Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management.

We studied a consecutive series of 40 patients presenting a septic knee arthritis, with a mean age of 49 +/- 20 (range 19-81) years. The aetiologies were: 18 postoperative arthritis, 12 haematogenous infections, 7 arthritis following aspiration or infiltration, and 3 articular wounds. The most common organisms were Staphylococcus aureus and epidermidis (23 cases). Surgical procedures consisted in 20 arthroscopic debridements, 6 open debridements, 14 synovectomies. According to Gächter's classification, there were 8 stage I, 18 stage II, 11 stage III and 3 stage IV cases. Fifteen patients had to be reoperated after the index procedure at our institution: one open debridement, six open synovectomies, one open arthrolysis, one arthrodesis and six total knee arthroplasties (TKA). Final examination was performed after 22 +/- 26 (range 12-96) months. All cases were considered free of infection. Good functional result was present by 19/33 cases (excluding arthrodesis and TKA). The delay between the onset of symptoms and surgery was the major prognostic factor of success (P=0.023). This delay was correlated with Gächter's staging of the intra-articular lesions. The diagnosis of septic knee arthritis must be suspected at the early stage of the disease, and diagnostic joint aspiration must be immediately performed when the diagnosis is suspected. We suggest that the treatment should be more aggressive than generally advocated. Needle aspiration should be only performed at the very early stages. Arthroscopic debridement should be the routine treatment. Synovectomy should be considered even as a primary procedure when significant synovial hypertrophy is present (Gächter stage III and IV) or when a more conservative treatment did not lead to a fast improvement.

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

No abstract

Poor performance status at presentation is the strongest indicator of poor short-term survival, whereas low disease load and favorable tumor histology are associated with longer-term survival.