of axillary tumors.

Published
2001
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