The treatment of superficial tumors does not lead to significant changes in MSTS score or TESS. Anatomical location is not a significant predictor of aggregated MSTS and TESS evaluations. However, there is variation in MSTS and TESS item scores across anatomical locations.

High rates of positive margins and the need for further excision makes this tumour particularly suited to management by multidisciplinary surgical teams. Microscopic tumour can be present up to 29 mm from the macroscopic tumour in fascially-based tumours. Cite this article: Bone Joint J 2016;98-B:1682-8.

Background: This retrospective cohort study aimed to investigate whether simple routine blood tests at presentation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alkaline phosphatase and albumin) predict survival in patients with osteosarcoma. Methods: Between January 1998 and February 2015, 134 patients with a histological diagnosis of osteosarcoma were treated in our unit. Of these, 79 patients with high-grade osteosarcomas were included in the study. Demographic and clinical data, and laboratory parameters obtained prior to biopsy (CRP, ESR, alkaline phosphatase and albumin levels), were obtained from patients' records. Results: There were 44 males and 35 females. Univariate analysis showed that high pre-biopsy CRP (p ¼ 0.004), raised pre-biopsy ESR (p ¼ 0.010), older age (p < 0.001), poor tumour necrosis rates (90%, p ¼ 0.023) and metastasis at presentation (p < 0.001) were poor prognostic factors. Multivariate analysis showed pre-biopsy CRP and ESR levels to be independent predictors of overall survival (p ¼ 0.020 and p ¼ 0.025, respectively). Kaplan-Meier survival was significantly lower in patients with elevated CRP (p ¼ 0.002) and ESR (p ¼ 0.003). Hypoalbuminaemia and elevated alkaline phosphatase levels did not correlate with overall survival. Conclusion: Preoperative CRP and ESR levels may have value in building a prognostic model for patients presenting with osteosarcoma.

Minimally invasive surgery (MIS) is no longer an experimental procedure. Not only has it been practised since 1993 but the single incision technique was accepted by the National Institute for Health and Clinical Excellence in January 2006 as a safe, proven approach for hip replacement surgery. 1 Furthermore, there is a recognised definition of MIS surgery where the incision is less than or equal to 10 cm. The average age of the cohort described in the paper by Gerrand and colleagues was 71 years. This represents a retired population in whom early rehabilitation and return to work or sport may not be priorities and this could possibly explain why their patients rated length of recovery and stay in hospital as 'not important'. The findings of these authors contrast with the findings in our unit, a high-volume centre performing over 600 hip arthroplasties annually, where the average patient age is 60-65 years, incision length is 8-10 cm, and length of stay is 5 days. MIS hip arthroplasty facilitates earlier recovery and rehabilitation 2 and causes significantly less blood loss with no difference in complication rates. 3