Surgical resection of osseous metastases is becoming more and more important in obtaining longer overall survival in carcinoma patients. In 228 cases surgically treated at our institution between 1980 and 1993, the survival was 49% after 1 year, 32% after 2 years, 22% after 3 years and, finally, 11% after 5 years. Retrospectively evaluated, breast and thyroid carcinoma proved to be of positive prognostic influence and lung cancer of negative significance. As a main significant parameter, further extraosseous metastases were evaluated. The prognostic influence of the number of osseous lesions could only be demonstrated in breast and renal cell carcinoma without involvement of further organs. Age and location of the skeletal lesions proved to be of no prognostic influence. Based on these prognostic parameters, three subgroups of patients with worse, median and good long-term survival could be defined. In conclusion, the indication and amount of surgery can be based on these prognostic factors, leading to a decrease in morbidity and hospitalization time in patients with limited survival.
Despite technical developments over the years, a complication rate > 10% remains. Secondary amputation due to local recurrence is reported in about 10% of cases and due to infection in 6-12%. Transient or permanent palsy of the peroneal nerve is observed in 5% of cases. A quarter of all patients have full (< 20° extension lag) active extension, the mean extension lag is about 30°. The probability of a revision (including implant related) is 60-70% after 10 years. Based on the clinical results, the technical demanding resection of the proximal tibia is a recommendable procedure.
This study was undertaken to determine whether there is a correlation between magnetic resonance imaging (MRI) and clinical success after reconstruction of the anterior cruciate ligament (ACL). In a prospective study, 28 patients underwent clinical and MRI examination 3 to 5 years after ACL reconstruction with either the semitendinosus tendon (n=15) or patellar ligament (n=13). Knee stability was assessed both clinically and by KT-1000 arthrometer testing. Magnetic resonance imaging was performed with a 0.2-T dedicated system (Artoscan, Esaote, Italy) including sagittal and oblique coronal T1 and T2-weighted images. Magnetic resonance images were evaluated by two readers with regard to signal intensity and continuity of the ACL reconstruction and presence or absence of posterior cruciate ligament buckling. Knee stability and MRI evaluation were each summarized in a 6-point score. Statistical correlation was checked with the Spearman ranked correlation for testing non-normal distributed samples. Statistical testing of all patients' results together showed a significant correlation with a prediction value of 12%, indicating no significant correlation between clinical results and MRI evaluation. Separate statistical testing of the patellar ligament and semitendinosus patients' results showed no significant correlation in either group at all. Thus, no correlation between clinical stability and MRI could be established. Magnetic resonance images after ACL reconstruction using the techniques mentioned above should be interpreted with caution, as they may not relate to the clinical function of the ligament.
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