Background:Human papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC) is associated with improved survival compared with HPV-negative disease. However, a minority of HPV-positive patients have poor prognosis. Currently, there is no generally accepted strategy for identifying these patients.Methods:We retrospectively analysed 270 consecutively treated OPSCC patients from three centres for effects of clinical, pathological, immunological, and molecular features on disease mortality. We used Cox regression to examine associations between factors and OPSCC death, and developed a prognostic model for 3-year mortality using logistic regression analysis.Results:Patients with HPV-positive tumours showed improved survival (hazard ratio (HR), 0.33 (0.21–0.53)). High levels of tumour-infiltrating lymphocytes (TILs) stratified HPV-positive patients into high-risk and low-risk groups (3-year survival; HPV-positive/TILhigh=96%, HPV-positive/TILlow=59%). Survival of HPV-positive/TILlow patients did not differ from HPV-negative patients (HR, 1.01; P=0.98). We developed a prognostic model for HPV-positive tumours using a ‘training' cohort from one centre; the combination of TIL levels, heavy smoking, and T-stage were significant (AUROC=0·87). This model was validated on patients from the other centres (detection rate 67% false-positive rate 5.6% AUROC=0·82).Interpretation:Our data suggest that an immune response, reflected by TIL levels in the primary tumour, has an important role in the improved survival seen in most HPV-positive patients, and is relevant for the clinical evaluation of HPV-positive OPSCC.

Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.

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Aims The aim of this study was to evaluate fretting and corrosion in retrieved oxidized zirconium (OxZr; OXINIUM, Smith & Nephew, Memphis, Tennessee) femoral heads and compare the results with those from a matched cohort of cobalt-chromium (CoCr) femoral heads. Patients and Methods A total of 28 OxZr femoral heads were retrieved during revision total hip arthroplasty (THA) and matched to 28 retrieved CoCr heads according to patient demographics. The mean age at index was 56 years (46 to 83) in the OxZr group and 70 years (46 to 92) in the CoCr group. Fretting and corrosion scores of the female taper of the heads were measured according to the modified Goldberg scoring method. Results The OxZr-retrieved femoral heads showed significantly lower mean corrosion scores than the CoCr heads (1.3 (1 to 2.75) vs 2.1 (1 to 4); p < 0.01). Mean fretting scores were also significantly lower in the OxZr cohort when compared with the CoCr cohort (1.3 (1 to 2) vs 1.5 (1 to 2.25); p = 0.02). OxZr heads had more damage in the proximal region compared with the distal region of the head. Location had no impact on damage of CoCr heads. A trend towards increased corrosion in large heads was seen only in the CoCr heads, although this was not statistically significant. Conclusion Retrieval analysis of OxZr femoral heads showed a decreased amount of fretting and corrosion compared with CoCr femoral heads. OxZr seems to be effective at reducing taper damage. Cite this article: Bone Joint J 2019;101-B:386–389.

Level of Evidence: V, Expert Opinion

The authors reviewed all patients treated for periprosthetic femur fractures between March 1, 2007, and January 31, 2010 at the senior author's institution. Demographic features, mechanism of injury, radiographs, and computed tomography scans were reviewed to determine the type and stability of the femoral implant at the time of injury. All Vancouver B1 fractures were treated with a novel technique that used a contoured distal femoral locking plate intended for the contralateral femur and reversed to accommodate the ipsilateral femoral bow and contour of the proximal femur. Fixation was achieved around the implant with percutaneously placed unicortical and/or bicortical screws. Radiographs were reviewed for fracture healing, malunion, implant failure, and prosthetic loosening. Fifteen patients were identified and underwent the procedure as described. One patient died soon after surgery of complications from a ruptured preexisting esophageal ulcer. Of the remaining 14 patients, the average duration of follow-up was 25 months (range, 6-31 months). Two patients did not achieve union; however, repeat interpretation of the presenting radiographs showed likely misdiagnosed Vancouver B2 fractures. The first patient had late aseptic loosening and underwent revision surgery 22 weeks postoperatively. The other had early loss of fixation that required revision with a long stem prosthesis. Other complications included 1 deep venous thrombosis and 2 superficial wound infections. The infections were successfully treated with a single formal irrigation and debridement, primary closure, and a short course of oral antibiotics. Ultimately, in 86% of patients (12/14), fracture healing occurred with this biologically friendly technique.