
Paul CoolRobert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK · Keele University
Paul Cool
MD DipStat MMedSc(Res) FRCS(Ed) FRCS(Orth)
About
101
Publications
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Introduction
Additional affiliations
April 2019 - present
June 2017 - September 2019
Publications
Publications (101)
Background
Central conventional chondrosarcoma (CS) is the most common subtype of primary malignant bone tumour in adults. Treatment options are usually limited to surgery, and prognosis is challenging. These tumours are characterised by the presence and absence of IDH1 and IDH2 mutations, and recently, TERT promoter alterations have been reported...
Abstract
Background: Non-diagnostic (ND) musculoskeletal biopsies of soft tissue lesions can increase patient anxiety
and delay definitive diagnosis and treatment. It is thought the specific histotype of the lesion may influence accuracy of
the biopsy. This study aims to assess if ND musculoskeletal biopsies are more likely to represent benign or m...
The aim of this study was to investigate the reproducibility, reliability and accuracy of Mirels’s score in upper limb bony metastatic disease and validate its use in predicting pathological fractures.
Methods
45 patients with upper limb bony metastases met the inclusion criteria (62% male 28/45). Mean age was 69 years (SD 9.5) and commonest prima...
The treatment options for central chondrosarcoma are limited, and prognoses are generally unreliable. The presence and absence of mutations in IDH1, and IDH2 are defining events, and TERT mutations have been recently been associated with poor outcome. Despite this, molecular biomarkers are lacking. Here, analysing data from 356 patients, comprising...
Chondrosarcoma (CS) is a rare tumour type and the most common primary malignant bone cancer in adults. The prognosis, currently based on tumour grade, imaging and anatomical location, is not reliable and more objective biomarkers are required. We aimed to determine whether the level of circulating tumour DNA (ctDNA) in the blood of CS patients coul...
Background
Review of mid-term results (five years) for tumour and revision arthroplasty surgery using the Stanmore METS® distal femoral replacement.
Methods
Data were collected retrospectively for 90 patients for procedures performed between 2002 and 2019. Kaplan-Meier survivorship for implant was estimated at five years post-op. Endpoints for sur...
Background
Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow.
Methods
A systematic review of PUB...
Introduction:
On June 24 in the United Kingdom, there were 277,989 cases of COVID-19 and 39,369 deaths recorded. The government enforced a complete lockdown on March 23 that resulted in cessation of all elective admissions on 24th onward, with only acute trauma cases being admitted to hospital. This study aims to characterize the changes in trauma...
Background
Bone tumours of the talus are a rare cause of ankle pain. This study aims to provide additional clinical clarity regarding the presentation and management of a minimally researched topic.
Methods
Sixteen patients were diagnosed with bone tumour of the talus between 2002 and 2020 following referral for ankle pain. Symptoms, diagnosis, and...
Aims
Malignancy and surgery are risk factors for venous thromboembolism (VTE). We undertook a systematic review of the literature concerning the prophylactic management of VTE in orthopaedic oncology patients.
Methods
MEDLINE (PubMed), EMBASE (Ovid), Cochrane, and CINAHL databases were searched focusing on VTE, deep vein thrombosis (DVT), pulmonar...
Abstract
Background
Delivering uninterrupted cancer treatment to patients with musculoskeletal tumors has been essential during the rapidly evolving coronavirus 2019 (COVID-19) pandemic, as delays in management can be detrimental. Currently, the risk of contracting COVID-19 in hospitals when admitted for surgery and the susceptibility due to adjuv...
Purpose:
Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishab...
Objective:
The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the a...
Aims
Our rural orthopaedic service has undergone service restructure during the COVID-19 pandemic in order to sustain hip fracture care. All adult trauma care has been centralised to the Royal Shrewsbury Hospital for assessment and medical input, before transferring those requiring operative intervention to the Robert Jones and Agnes Hunt Orthopaed...
Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. While the initial American Spinal Injury Association Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of...
This study evaluates the relationship between pregnancy, comorbid conditions and giant cell tumour of bone. Furthermore, it examines if pregnancy and comorbid conditions affect the outcome following treatment for this tumour.
A multi-centre retrospective review was conducted of consecutive patients with a confirmed histological diagnosis of giant c...
Introduction
The aim of this study was to evaluate radiological measurements to establish the origin of giant cell tumours of bone.
Methods
A multi-centre retrospective review was conducted of patients with histologically confirmed giant cell tumours of bone. Images were analysed to estimate the centre of the tumour. Measured from the joint line, t...
Objective:
To predict accurately whether a soft tissue mass was benign or malignant and to characterize its type using ultrasound, shear wave elastography and MRI. We hypothesized that with the addition of shear wave elastography, it would be possible to determine a threshold velocity value to classify a lesion as benign or malignant.
Materials a...
Introduction
Annually 80,000 hip fractures are treated at an estimated cost of two billion pounds. The 2011 guidance from the Royal College of Pathologists recommended all specimens where there is fracture through or below the articular surface should be examined to exclude/ identify an underlying cause (pathological fracture). The questions posed...
The aim of this study was to investigate if the risk of pathological fracture can be predicted with the proportion of body weight that can be put through the affected leg in patients with metastatic bone disease of the lower limb. A prospective observational study was conducted in patients with metastatic disease in the lower limb. Receiver Operato...
Osteoblastoma and osteoid osteoma together are the most frequent benign bone-forming tumor, arbitrarily separated by size. In some instances, it can be difficult to differentiate osteoblastoma from osteosarcoma. Following our recent description of FOS gene rearrangement in these tumors, the aim of this study is to evaluate the value of immunohistoc...
A fusion between fibronectin 1 (FN1) and activin receptor 2A (ACVR2A) has been reported previously in isolated cases of the synovial chondromatosis. To analyze further and validate the findings, we performed FISH and demonstrated recurrent FN1–ACVR2A rearrangements in synovial chondromatosis (57%), and chondrosarcoma secondary to synovial chondroma...
Aims:
The purpose of this study was to identify prognostic indicators of outcome at presentation to the orthopaedic surgeon, in patients with metastatic prostate cancer. Our aim was to use this information in a pragmatic, clinic-based approach so that surgical decision making could be optimized to benefit the patient in their remaining lifetime....
Aims:
The aim of this study was to validate the Mirels score in predicting pathological fractures in metastatic disease of the lower limb.
Patients and methods:
A total of 62 patients with confirmed metastatic disease met the inclusion criteria. Of the 62 patients, 32 were female and 30 were male. The mean age of patients was 65 years (35 to 89)...
Aims:
Dislocation rates are reportedly lower in patients requiring proximal femoral hemiarthroplasty than for patients undergoing hip arthroplasty for neoplasia. Without acetabular replacement, pain due to acetabular wear necessitating revision surgery has been described. We aimed to determine whether wear of the native acetabulum following hemiar...
Objectives:
In this cross sectional study, the impact and the efficacy of a surveillance programme for sarcomas of the extremities was analysed.
Methods:
All patients who had treatment with curative intent for a high-grade sarcoma and were diagnosed before 2014 were included and followed for a minimum of two years.
Results:
Of the 909 patients...
Osteoblastoma is benign bone forming tumour with rare malignant transformation. The common locations include spine, proximal humerus and hip. It rarely affects the talus. A case of osteoblastoma of the talus in a 33-years old healthy male who presented to the foot and ankle clinic in October 2015 complaining of pain of the right ankle for 12 months...
Breast cancer diagnosed during pregnancy is a relatively uncommon event. This challenging situation presents clinicians with diffi cult decisions, often requiring a multidisciplinary approach at a time of heightened anxiety for the patient and their family. This paper describes the case of a young woman with metastatic breast cancer diagnosed in ea...
Aims:
The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate.
Patients and methods:
A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone...
Aims The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. Patients and Methods A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a tot...
Impingement syndrome is usually caused by irritation of the rotator cuff within the sub acromial space and this includes the coraco-acromial arch (Acromion and Coraco-acromial ligament), the acromio-clavicular joint and occasionally the coracoid. Iatrogenic causes such as sutures, pins, plates or wires left from previous surgery can cause similar s...
Purpose:
After amputation, rehabilitation and limb fitting services are critically important to optimise outcomes. We investigated the reported patient experience and variation in limb fitting services after amputation for musculoskeletal tumours in England.
Methods:
A postal survey instrument was developed following literature review, patient a...
Background and objectives:
The Toronto extremity salvage score (TESS) assesses physical function following limb salvage for bone and soft tissue sarcoma. In 2012, Clayer et al. showed increasing age affects the TESS score in normal individuals. The purpose of this study was to investigate what other patient factors affect outcome?
Methods:
We re...
Aims:
Surgical intervention in patients with bone metastases from breast cancer is dependent on the estimated survival of the patient. The purpose of this paper was to identify factors that would predict survival so that specific decisions could be made in terms of surgical (or non-surgical) management.
Methods:
The records of 113 consecutive pa...
Myxoid liposarcomas (MLS) are a subgroup of soft-tissue sarcomas which have a propensity for extra-pulmonary metastases. Conventional radiological staging of soft-tissue sarcomas consists of chest radiographs (CXR) and thoracic computed tomography (CT) for possible chest metastases, supplemented by magnetic resonance imaging (MRI) for local disease...
Plots are an elegant and effective way to represent data. At their best they encourage the reader and promote comprehension. A graphical representation can give a far more intuitive feel to the pattern of results in the study than a list of numerical data, or the result of a statistical calculation.
The temptation to exaggerate differences or relat...
Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue...
Pigmented villonodular synovitis (PVNS) is normally treated by arthroscopic or open surgical excision. We present our initial experience with radiofrequency thermo-ablation (RF ablation) of PVNS located in an inaccessible location in the knee.
Review of all patients with histologically proven PVNS treated with RF ablation and with at least 2-year f...
We present a rare case of metacarpal chondrosarcoma with cutaneous metastases in the ipsilateral upper arm. Chondrosarcomas of the small bones of the hand rarely metastasise unlike chondrosarcomas elsewhere in the body. Excision/ray amputation rather than curettage may be preferable in the treatment of high-grade chondrosarcomas in the hand.
To promote early diagnosis of cancer, NICE published updated guidelines ‘Suspected cancer: recognition and referral – NICE guidelines NG 12 in June 20151. It is our opinion that the new guidelines on sarcomas need urgent review/update to provide clarity on recognition and referral and our response was published on 26th July 20152
Soft tissue lumps...
To promote early diagnosis of cancer, NICE published updated guidelines ‘Suspected cancer: recognition and referral – NICE guidelines NG 12 in June 20151. It is our opinion that the new guidelines on sarcomas need urgent review to provide clarity on recognition and referral.
Sarcomas are rare malignancies constituting about 1% of all cancers. Howev...
Stress induced injuries affecting the physeal plate or cortical bone in children and adolescents, especially young athletes, have been well described. However, there are no reports in the current English language literature of stress injury affecting the incompletely ossified epiphyseal cartilage. We present four cases of stress related change to t...
Objective:
Assessment of the extent of tumours using magnetic resonance imaging (MRI) is the basis for bone resection in limb-salvage surgery. We aimed to compare the accuracy of T1-weighted MRI and STIR sequences in measuring the extent of proximal femoral tumours, using the macroscopic specimens as the gold standard for comparison.
Materials an...
To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery.
Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablat...
Osteoid osteoma and osteoblastoma have, in the past, been variously regarded as both similar and distinct entities. Currently, WHO classifies these tumours separately. We compared archetypal cases to identify novel histomorphological and immunohistochemical features attempting to clarify their mutual relationship.
10 osteoid osteomas and 20 osteobl...
Pigmented villonodular synovitis (PVNS) is a rare benign disease of the synovium of joints and tendon sheaths, which may be locally aggressive. We present 18 patients with diffuse-type PVNS of the foot and ankle followed for a mean of 5.1 years (2 to 11.8). There were seven men and 11 women, with a mean age of 42 years (18 to 73). A total of 13 pat...
Pigmented villo-nodular synovitis (PVNS) is a rare, benign and aggressive disorder of synovial joints and tendon sheaths which is capable of eroding articular structures and bone. It represents a spectrum of pathological disorders ranging from the most common giant-cell tumour of tendon sheath to localized or diffuse intra-articular PVNS lesions an...
Periarticular bone metastasis may be treated with endoprosthetic reconstruction. The extensive surgery required may not, however, be appropriate for all patients. Our aim was to establish whether locking plates provide good functional outcomes and a durable construct when used in the management of metastatic disease. Prospective data collection was...
Background:
A recent study has provided evidence-based guidelines for the follow-up of cemented total hip arthroplasty. As yet, there are no such guidelines on the surveillance of total knee arthroplasty. We reviewed the outcomes of patients who underwent this procedure in 1998 and 1999 at our institution.
Methods:
All patients were identified f...
Objective. To evaluate rise in impedance during percutaneous radiofrequency thermocoagulation (PRFTC) of osteoid osteomas as a predictor of local recurrence.
Design and Patients. A prospective study of 23 patients (24 PRFTC procedures) with minimum of 2.25-year followup (average 3.3 years). Average age 19.6 years (range 4–44), sex ratio 15 : 8 (ma...
The outcome of patients with a displaced intracapsular femoral neck fracture treated non-operatively was assessed at 1 year and compared with patients managed operatively over the same time period. Data were collected prospectively for 102 consecutive patients. 80 patients underwent hemiarthroplasty and 22 were managed non-operatively. Patients wer...
To the Editor:
Tenosynovitis occurring over the digital extensors of the extremities is a common cause of soft tissue swelling seen by the rheumatologist. We describe a case of long-standing soft tissue swelling on the dorsum of the foot. This was initially attributed to tenosynovitis but gradually became more edematous. Indeterminate radiologica...
We were surprised that only six out of 195 papers (or 20 infections) were considered suitable for inclusion in the meta-analysis of Smith and colleagues on sutures v staples for wound closure.1The papers selected are a mixture of trauma and elective orthopaedics. These are two heterogeneous …
Angiomatoid fibrous histiocytoma is a neoplasm of uncertain histogenesis, which most commonly arises in the subcutaneous tissue of the extremities of children and young adults. We report the first case of a calcifying sclerosing variant of this entity. This case arose in bone-a site where there has been just 1 previously published case of typical (...
In this review, we aim to (1) outline the nature and scale of metastatic skeletal disease; (2) describe the role of the multidisciplinary musculoskeletal medical and surgical team; and (3) discuss and illustrate the diagnostic pathology approach with emphasis on its clinical relevance. The employment of immunohistochemistry in helping to establish...
A 36-year-old man presented with a long history of pain in his left ankle. Imaging and biopsy confirmed this to be a giant cell tumour of bone. This was treated with curettage of the lesion and stabilisation with an Ilizarov frame. After a prolonged course of rehabilitation he has excellent function and has returned to hill walking and there is no...
No evidence based guidelines on surveillance of cemented total hip arthroplasty exist. We reviewed outcomes of this procedure from 1996 & 1997. Patients were identifed from theatre log books. Follow up data was retrieved from patient records. Evidence of radiological loosening & time of revision were recorded. Data was analysed using a ® statistica...
We performed an in vitro study to examine the effect of distal femoral centralising devices on the cement mantle after introduction of a tapered femoral prosthesis (Exeter no2 44 mm offset stem). This was assessed in relation to the timing of insertion (early, middle and late) and three different cement products (CMW 1, Simplex and Palamed). Forty-...
Although the rare complication of squamous cell carcinoma in chronic osteomyelitis is well known, benign squamous epithelial proliferation can also occur, causing osteolysis and fracture. The radiological and correlated pathological features of osteolysis from this benign complication of chronic osteomyelitis are presented.
The standard treatment for chondroblastoma is surgery, which can be difficult and disabling due to its apo- or epiphyseal location. Radiofrequency (RF) ablation potentially offers a minimally invasive alternative. The often large size of chondroblastomas can make treatment with plain electrode systems difficult or impossible. This article describes...
The extended lateral approach to the calcaneum is the only adequate exposure to allow open reduction and internal fixation of calcaneal fractures. The main early complication of operative intervention is wound breakdown at the apex of the flap. We present a technique that avoids excessive retraction of the tip of the flap, provides excellent exposu...
To evaluate the efficiency of our follow-up regime for patients with sarcoma of the extremities.
We have reviewed our follow-up policy in 480 patients with non-metastatic bone or soft tissue sarcomas and with more than 5 years of follow-up.
We detected 24% of the soft tissue sarcoma recurrences and 38% of the bone tumour recurrences. We detected 67...
To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation.
A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 months.
There were seven local recurrences (16%)...
This study examines the presentation, management and outcomes of a series of 10 patients with giant lipomatous tumours (defined as greater than 5 cm diameter) of the hand and forearm who presented to our orthopaedic oncology service. All patients underwent local staging and were discussed at our multidisciplinary tumour meeting prior to definitive...
The aim of this study was to assess the effect on operative exposure of orthopaedic SpRs in a district general hospital when the number of middle-grade doctors increased from three to five. The appointment of two additional non-training middle-grade surgeons in August 2004 had the potential to reduce the operative cases available to the two SpRs.
Degenerative subchondral acetabular cysts are a common finding in patients with primary osteoarthritis of the hip. These mainly occur in the superior weight-bearing region of the acetabulum. The aim of this study was to identify the presence and distribution of degenerative acetabular cysts in patients with primary osteoarthritis of the hip. The ra...
Degenerative subchondral acetabular cysts are a common finding in patients with primary osteoarthritis of the hip. These mainly occur in the superior weight-bearing region of the acetabulum. The aim of this study was to identify the presence and distribution of degenerative acetabular cysts in patients with primary osteoarthritis of the hip. The ra...
The surgical management of patients with metastases around the hip is a challenging problem and its main aim is to improve quality of life. Complete and appropriate work up is an essential part of the process; a biopsy may well be required to confirm the diagnosis. If a patient presents with a patholcgical fracture, it should be assumed that the fr...
e report the results of a prospective study of 23 patients in which interstitial laser photocoagulation (ILP) was used to treat an osteoid osteoma. ILP is a technique in which tumour tissue is destroyed by direct heating using low-power laser light energy delivered by thin (400 µm) optical fibres which are introduced percutaneously into the tumour...
Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease...
Pathological fractures of the appendicular skeleton due to tumours are relatively uncommon. Patients who are older than 50 years are most likely to have a metastasis, while patients who are younger than 20 are more likely to have a primary bone neoplasm.
Pathological fractures of the appendicular skeleton due to tumours are relatively uncommon. Patients who are older than 50 years are most likely to have a metastasis, while patients who are younger than 20 are more likely to have a primary bone neoplasm.
In all fractures, but especially those that present after minimal trauma, one should have a hig...
Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease...
Inefficiency in surgical training has been identified as a result of low rates of supervision, with direct teaching of operating by consultants occurring in less than 20% of cases in papers dealing with general surgery and cardiac surgery training. The introduction of an audit system in an orthopaedic training programme was associated with an impro...
This paper reports psychometric evaluation of the Perceived illness Experience Scale (PIE). This includes eight sub-scales developed to determine the impact of a chronic illness from the patient's perspective. The sample included 34 patients (mean age = 17 years) successfully treated by limb salvage procedures for a primary bone tumour. Patients al...
The purpose of this investigation was to determine which geometric and surface properties encouraged optimal ingrowth and bonding of bone to an extra-cortical plate. Forty-eight titanium extra-cortical plates were attached onto the left and right femora of adult rabbits. The plates were of six different designs and the osseoconductive effects of fo...