[show abstract][hide abstract] ABSTRACT: The failure of total hip systems caused by wear-particle-induced loosening has focused interest on factors potentially affecting wear rate. Remnants of the blasting material were reported on grit-blasted surfaces for cementless fixation. These particles are believed to cause third-body wear and implant loosening. The purpose of this study was to evaluate the early clinical and radiological outcomes of a cementless hip system with a new, contamination-free, roughened surface with regard to prosthesis-related failures.
Between May 2004 and March 2009, 202 consecutive primary total hip arthroplasties (THAs) (192 patients with a mean age of 62.6 years) were performed using a cementless stem (Hipstar®) and a hemispherical acetabular cup (Trident®).
At a minimum follow-up of two years, five revisions (2.5 %) due to aseptic loosening of the stem and three (1.5 %) of the cup were necessary. The cumulative rate of prostheses survival, counting revision of both components and with aseptic failure as end point, was 92.9 % at 8.8 years. Radiolucent lines up to three millimetres were evaluated in the proximal part of the femur in 61 % of cases.
Although the incidence of radiolucent lines was decreased, the revision rate was considerably increased compared to other uncemented hip implants with grit-blasted surfaces in the short- to mid-term follow-up of our study. Subsequent studies are needed to confirm whether these changes in implant material and surface affect the radiological and clinical outcome in the long term.
International Orthopaedics 10/2013; · 2.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: Osteosarcoma is the most common primary malignant bone tumour. Currently osteosarcoma classification is based on histological appearance. It was the aim of this study to use a more systematic approach to osteosarcoma classification based on gene expression analysis and to identify subtype specific differentially expressed genes. We analysed the global gene expression profiles of ten osteosarcoma samples using Affymetrix U133A arrays (five osteoblastic and five non-osteoblastic osteosarcoma patients). Differential gene expression analysis yielded 75 genes up-regulated and 97 genes down-regulated in osteoblastic versus non-osteoblastic osteosarcoma samples, respectively. These included genes involved in cell growth, chemotherapy resistance, angiogenesis, steroid- and neuropeptide hormone receptor activity, acute-phase response and serotonin receptor activity and members of the Wnt/ß-catenin pathway and many others. Furthermore, we validated the highly differential expression of six genes including angiopoietin 1, IGFBP3, ferredoxin 1, BMP, decorin, and fibulin 1 in osteoblastic osteosarcoma relative to non-osteoblastic osteosarcoma. Our results show the utility of gene expression analysis to study osteosarcoma subtypes, and we identified several genes that may play a role as potential therapeutic targets in the future.
International Orthopaedics 03/2010; 35(3):401-11. · 2.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: COSS, the interdisciplinary Cooperative German-Austrian-Swiss Osteosarcoma Study Group, was founded in 1977 and has since registered some 3,500 bone sarcoma patients from over 200 institutions. For the purpose of the Pediatric and Adolescent Osteosarcoma Conference in Houston, March 2008, the outcomes of 2,464 consecutive patients with high-grade central osteosarcoma, who had been diagnosed between 1980 and 2005 and had been treated on neoadjuvant COSS protocols, were reviewed. Intended treatment had included surgery and multidrug chemotherapy, with high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide being used in most protocols. After a median follow-up of 7.31 years for 1,654 survivors, 5- and 10-year survival estimates were 0.748/0.695 for 2,017 patients with localized extremity tumors and 0.369/0.317 for 444 patients with axial tumors or/and primary metastases, respectively. Tumor response to preoperative chemotherapy was of independent prognostic significance. Over the years, there was a major shift from amputation towards limb-salvage. This development was least evident for patients below the age of 10. While survival expectancies improved from the first to the second half of the recruitment period, no further improvement was evident within the latter period. In the manuscript, the results described above are discussed based on the findings of the previous analyses of our group.
Cancer treatment and research 01/2010; 152:289-308.
[show abstract][hide abstract] ABSTRACT: Tissue engineering has become available for cartilage repair in clinical practice.
The treatment of full-thickness chondral defects in the knee with a hyaluronan-based scaffold seeded with autologous chondrocytes provides stable improvement of clinical outcome up to 7 years.
Case series; Level of evidence, 4.
Fifty-three patients with deep osteochondral defects in the knee were treated with Hyalograft C. The mean age at implantation was 32 +/- 12 years, the mean defect size was 4.4 +/- 1.9 cm(2), and the mean body mass index was 24.5 +/- 3.8 kg/m(2). Implantations were performed with miniarthrotomy or arthroscopy. The primary indications for implantation with Hyalograft C included young patients with a stable joint, normal knee alignment, and isolated chondral defects with otherwise healthy adjacent cartilage. The secondary indications were patients who did not meet the primary indication criteria or were salvage procedures. Forty-two patients with primary indications and 11 patients with secondary indications were evaluated. Outcome was evaluated with the International Cartilage Repair Society and International Knee Documentation Committee scales, the Lysholm score, the modified Cincinnati score, and with Kaplan-Meier survival analysis. Statistical analysis consisted of bivariate correlation analysis and unpaired, 2-tailed t tests.
A highly significant increase (P <.001) in all knee scores was found in patients treated for the primary indications. Nine of 11 secondary indication cases underwent total knee arthroplasty due to persisting pain between 2 and 5 years after implantation. Graft failure occurred in 3 of 42 patients with primary indication between 6 months and 5 years after implantation. Kaplan-Meier survival demonstrated significantly different chances for survival between primary and secondary outcome and between simple, complex, and salvage cases, respectively (P <.001).
Hyalograft C autograft provides clinical improvement in healthy young patients with single cartilage defects. Less complicated surgery and lower morbidity are considered advantages of the technique. The results of treatment with Hyalograft C as a salvage procedure or in patients with osteoarthritis are poor.
The American journal of sports medicine 10/2009; 37 Suppl 1:81S-87S. · 3.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Fifty-six years after the introduction of Chiari's pelvic osteotomy, we report the long-term function scores and radiographic grade of osteoarthritis in 66 patients with 80 pelvic osteotomies with a minimum followup time of 27 years (average, 32 years; range, 27-48 years). These 66 patients were those who could be contacted and who returned for a followup visit from among 450 patients operated between 1961 and 1981. Thirty-two hips (40%) in 28 patients had undergone a total joint arthroplasty after an average 26 years (range, 13-41 years). Forty-eight hips in 41 patients (60%) were not replaced, their Harris hip score being a median of 82 points (range, 37-100 points). For the 22 patients for whom we had complete radiographs the average preoperative CE angle was 11.6 degrees, 48.6 degrees (range, 31 degrees-82.8 degrees) immediately postoperatively, and 41.6 degrees (range, 13.7 degrees-90 degrees) at last followup . Despite a functional hip score in most patients retaining their native hip, the degree of osteoarthritis progressed at last followup. We observed a similar mean age at the time of osteotomy in patients converted to total hip arthroplasty and those retaining their native hip. Age at time of surgery was inversely correlated (r = -0.78) with the interval between the osteotomy and THA. In this select patient group we found good functional outcome in patients who underwent Chiari pelvic osteotomy, with a conversion rate of 40% to total hip arthroplasty a mean of 32 years after the procedure. Level of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 07/2009; 467(9):2215-20. · 2.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of our study was to investigate a potential influence of elevated serumcobalt and serumchromiumlevels on renal function at minimum 10 years after implantation of a metal-on-metal hip.
Between November 1992 and June 1994 98 patients (44 m, 54 f) with an average age of 56 (22-79) years received a metal-on-metal bearing Metasul. At the time of the 10-year follow-up, 15 patients had died and 8 were lost to follow-up. The remaining 75 patients had laboratory analysis including serumcreatinine and full blood cell count as well as chromium and cobalt serum levels.
Ten years postoperatively the median serumcreatinine level was 0.86 (0.55-1.51) mg/dl, the serumcreatinine clearance Ccr was in the normal range. The hemogram did not differ from that measured at the time of surgery. The median serumcobalt concentration was 0.75 (0.3-50.10) microg/l and the serumchromium concentration was 0.95 (0.3-58.6) mug/l, 10 years postoperatively.
Our long-term data do not show any influence of serum cobalt or chromium concentrations on renal function following total hip arthroplasty.
Archives of Orthopaedic and Trauma Surgery 11/2007; 128(9):915-9. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was undertaken to verify whether or not the microstructure of aluminum alloy implants interferes with the characterization and quantification of aluminum inclusions on their surfaces, resulting from grit blasting.
Four factory-fresh prostheses were investigated by scanning electron microscopy and X-ray microanalysis. Specimens were cut out of the stems and the cross-sections analyzed. The specimens were etched in hot 25% hydrochloric acid. The hydrochloric acid was subsequently filtered with a 0.2-microm-pore filter. The filters were scanned using electron microscopy and X-ray microanalysis.
Aluminum oxide particles were found on all investigated stems; the diameter of the particles ranged from 4 to 100 microm. One hundred fifty-four particles were counted per mm(2). No particles were seen on the cross-sections of the implants. Scanning electron microscopy of the Millipore filters revealed aluminum oxide particles.
Remnants of grit blasting were found only on the surfaces; none were observed on cross-sections. We conclude that the microstructure of titanium aluminum alloy does not interfere with the identification and quantification of particles. Particles were identified on the filters by electron microscopy and X-ray microanalysis. Aluminum oxide on the surface of grit-blasted titanium aluminum alloy implants is, in fact, a residue of grit blasting.
Journal of Biomedical Materials Research Part B Applied Biomaterials 11/2007; 83(1):127-31. · 2.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Bone and soft-tissue sarcomas are uncommon, and their location in the foot is extremely rare. While limb salvage has become the standard of care in the treatment of sarcoma in an extremity, the unique anatomy of the foot presents challenges in reconstructing a viable and functional limb.
Between 1998 and 2005, we used free microvascularized osteomyocutaneous fibular grafts to reconstruct the defects created after extensive midfoot resection in six consecutive patients with a primary malignant tumor. In all but one patient, the extent of the resection involved at least two metatarsals. The mean age (and standard deviation) at the time of the operation was 30+/-13 years. At the final follow-up examination, clinical and radiographic evaluations were performed on all patients, and functional outcome and quality of life were assessed with use of the Musculoskeletal Tumor Society score, the American Orthopaedic Foot and Ankle Society Score, and the Toronto Extremity Salvage Score.
The median duration of follow-up was 52.2 months. Limb salvage was achieved in five patients. In the remaining patient, amputation was necessary because of flap failure. Revision surgery was necessary in all patients because of complications (skin ulcerations in three patients; hematoma in two patients; and infection, necrosis of the second toe, and flap necrosis in one patient each). At the time of final follow-up, five patients had satisfactory function and reported good quality of life. The average Musculoskeletal Tumor Society, American Orthopaedic Foot and Ankle Society, and Toronto Extremity Salvage scores were 82%, 75 points, and 92%, respectively. At the time of the final follow-up, five patients had no evidence of disease and one patient had disease.
Following the resection of a malignant tumor in the midfoot, the use of microvascularized osteomyocutaneous fibular grafts has proven to be a successful surgical technique, offering an alternative to ablative surgery with functional restoration of the salvaged limb.
The Journal of Bone and Joint Surgery 08/2007; 89(7):1553-64. · 3.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis. Elevated serum metal levels have been detected at short- and intermediate-term follow-up. There is little knowledge about long-term effects of increased ionic metal generation. Our study was undertaken to provide information about long-term survival, clinical outcome, radiographic appearance, and serum metal concentrations after a minimum 10 years follow-up with a metal-on-metal hip prosthesis: 105 cementless primary total hip prostheses with metal-on-metal articulating surfaces were implanted in 98 patients with a mean age of 56 years. Clinical data, radiographs, and blood samples were obtained at a follow-up visit 10 years after implantation. Serum cobalt and chromium levels were determined with use of atomic absorption spectrometry. General laboratory analyses included a full blood count and kidney function parameters. The Harris score was 92 points and the UCLA score 6 points after 10 years. Small osteolytic lesions and radiolucent lines were found in Gruen's zones 1, 7, 8, and 14. The probability of survival was 98.6%. The median serum cobalt concentration of the 22 patients with their hip replacement as the only source of cobalt was 0.75 microg/L (range, 0.3-50.1 microg/L). No patient was diagnosed with renal insufficiency during the study period. Five patients were diagnosed with a malignancy between surgery and the follow-up. We do not have evidence of an increased rate of primary malignancies nor could we detect renal failure in our study group. Serum metal levels did not differ from short- and intermediate term follow-up values.
Journal of Orthopaedic Research 07/2007; 25(7):841-8. · 2.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: Studies investigating the outcome of pigmented villonodular synovitis have been restricted to certain locations or types of the disease and have not provided adequate documentation of followup. We asked the following questions: What were the recurrence rates especially when considering location and type of pigmented villonodular synovitis?; What was the long-term clinical outcome?; and Was MR imaging essential for the correct diagnosis? We retrospectively reviewed 42 of 53 consecutive patients primarily treated at our institution (19 diffuse lesions and 23 nodular lesions in 19 large joints and 23 digits of the hands or feet). Ten patients had recurrences after an average followup of 80 months (range, 26-293.8 months). Recurrences were more frequent for the diffuse type than the nodular type and in large joints rather than in digits. The average Enneking score was 92% of normal limb function indicating that surgical treatment led to good functional results. Preoperative magnetic resonance imaging results corresponded well with histologic diagnoses and intraoperative findings. LEVEL OF EVIDENCE: Therapeutic Level IV.
Clinical Orthopaedics and Related Research 10/2006; 450:172-8. · 2.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our aim with this study was to establish the prevalence of flat foot in a population of 3- to 6-year-old children to evaluate cofactors such as age, weight, and gender and to estimate the number of unnecessary treatments performed.
A total of 835 children (411 girls and 424 boys) were included in this study. The clinical diagnosis of flat foot was based on a valgus position of the heel and a poor formation of the arch. Feet of the children were scanned (while they were in a standing position) by using a laser surface scanner, and rearfoot angle was measured. Rearfoot angle was defined as the angle of the upper Achilles tendon and the distal extension of the rearfoot.
Prevalence of flexible flat foot in the group of 3- to 6-year-old children was 44%. Prevalence of pathological flat foot was < 1%. Ten percent of the children were wearing arch supports. The prevalence of flat foot decreases significantly with age: in the group of 3-year-old children 54% showed a flat foot, whereas in the group of 6-year-old children only 24% had a flat foot. Average rearfoot angle was 5.5 degrees of valgus. Boys had a significant greater tendency for flat foot than girls: the prevalence of flat foot in boys was 52% and 36% in girls. Thirteen percent of the children were overweight or obese. Significant differences in prevalence of flat foot between overweight, obese, and normal-weight children were observed.
This study is the first to use a three-dimensional laser surface scanner to measure the rearfoot valgus in preschool-aged children. The data demonstrate that the prevalence of flat foot is influenced by 3 factors: age, gender, and weight. In overweight children and in boys, a highly significant prevalence of flat foot was observed; in addition, a retarded development of the medial arch in the boys was discovered. At the time of the study, > 90% of the treatments were unnecessary.
[show abstract][hide abstract] ABSTRACT: The outlook for patients with osteosarcoma who present with synchronous regional bone metastases (skip metastases), either in the primary bone site or transarticular, is considered to be extremely poor. This study was conducted to further investigate the prognostic implication of skip metastases in osteosarcoma.
The authors retrospectively analyzed the collected data of 1,765 consecutive patients with newly diagnosed high-grade osteosarcoma of bone who were registered in the neoadjuvant Cooperative Osteosarcoma Study Group studies and identified 24 patients (1.4%) with unequivocally proven skip metastases. All 24 patients were treated by an aggressive surgical approach coupled with polychemotherapy. Demographic, diagnostic, tumor, and treatment-related variables and response and survival data were analyzed.
Skip metastases were identified preoperatively in 11 of 24 patients by bone scan, eight of 22 patients by plain x-ray, 15 of 18 patients by magnetic resonance imaging, and five of 10 patients by computed tomography. A complete surgical remission (CSR) of all clinically detectable tumor sites was achieved in 22 of 24 patients during front-line therapy. With a median follow-up time of 4.4 years (8 years for survivors) from diagnosis, 12 patients were alive, all of whom were in continuous CSR. Survival did correlate with location of skip metastases and histologic response to neoadjuvant chemotherapy.
Synchronous regional bone metastases are rare in osteosarcoma, and preoperative detection relies on appropriate diagnostic imaging. Aggressive multimodal therapy holds the promise to achieve prolonged survival, especially in patients in whom these metastases occur within the same bone as the primary lesion and whose tumors respond well to chemotherapy.
Journal of Clinical Oncology 05/2006; 24(10):1535-41. · 18.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aneurysmal and solitary bone cysts develop most commonly during skeletal growth. The objective of our epidemiologic study was to evaluate the prevalence, recurrence rate, and probability of recurrence-free survival for aneurysmal and solitary bone cysts in young patients. We did a population-based analysis of 141 histologically confirmed cases. Seventy-three patients with aneurysmal bone cysts and 68 patients with solitary bone cysts were registered. The annual prevalence was 0.32 per 100,000 individuals (range, 0-1.238) for aneurysmal cysts, with a 1.8:1 male to female ratio and a median age of the patients of 11.1 years (range, 1-19.7 years). For solitary bone cysts, the calculated annual prevalence was 0.30 (range, 0-0.963) with a median age of the patients of 1.1 years (range, 0.5-19.9) and a 1.96:1 male to female ratio. Recurrent lesions occurred frequently in young males. Secondary aneurysmal bone cysts were observed only in females. During skeletal growth, aneurysmal and juvenile bone cysts more often occur in males with a peak prevalence at approximately 11 years of age. A greater prevalence of aneurysmal bone cysts in young individuals is associated with skeletal growth and immaturity. Young age and male gender are associated with an increased risk of local recurrence.
Clinical Orthopaedics and Related Research 11/2005; 439:136-43. · 2.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: Surgical treatment in the skeleton region and its adjacent tissue causes severe pain, demonstrated by the high demand of anaesthetics in the early postoperative phase. In order to offer adequate and individually adapted pain management, the orthopaedic department is working closely with the departments of anaesthesiology and intensive care medicine of the Vienna Medical University at the Vienna's General Hospital. The aim of this cooperation is to start postoperative rehabilitation early, to increase postoperative quality of life and to reduce the length of hospital stay. The surgical spectrum of the orthopaedic department consists of general orthopaedic, paediatric-orthopaedic-, sport- and rheuma-orthopaedic, tumour and spine interventions. The purpose of this review is to describe the cooperation between orthopaedic surgeons and anaesthetists at the Vienna Medical University.
Wiener Medizinische Wochenschrift 06/2005; 155(9-10):207-10.
[show abstract][hide abstract] ABSTRACT: Osteosarcoma is extremely rare in the hand and forearm. Therefore, only limited data are available for planning treatment or predicting the outcome and prognosis of osteosarcoma in the peripheral upper extremity.
Epidemiological, clinical, and histopathologic data were analyzed in 39 patients with osteosarcoma of the forearm or hand who were enrolled in studies of the Cooperative German-Austrian-Swiss Osteosarcoma Study Group from 1977 to December 2000. In patients with high-grade osteosarcoma, the treatment entailed surgical resection in combination with chemotherapy, whereas patients with low-grade osteosarcoma underwent only surgery.
The 5-year overall survival rate among the 33 patients with high-grade central osteosarcoma of the distal upper extremity was 86.2% +/- 6.4%. The 5-year event-free survival rate was 65.4% +/- 9.6%. Five of the eight patients with secondary metastases were in remission at the time of analysis. Four patients died of their disease, and two patients died of chemotherapy-related complications. The mean overall survival rate was 88.0% +/- 6.5% in patients treated by wide or radical tumor resection and was 75.0% +/- 21.7% in patients with nonwide margins of resection. Whether amputation or local resection was performed had no significant influence on the prognosis. All six patients whose osteosarcoma was not classified as high-grade central osteosarcoma were in remission at the time of analysis.
The results demonstrate a remarkably high survival rate for patients with high-grade osteosarcoma of the hand and forearm and confirm that multiagent chemotherapy in combination with wide excision is a highly effective treatment for this malignant tumor.
Annals of Surgical Oncology 05/2005; 12(4):322-31. · 4.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Because Ewing's sarcoma (EWS) is extremely rare in the hand and forearm, only limited data are available for planning treatment or predicting prognosis.
Data of 33 patients with EWS of the forearm or hand who were enrolled in studies of the German Association for Paediatric Oncology/Haematology and the European Intergroup Cooperative Ewing's Sarcoma Study Group were analyzed. Patients received neoadjuvant multi-agent chemotherapy according to the valid protocol. Local treatment consisted of surgery (n=7), radiotherapy (n=7), or a combination of both (n=19).
The 5/10-year overall survival rate was 84.1% (95% CI: 71.2-96.9)/74.1% (95% CI: 56.8-91.5), and both 5/10-year event-free survival rate were 71.3% (95% CI: 55.4-87.1). Only one of seven patients with secondary metastases was in remission at the time of analysis. One patient with local recurrence and another with primary metastases died. Altogether, eight of 33 patients died of their disease. The event-free survival rate was 80.6% in patients with good response to chemotherapy and 33.3% in patients with poor response. Surgery in combination with radiotherapy achieved a higher survival rate compared with radiotherapy or surgery alone. One out of two patients with non-wide margins of resection died of disease.
The results demonstrate a remarkably high survival rate for patients with EWS of the hand and forearm.
Journal of Cancer Research and Clinical Oncology 05/2005; 131(4):219-25. · 2.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the impact of patient, tumor, and treatment-related factors on outcome in unselected patients with recurrent osteosarcoma.
Five hundred seventy-six consecutive patients who had achieved a first complete surgical remission (CR) during combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group (COSS) protocols and then developed recurrent osteosarcoma were analyzed (median time from biopsy to relapse, 1.6 years; range, 0.1 to 14.3 years). There were 501 patients with metastases, 44 with local recurrences, and 31 with both. Metastases involved lungs (469 patients), bones (90 patients), and/or other sites (54 patients).
After a median follow-up of 1.2 years for all patients and 4.2 years for survivors, actuarial overall survival (OS) rates at 2, 5, and 10 years were 0.38, 0.23, and 0.18, respectively. Five-year OS was 0.39 for 339 patients with and 0.00 for 229 patients without a second surgical CR (P < .0001). A long time to relapse, a solitary lesion, and, in the case of pulmonary metastases, unilateral disease and the absence of pleural disruption, were of positive prognostic value in uni- and multivariate analyses, as were a second surgical CR and the use of second-line chemotherapy. Radiotherapy was associated with moderately prolonged survival in patients without a second CR. The very limited prognostic differences associated with the use of second-line chemotherapy appeared to be more pronounced with polychemotherapy.
Time to relapse and tumor burden correlate with postrelapse outcome in osteosarcoma. Complete surgery is an essential component of curative second-line therapy. Chemotherapy, particularly chemotherapy with more than one agent, may contribute to limited improvements in outcome.
Journal of Clinical Oncology 02/2005; 23(3):559-68. · 18.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: Umbilical cord serum and corresponding maternal serum of 3 women with uncemented metal-on-metal total hip arthroplasties were analyzed for cobalt and chromium. The women were an average 3.8 (range, 2-5) years after hip surgery. At the time of delivery, the maternal chromium concentrations were 1.6 microg/l, 0.5 microg/l, and 0.9 microg/l, respectively, and the maternal cobalt concentration was 1 microg/l in the first woman and below the detection limit in the other 2 women. Cobalt and chromium concentrations of the 3 umbilical cord sera also were below the detection limit. This indicates that-with regard to the detection limit of our laboratory-we were unable to observe a passage of cobalt and chromium ions from metal-on-metal articulations across the placenta at the time of delivery.
The Journal of Arthroplasty 01/2005; 19(8 Suppl 3):102-6. · 2.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chondrosarcomas of the hand are rare and generally treated with surgical resection. Thirteen patients with Grade 1 chondrosarcoma of the small bones of the hand were followed up for a mean of 99.8 months (range, 26-293 months). In eight patients (Group 1) curettage and reconstruction with cancellous bone was done and in five patients (Group 2) a wide resection was done. No patient experienced relapse in Group 2. In Group 1 one patient had a local relapse 18 months after intralesional resection. Using the Musculoskeletal Tumor Society score for evaluation, the clinical results showed an average of 98% and 95% of the normal function in Groups 1 and 2, respectively. None of the patients had evidence of systemic spread of the disease. With a relapse rate of 12.5% and no distant metastases after curettage, intralesional resection is the preferred method of treatment in Grade 1 chondrosarcoma of the hand, allowing the patient to avoid amputation and major loss of function.
Clinical Orthopaedics and Related Research 08/2004; · 2.79 Impact Factor