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From the European Osteosarcoma Intergroup study 202 patients were assessed with respect to their surgical treatment. Although treated in three different centres the survival of the three groups was identical (57% at five years). Two of the centres had rates of limb salvage of 85% and 83%, respectively, while the third had a rate of 49%. The corresponding risks of local recurrence were 13.3%, 6.8% and 2.5%, with all local recurrences arising in limbs with attempted limb salvage. Local recurrence was closely related to the adequacy of the margins of excision and to the chemotherapeutic response. Patients who had undergone limb-salvage surgery and who developed local recurrence still had a better survival than those who had primary amputation (37% v 31% survival at five years). Of patients who relapsed, 31% of those with local recurrence alone were cured by further treatment, as compared with only 10% of those with metastases. Limb-salvage surgery with effective chemotherapy remains the optimum treatment for osteosarcoma.

Primary synovial chondromatosis is a relatively uncommon condition. Synovial chondrosarcoma is considered to be very rare and it is not always clear whether the sarcoma develops by malignant transformation of synovial chondromatosis or whether it arises de novo. Differentiation of the two conditions on clinical and radiographic features is not possible and on histological criteria can be difficult. We report the case of a 59-year-old man who, 4 years after a synovectomy for synovial chondromatosis, developed a synovial chondrosarcoma of the hip. The literature is reviewed.

From the European Osteosarcoma Intergroup study 202 patients were assessed with respect to their surgical treatment. Although treated in three different centres the survival of the three groups was identical (57% at five years). Two of the centres had rates of limb salvage of 85% and 83%, respectively, while the third had a rate of 49%. The corresponding risks of local recurrence were 13.3%, 6.8% and 2.5%, with all local recurrences arising in limbs with attempted limb salvage. Local recurrence was closely related to the adequacy of the margins of excision and to the chemotherapeutic response. Patients who had undergone limb-salvage surgery and who developed local recurrence still had a better survival than those who had primary amputation (37% v 31% survival at five years). Of patients who relapsed, 31% of those with local recurrence alone were cured by further treatment, as compared with only 10% of those with metastases. Limb-salvage surgery with effective chemotherapy remains the optimum treatment for osteosarcoma. [Br] 2002;84-B:395-400. J Bone Joint Surg Received 22 December 2000; Accepted after revision 21 June 2001Osteosarcoma remains a challenging condition to treat. Despite the advances in surgery and chemotherapy over the past 25 years there remains a cohort of patients who do not survive. Numerous studies have been carried out in an attempt to improve the overall rate of survival for this condition. Despite this, rates of cure have remained unchanged at around 55% to 70% for the past 15 years. [1][2][3][4] During this period limb salvage surgery has become more commonly practised, and in many centres will now be offered to 80% or more of patients presenting with osteosarcoma. Simon et al 5 and Rougraff et al 6 have shown that the survival of patients with either limb salvage or amputation is no different, even though there is a higher rate of local recurrence in patients with limb salvage. It is generally accepted that, provided the surgery is carried out in an appropriate oncological manner, there is no detriment to the survival of patients treated with limb salvage in a variety of techniques. The European Osteosarcoma Intergroup (EOI) has now completed two studies on osteosarcoma. In the first, which took place between 1983 and 1986, 198 eligible and assessable patients were randomised to receive either a two-drug regime of doxorubicin and cisplatin or a three-drug regime of doxorubicin, cisplatin and high-dosage methotrexate. 7The overall survival was 57% and the two-drug regime was found to be superior, in terms of disease-free survival, to the three-drug regime.The second EOI study ran from 1986 to 1993. A total of 391 eligible patients with non-metastatic peripheral osteosarcoma were entered into the study in order to compare the previous two-drug regime with a multidrug regime based on the T10 protocol. 8 The results showed no significant difference between the two regimes, with an overall survival of 55% at five years. In that study, 101 of 391 patients (26%) had an amputation, seven had a r...