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August 30, 2023

Rodney Saville Sneath FRCS & Professor John Scales FRCS

“The World is not limited by IQ. We are all limited by bravery and creativity”

Astro Teller Entrepreneur, Computer scientist & Author.

The names & achievements of the 20th Centuries’ orthopaedic giants are well known to all. Barely a professional conversation can still be had about total hip replacement without the mention of Sir John Charnley or in knee replacement John Insall. In trauma the legacy of Maurice Muller & the AO Group in transforming the science & surgical armamentarium for orthopaedic fracture management sits easily alongside the individual genius of Gregor Ilizarov in limb salvage. The orthopaedic conditions to which they dedicated their lives were very common ones & so their landmark innovations have been “scalable” & lent themselves to worldwide adoption by the lesser surgeons amongst us who have followed. In contrast, musculoskeletal tumours are very uncommon conditions for which the best results have been achieved only by concentrating the required experience in specialised units worldwide. Mastery of the surgical techniques required, & logistics needed to obtain the best outcomes, is not something that lends itself to widespread dissemination. An inevitable result of these facts means that the pioneers of orthopaedic surgical oncology, who achievements are every bit as noteworthy, remain far less known.

In the 1970s the outlook for patients with bone tumours was dismal with very high mortality and morbidity rates and the default operation generally was amputation.  Two orthopaedic surgeons, Rodney Saville Sneath,  at the Royal Orthopaedic Hospital in Birmingham & Professor John Scales   at the Royal National Orthopaedic Hospital, Stanmore, UK refused to accept this status quo & set about founding the principles of modern limb salvage surgery in orthopaedic oncology. They collaborated on the concept, design & successful execution of large endoprostheses as a viable alternative to amputation & progressively transformed the landscape for orthopaedic oncology patients. Where once amputation was the main option now in modern practice its indication has been reduced to approximately 15% of primary & recurrent disease cases. Their legacy has been even greater with endoprostheses having now moved into the mainstream and transforming what can be achieved in the revision joint replacement.

This month from the Bone & Joint Journals’ back catalogue, we are delighted to republish two excellent overview articles covering the area of Bone and Soft tissue orthopaedic tumours, one covering the latest options for Limb salvage surgery, and the other a key read to remind all orthopaedic surgeons of what a trap for the unwary soft tissue sarcoma can be. The Bone and Joint Journals back catalogue contains a wealth of over 800 peer reviewed academic papers in orthopaedic oncology alone, from 1948 to date, and full access to this definitive resource should be a requirement for any practicing Orthopaedic Surgeon.

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