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Aim This study investigated whether wire localisation of the histologically proven positive, clipped axillary lymph node (ALN) with subsequent targeted axillary dissection (TAD) following neoadjuvant chemotherapy (NACT) improves axillary staging in breast cancer. Materials and methods We performed a retrospective review of patients with primary breast cancer and core biopsy proven metastatic ALNs, that had an excellent nodal radiological response following NACT, treated at our centre between January 2016 and December 2018. The initial cohort of patients (Group 1) underwent sentinel lymph node biopsy (SLNB), with a minimum of three nodes were sampled. The subsequent cohort (Group 2) had a marker clip inserted in the metastatic ALN prior to NACT. This cohort underwent wire guided excision of the clipped node in addition to SLNB, with a minimum of three nodes sampled. Results A total of 47 patients were identified. Group 1 comprised 22 patients with a sentinel lymph node (SLN) identification rate (IR) of 95%. 25 patients (Group 2) underwent wire guided clip location and the SLN IR was 100% with a 92% clipped node IR. Evidence of pathological complete response (pCR) in the clipped node was associated with pCR in other nodes. Conclusion Targeted axillary dissection is a feasible technique following excellent response to NACT in selected patients with limited volume ALN metastasis, at diagnosis. The identification of the positive ALN during surgery is vital and the IR can be improved by clipping the node prior to NACT and wire guided localisation at the time of surgery.

The aim of our study was to assess the effect of knee replacement with or without bone cement on periprosthetic bone density. Periprosthetic bone density in two comparable groups (30 each) of cemented and uncemented knee replacements was measured with DEXA scanner. Bone loss was more in the area posterior to the anterior femoral flange in the cemented subgroup, nearing statistical significance (p = 0.059). In both groups, the reported bone density at a median of four years postoperatively was reduced at several periprosthetic sites. However, the method of fixation could not be clearly demonstrated to influence the bone loss differentially. This brings into question the use of the more expensive cementless implants. Reduction in bone density in both groups at several periprosthetic sites remains a concern. Whether or not this can be addressed with medical intervention like post arthroplasty bisphosphonate treatment needs further consideration.