The aim of this double-blind prospective randomised controlled
trial was to assess whether low intensity pulsed ultrasound (LIPUS)
accelerated or enhanced the rate of bone healing in adult patients
undergoing distraction osteogenesis. A total of 62 adult patients undergoing limb lengthening or bone
transport by distraction osteogenesis were randomised to treatment
with either an active (n = 32) or a placebo (n = 30) ultrasound
device. A standardised corticotomy was performed in the proximal
tibial metaphysis and a circular Ilizarov frame was used in all
patients. The rate of distraction was also standardised. The primary
outcome measure was the time to removal of the frame after adjusting
for the length of distraction in days/cm for both the per protocol
(PP) and the intention-to-treat (ITT) groups. The assessor was blinded
to the form of treatment. A secondary outcome was to identify covariates affecting
the time to removal of the frame.Aims
Patients and Methods
Preservation of posterior condylar offset (PCO) has been shown to correlate with improved functional results after primary total knee arthroplasty (TKA). Whether this is also the case for revision TKA, remains unknown. The aim of this study was to assess the independent effect of PCO on early functional outcome after revision TKA. A total of 107 consecutive aseptic revision TKAs were performed by a single surgeon during an eight-year period. The mean age was 69.4 years (39 to 85) and there were 59 female patients and 48 male patients. The Oxford Knee Score (OKS) and Short-form (SF)-12 score were assessed pre-operatively and one year post-operatively. Patient satisfaction was also assessed at one year. Joint line and PCO were assessed radiographically at one year.Objectives
Methods
Our aim was to compare kinematic with mechanical alignment in
total knee arthroplasty (TKA). We performed a prospective blinded randomised controlled trial
to compare the functional outcome of patients undergoing TKA in
mechanical alignment (MA) with those in kinematic alignment (KA).
A total of 71 patients undergoing TKA were randomised to either
kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative
hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis
outcome score (KOOS), American Knee Society Score, Short Form-36,
Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed
up and go tests were assessed pre-operatively and at six weeks,
three and six months and one year post-operatively.Aims
Patients and Methods
The aim of this study was to report the outcome following primary
fixation or a staged protocol for type C fractures of the tibial
plafond. We studied all patients who sustained a complex intra-articular
fracture (AO type C) of the distal tibia over an 11-year period.
The primary short-term outcome was infection. The primary long-term
outcome was the Foot and Ankle Outcome Score (FAOS).Aims
Patients and Methods
To examine the mid-term outcome and cost utility of the BioPro
metallic hemiarthroplasty for the treatment of hallux rigidius. We reviewed 97 consecutive BioPro metallic hemiarthroplasties
performed in 80 patients for end-stage hallux rigidus, with a minimum
follow-up of five years. There were 19 men and 61 women; their mean
age was 55 years (22 to 74). No patient was lost to follow-up.Aims
Patients and Methods
The primary aim of this study was to investigate the effect of
an enhanced recovery program (ERP) on the short-term functional
outcome after total hip arthroplasty (THA). Secondary outcomes included
its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which
included 611 patients treated with traditional rehabilitation and
550 treated with an ERP. Aims
Patients and Methods
The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison. A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison.Objectives
Methods
The pre-operative level of haemoglobin is the strongest predictor
of the peri-operative requirement for blood transfusion after total
knee arthroplasty (TKA). There are, however, no studies reporting
a value that could be considered to be appropriate pre-operatively. This study aimed to identify threshold pre-operative levels of
haemoglobin that would predict the requirement for blood transfusion
in patients who undergo TKA. Analysis of receiver operator characteristic (ROC) curves of
2284 consecutive patients undergoing unilateral TKA was used to
determine gender specific thresholds predicting peri-operative transfusion
with the highest combined sensitivity and specificity (area under
ROC curve 0.79 for males; 0.78 for females).Aims
Patients and Methods
This study identifies early risk factors for symptomatic nonunion
of displaced midshaft fractures of the clavicle that aid identification
of an at risk group who may benefit from surgery. We performed a retrospective study of 88 patients aged between
16 and 60 years that were managed non-operatively. Aims
Methods
Controversy remains whether the contralateral
hip should be fixed in patients presenting with unilateral slipped capital
femoral epiphysis (SCFE). This retrospective study compares the
outcomes and cost of those patients who had prophylactic fixation
with those who did not. Between January 2000 and December 2010 a total of 50 patients
underwent unilateral fixation and 36 had prophylactic fixation of
the contralateral hip. There were 54 males and 32 females with a
mean age of 12.3 years (9 to 16). The rate of a subsequent slip
without prophylactic fixation was 46%. The risk of complications
was greater, the generic health measures (Short Form-12 physical
(p <
0.001) and mental (p = 0.004) summary scores) were worse.
Radiographic cam lesions in patients presenting with unilateral
SCFE were only seen in patients who did not have prophylactic fixation.
Furthermore, prophylactic fixation of the contralateral hip was
found to be a cost-effective procedure, with a cost per quality
adjusted life year gained of £1431 at the time of last follow-up. Prophylactic fixation of the contralateral hip is a cost-effective
operation that limits the morbidity from the complications of a
further slip, and the diminished functional outcome associated with
unilateral fixation. Cite this article:
This study demonstrates a significant correlation
between the American Knee Society (AKS) Clinical Rating System and
the Oxford Knee Score (OKS) and provides a validated prediction
tool to estimate score conversion. A total of 1022 patients were prospectively clinically assessed
five years after TKR and completed AKS assessments and an OKS questionnaire.
Multivariate regression analysis demonstrated significant correlations between
OKS and the AKS knee and function scores but a stronger correlation
(r = 0.68, p <
0.001) when using the sum of the AKS knee and
function scores. Addition of body mass index and age (other statistically
significant predictors of OKS) to the algorithm did not significantly
increase the predictive value. The simple regression model was used to predict the OKS in a
group of 236 patients who were clinically assessed nine to ten years
after TKR using the AKS system. The predicted OKS was compared with
actual OKS in the second group. Intra-class correlation demonstrated
excellent reliability (r = 0.81, 95% confidence intervals 0.75 to
0.85) for the combined knee and function score when used to predict
OKS. Our findings will facilitate comparison of outcome data from
studies and registries using either the OKS or the AKS scores and
may also be of value for those undertaking meta-analyses and systematic
reviews. Cite this article:
Paediatric fractures are common and can cause
significant morbidity. Socioeconomic deprivation is associated with an
increased incidence of fractures in both adults and children, but
little is known about the epidemiology of paediatric fractures.
In this study we investigated the effect of social deprivation on
the epidemiology of paediatric fractures. We compiled a prospective database of all fractures in children
aged <
16 years presenting to the study centre. Demographics,
type of fracture, mode of injury and postcode were recorded. Socioeconomic
status quintiles were assigned for each child using the Scottish
Index for Multiple Deprivation (SIMD). We found a correlation between increasing deprivation and the
incidence of fractures (r = 1.00, p <
0.001). In the most deprived
group the incidence was 2420/100 000/yr, which diminished to 1775/100
000/yr in the least deprived group. The most deprived children were more likely to suffer a fracture
as a result of a fall (odds ratio (OR) = 1.5, p <
0.0001), blunt
trauma (OR = 1.5, p = 0.026) or a road traffic accident (OR = 2.7,
p <
0.0001) than the least deprived. These findings have important implications for public health
and preventative measures. Cite this article:
There is conflicting evidence about the functional
outcome and rate of satisfaction of super-elderly patients (≥ 80 years
of age) after carpal tunnel decompression. We compiled outcome data for 756 patients who underwent a carpal
tunnel decompression over an eight-year study period, 97 of whom
were super-elderly, and 659 patients who formed a younger control
group (<
80 years old). There was no significant difference between
the super-elderly patients and the younger control group in terms
of functional outcome according to the mean (0 to 100) QuickDASH
score (adjusted mean difference at one year 1.8; 95% confidence
interval (CI) -3.4 to 7.0) and satisfaction rate (odds ratio (OR)
0.78; 95% CI 0.34 to 1.58). Super-elderly patients were, however,
more likely to have thenar muscle atrophy at presentation (OR 9.2,
95% CI 5.8 to 14.6). When nerve conduction studies were obtained,
super-elderly patients were more likely to have a severe conduction deficit
(OR 12.4, 95% CI 3.0 to 51.3). Super-elderly patients report functional outcome and satisfaction
rates equal to those of their younger counterparts. They are more
likely to have thenar muscle atrophy and a severe nerve conduction
deficit at presentation, and may therefore warrant earlier decompression. Cite this article:
This study describes the epidemiology and outcome
of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients.
Most were either minimally displaced (n = 278, 44%) or two-part
fractures (n = 250, 39%) that predominantly occurred in women (n
= 525, 82%) after a simple fall (n = 604, 95%), who lived independently
in their own home (n = 560, 88%), and one in ten sustained a concomitant
fracture (n = 76, 11.9%). The rate of mortality at one year was
10%, with the only independent predictor of survival being whether
the patient lived in their own home (p = 0.025). Many factors associated
with the patient’s social independence significantly influenced
the age and gender adjusted Constant score one year after the fracture.
More than a quarter of the patients had a poor functional outcome,
with those patients not living in their own home (p = 0.04), participating
in recreational activities (p = 0.01), able to perform their own
shopping (p <
0.001), or able to dress themselves (p = 0.02)
being at a significantly increased risk of a poor outcome, which
was independent of the severity of the fracture (p = 0.001). A poor functional outcome after a proximal humeral fracture is
not independently influenced by age in the elderly, and factors
associated with social independence are more predictive of outcome. Cite this article:
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar femoral stem or a cemented
Exeter stem for a displaced intracapsular fracture of the hip. The
mean age of the patients in the uncemented group was 82.5 years
(53 to 97) and in the cemented group was 82.7 years (51 to 99) We used
propensity score matching, adjusting for age, gender and the presence
or absence of dementia and comorbidities, to produce a matched cohort
receiving an Exeter stem (n = 69) with which to compare the outcome of
patients receiving a Corail stem (n = 69). The Corail had a significantly
lower all-cause rate of further surgery (p = 0.016; odds ratio (OR)
0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further
surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating
time was significantly less for the Corail group than for the cemented Exeter
group (59 min [12 to 136] Cite this article:
Fractures in patients aged ≥ 65 years constitute
an increasing burden on health and social care and are associated with
a high morbidity and mortality. There is little accurate information
about the epidemiology of fractures in the elderly. We have analysed
prospectively collected data on 4786 in- and out-patients who presented
with a fracture over two one-year periods. Analysis shows that there
are six patterns of the incidence of fractures in patients aged ≥ 65
years. In males six types of fracture increase in incidence after
the age of 65 years and 11 types increase in females aged over 65
years. Five types of fracture decrease in incidence after the age
of 65 years. Multiple fractures increase in incidence in both males
and females aged ≥ 65 years, as do fractures related to falls. Analysis of the incidence of fractures, together with life expectancy,
shows that the probability of males and females aged ≥ 65 years
having a fracture during the rest of their life is 18.5% and 52.0%,
respectively. The equivalent figures for males and females aged ≥ 80
years are 13.3% and 34.8%, respectively. Cite this article:
This study assessed the effect of concomitant
back pain on the Oxford knee score (OKS), Short-Form (SF)-12 and patient
satisfaction after total knee replacement (TKR). It involved a prospectively
compiled database of demographics and outcome scores for 2392 patients
undergoing primary TKR, of whom 829 patients (35%) reported back
pain. Compared with those patients without back pain, those with
back pain were more likely to be female (odds ratio (OR) 1.5 (95%
confidence interval (CI) 1.3 to 1.8)), have a greater level of comorbidity,
a worse pre-operative OKS (2.3 points (95% CI 1.7 to 3.0)) and worse
SF-12 physical (2.0 points (95% CI 1.4 to 2.6)) and mental (3.3
points (95% CI 2.3 to 4.3)) components. One year post-operatively, those with back pain had significantly
worse outcome scores than those without with a mean difference in
the OKS of 5 points (95% CI 3.8 to 5.4), in the SF-12 physical component
of 6 points (95% CI 5.4 to 7.1) and in the mental component of
4 points (95% CI 3.1 to 4.9). Patients with back pain were less
likely to be satisfied (OR 0.62, 95% CI 0.5 to 0.78). After adjusting for confounding variables, concomitant back pain
was an independent predictor of a worse post-operative OKS, and
of dissatisfaction. Clinicians should be aware that patients suffering
concomitant back pain pre-operatively are at an increased risk of
being dissatisfied post-operatively. Cite this article:
We describe the outcome of tibial diaphyseal
fractures in the elderly (≥ 65 years of age). We prospectively followed 233
fractures in 225 elderly patients over a minimum ten-year period.
Demographic and descriptive data were acquired from a prospective
trauma database. Mortality status was obtained from the General
Register Office database for Scotland. Diaphyseal fractures of the
tibia in the elderly occurred predominantly in women (73%) and after
a fall (61%). During the study period the incidence of these fractures
decreased, nearly halving in number. The 120-day and one-year unadjusted
mortality rates were 17% and 27%, respectively, and were significantly
greater in patients with an open fracture (p <
0.001). The overall
standardised mortality ratio (SMR) was significantly increased (SMR
4.4, p <
0.001) relative to the population at risk, and was greatest
for elderly women (SMR 8.1, p <
0.001). These frailer patients
had more severe injuries, with an increased rate of open fractures
(30%), and suffered a greater rate of nonunion (10%). Tibial diaphyseal fractures in the elderly are most common in
women after a fall, are more likely to be open than in the rest
of the population, and are associated with a high incidence of nonunion
and mortality. Cite this article:
We assessed the effect of mental disability on
the outcome of total knee replacement (TKR) and investigated whether
mental health improves post-operatively. Outcome data were prospectively
recorded over a three-year period for 962 patients undergoing primary
TKR for osteoarthritis. Pre-operative and one year Short-Form (SF)-12 scores
and Oxford knee scores (OKS) were obtained. The mental component
of the SF-12 was stratified into four groups according to level
of mental disability (none ≥ 50, mild 40 to 49, moderate 30 to 39,
severe <
30). Patients with any degree of mental disability had
a significantly greater subjective physical disability according
to the SF-12 (p = 0.06) and OKS (p <
0.001). The improvement
in the disease-specific score (OKS) was not affected by a patient’s
mental health (p = 0.33). In contrast, patients with mental disability
had less of an improvement in their global physical health (SF-12)
(p <
0.001). However, patients with any degree of mental disability
had a significant improvement in their mental health post-operatively
(p <
0.001). Despite a similar improvement in their disease-specific scores
and improvement in their mental health, patients with mental disability
were significantly more likely to be dissatisfied with their TKR
at one year (p = 0.001). Patients with poor mental health do benefit
from improvements in their mental health and knee function after
TKR, but also have a higher rate of dissatisfaction. Cite this article:
The aim of this study was to perform a cost–utility
analysis of total hip (THR) and knee replacement (TKR). Arthritis is
a disabling condition that leads to long-term deterioration in quality
of life. Total joint replacement, despite being one of the greatest
advances in medicine of the modern era, has recently come under
scrutiny. The National Health Service (NHS) has competing demands,
and resource allocation is challenging in times of economic restraint. Patients
who underwent THR (n = 348) or TKR (n = 323) between January and
July 2010 in one Scottish region were entered into a prospective
arthroplasty database. A health–utility score was derived from the
EuroQol (EQ-5D) score pre-operatively and at one year, and was combined
with individual life expectancy to derive the quality-adjusted life years
(QALYs) gained. Two-way analysis of variance was used to compare
QALYs gained between procedures, while controlling for baseline
differences. The number of QALYs gained was higher after THR than
after TKR (6.5 Cite this article:
We assessed the effect of social deprivation
upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient
satisfaction after total knee replacement (TKR). An analysis of
966 patients undergoing primary TKR for symptomatic osteoarthritis
(OA) was performed. Social deprivation was assessed using the Scottish
Index of Multiple Deprivation. Those patients that were most deprived
underwent surgery at an earlier age (p = 0.018), were more likely
to be female (p = 0.046), to endure more comorbidities (p = 0.04)
and to suffer worse pain and function according to the OKS (p <
0.001). In addition, deprivation was also associated with poor mental
health (p = 0.002), which was assessed using the mental component
(MCS) of the SF-12 score. Multivariable analysis was used to identify
independent predictors of outcome at one year. Pre-operative OKS,
SF-12 MCS, back pain, and four or more comorbidities were independent
predictors of improvement in the OKS (all p <
0.001). Pre-operative
OKS and improvement in the OKS were independent predictors of dissatisfaction
(p = 0.003 and p <
0.001, respectively). Although improvement
in the OKS and dissatisfaction after TKR were not significantly
associated with social deprivation Cite this article:
Patient expectations and their fulfilment are
an important factor in determining patient-reported outcome and satisfaction
of hip (THR) and knee replacement (TKR). The aim of this prospective
cohort study was to examine the expectations of patients undergoing
THR and TKR, and to identify differences in expectations, predictors
of high expectations and the relationship between the fulfilment
of expectations and patient-reported outcome measures. During the
study period, patients who underwent 346 THRs and 323 TKRs completed
an expectation questionnaire, Oxford score and Short-Form 12 (SF-12)
score pre-operatively. At one year post-operatively, the Oxford
score, SF-12, patient satisfaction and expectation fulfilment were
assessed. Univariable and multivariable analysis were performed.
Improvements in mobility and daytime pain were the most important
expectations in both groups. Expectation level did not differ between
THR and TKR. Poor Oxford score, younger age and male gender significantly
predicted high pre-operative expectations (p <
0.001). The level
of pre-operative expectation was not significantly associated with
the fulfilment of expectations or outcome. THR better met the expectations
identified as important by patients. TKR failed to meet expectations
of kneeling, squatting and stair climbing. High fulfilment of expectation
in both THR and TKR was significantly predicted by young age, greater
improvements in Oxford score and high pre-operative mental health
scores. The fulfilment of expectations was highly correlated with satisfaction.
We present the prevalence of multiple fractures
in the elderly in a single catchment population of 780 000 treated over
a 12-month period and describe the mechanisms of injury, common
patterns of occurrence, management, and the associated mortality
rate. A total of 2335 patients, aged ≥ 65 years of age, were prospectively
assessed and of these 119 patients (5.1%) presented with multiple
fractures. Distal radial (odds ratio (OR) 5.1, p <
0.0001), proximal humeral
(OR 2.2, p <
0.0001) and pelvic (OR 4.9, p <
0.0001) fractures
were associated with an increased risk of sustaining associated
fractures. Only 4.5% of patients sustained multiple fractures after
a simple fall, but due to the frequency of falls in the elderly
this mechanism resulted in 80.7% of all multiple fractures. Most
patients required admission (>
80%), of whom 42% did not need an
operation but more than half needed an increased level of care before
discharge (54%). The standardised mortality rate at one year was
significantly greater after sustaining multiple fractures that included
fractures of the pelvis, proximal humerus or proximal femur (p <
0.001). This mortality risk increased further if patients were <
80 years of age, indicating that the existence of multiple fractures after
low-energy trauma is a marker of mortality.
We report the general mortality rate after total
knee replacement and identify independent predictors of survival. We
studied 2428 patients: there were 1127 men (46%) and 1301 (54%)
women with a mean age of 69.3 years (28 to 94). Patients were allocated
a predicted life expectancy based on their age and gender. There were 223 deaths during the study period. This represented
an overall survivorship of 99% (95% confidence interval (CI) 98
to 99) at one year, 90% (95% CI 89 to 92) at five years, and 84%
(95% CI 82 to 86) at ten years. There was no difference in survival
by gender. A greater mortality rate was associated with increasing
age (p <
0.001), American Society of Anesthesiologists (ASA)
grade (p <
0.001), smoking (p <
0.001), body mass index (BMI)
<
20 kg/m2 (p <
0.001) and rheumatoid arthritis
(p <
0.001). Multivariate modelling confirmed the independent
effect of age, ASA grade, BMI, and rheumatoid disease on mortality.
Based on the predicted average mortality, 114 patients were predicted
to have died, whereas 217 actually died. This resulted in an overall
excess standardised mortality ratio of 1.90. Patient mortality after
TKR is predicted by their demographics: these could be used to assign
an individual mortality risk after surgery.
Most surgeons favour removing forearm plates
in children. There is, however, no long-term data regarding the complications
of retaining a plate. We present a prospective case series of 82
paediatric patients who underwent plating of their forearm fracture
over an eight-year period with a minimum follow-up of two years.
The study institution does not routinely remove forearm plates.
A total of 116 plates were used: 79 one-third tubular plates and 37 dynamic
compression plates (DCP). There were 12 complications: six plates
(7.3%) were removed for pain or stiffness and there were six (7.3%)
implant-related fractures. Overall, survival of the plates was 85%
at 10 years. Cox regression analysis identified radial plates (odds
ratio (OR) 4.4, p = 0.03) and DCP fixation (OR 3.2, p = 0.02) to
be independent risk factors of an implant-related fracture. In contrast
ulnar plates were more likely to cause pain or irritation necessitating
removal (OR 5.6, p = 0.04). The complications associated with retaining a plate are different,
but do not occur more frequently than the complications following
removal of a plate in children.
Primary arthroplasty may be denied to very elderly patients based upon the perceived outcome and risks associated with surgery. This prospective study compared the outcome, complications, and mortality of total hip (TKR) and total knee replacement (TKR) in a prospectively selected group of patients aged ≥ 80 years with that of a control group aged between 65 and 74 years. There were 171 and 495 THRs and 185 and 492 TKRs performed in the older and control groups, respectively. No significant difference was observed in the mean improvement of Oxford hip and knee scores between the groups at 12 months (0.98, (95% confidence interval (CI) −0.66 to 2.95), p = 0.34 and 1.15 (95% CI −0.65 to 2.94), p = 0.16, respectively). The control group had a significantly (p = 0.02 and p = 0.04, respectively) greater improvement in the physical well being component of their SF-12 score, but the older group was more satisfied with their THR (p = 0.047). The older group had a longer hospital stay for both THR (5.9
We compared case-mix and outcome variables in 1310 patients who sustained an acute fracture at the age of 80 years or over. A group of 318 very elderly patients (≥ 90 years) was compared with a group of 992 elderly patients (80 to 89 years), all of whom presented to a single trauma unit between July 2007 and June 2008. The very elderly group represented only 0.6% of the overall population, but accounted for 4.1% of all fractures and 9.3% of all orthopaedic trauma admissions. Patients in this group were more likely to require hospital admission (odds ratio 1.4), less likely to return to independent living (odds ratio 3.1), and to have a significantly longer hospital stay (ten days, p = 0.01). The 30- and 120-day unadjusted mortality was greater in the very elderly group. The 120-day mortality associated with non-hip fractures of the lower limb was equal to that of proximal femoral fractures, and was significantly increased with a delay to surgery >
48 hours for both age groups (p = 0.04). This suggests that the principle of early surgery and mobilisation of elderly patients with hip fractures should be extended to include all those in this vulnerable age group.
This prospective study assessed the effect of social deprivation on the Oxford hip score at one year after total hip replacement. An analysis of 1312 patients undergoing 1359 primary total hip replacements for symptomatic osteoarthritis was performed over a 35-month period. Social deprivation was assessed using the Carstairs index. Those patients who were most deprived underwent surgery at an earlier age (p = 0.04), had more comorbidities (p = 0.02), increased severity of symptoms at presentation (p = 0.001), and were not as satisfied with their outcome (p = 0.03) compared with more affluent patients. There was a significant improvement in Oxford scores at 12 months relative to pre-operative scores for all socioeconomic categories (p <
0.001). Social deprivation was a significant independent predictor of mean improvement in Oxford scores at 12 months, after adjusting for confounding variables (p = 0.001). Deprivation was also associated with an increased risk of dislocation (odds ratio 5.3, p <
0.001) and mortality at 90 days (odds ratio 3.2, p = 0.02). Outcome, risk of dislocation and early mortality after a total hip replacement are affected by the socioeconomic status of the patient
We compared the outcome of arthroscopic repair of the rotator cuff in 32 diabetic patients with the outcome in 32 non-diabetic patients matched for age, gender, size of tear and comorbidities. The Constant-Murley score improved from a mean of 49.2 (24 to 80) pre-operatively to 60.8 (34 to 95) post-operatively (p = 0.0006) in the diabetic patients, and from 46.4 (23 to 90) pre-operatively to 65.2 (25 to 100) post-operatively (p = 0.0003) in the non-diabetic patients at six months. This was significantly greater (p = 0.0002) in non-diabetic patients (18.8) than in diabetics (11.6). There was no significant change in the mean mental component of the Short-Form 12, but the mean physical component increased from 35 to 41 in non-diabetics (p = 0.0001), and from 37 to 39 (p = 0.15) in diabetics. These trends were observed at one year. Patients with diabetes showed improvement of pain and function following arthroscopic rotator cuff repair in the short term, but less than their non-diabetic counterparts.