The posterior capsule is variously incised and excised during total hip replacement (THR). There is no consensus on the direction of the capsulotomy and the need to repair the posterior capsule. The objective of this study was to determine the orientation of the collagen fibres and nerves in the posterior hip capsule in patients undergoing THR.

Specimens from five patients with osteoarthrosis of the hip (with no fixed deformity) were obtained and fixed in 10% neutral buffered formalin. Sutures were placed to mark the head and trochanteric end before excising. A standard posterior approach was used. The samples were examined and reported by a pathologist. Samples were processed overnight in a VIP5 automatic tissue processor and embedded in paraffin wax, preserving the location of the suture sites on embedding. Sections were cut at 5 Ïm and routinely stained with haematoxylin and eosin. The van Gieson stain was used for collagen fibres. Nerve fibres were highlighted using immunohistochemistry for S100 protein and blood vessels using an antibody to CD34.

The collagen bundles seen were predominantly parallel to the axis of the specimen. Dispersed within the collagen bundles were small vascular leashes that were parallel with the collagen fibres. The S100 staining revealed that these were neurovascular leashes, with small nerves running alongside the vessels and the collagen. Nerves that separate from the vessels were likely to serve proprioceptive and nociceptive functions.

The direction of the capsulotomy during THR by posterior approach has been traditionally perpendicular to the direction of the capsular fibres. However, if possible, capsulotomy along the orientation of the collagen fibres may be advantageous. As this study demonstrates, it will result in less damage to the capsular collagen fibres, blood vessels and nerves resulting in better capsular repair and healing, and better conservation of pro-prioceptive and nociceptive functions.

Introduction: Over the last decade there have been a series of papers, with a follow-up of less than 5 years, demonstrating the beneþcial effects of elbow arthrolysis. There are doubts about the durability of this procedure as most patients develop early arthritis of the elbow joint as a consequence of their injury, which, in theory, could reduce the range of movement in the joint. Aim: The aim of this study was to assess whether the improvement in the range of movement of the elbow achieved through arthrolysis changed in the postoperative period. Methods: This is a prospective study of 25 patients who had arthrolysis of the elbow performed to improve posttraumatic stiffness. All these patients had a minimum follow up period of 5 years. (Mean followup 8.2 years). Range of movement at the elbow was recorded using a goniometer. Functional outcomes and pain were also assessed at each of these visits using the Mayo elbow score and the visual analogue score. Results: Range of movement improved from 55 degrees preoperatively to 105 degrees postoperatively at 1 year and this improvement was maintained at their last followup. Similarly, the Mayo elbow score and visual analogue score also improved following an elbow arthrolysis and again this improvement was maintained at their last followup. Conclusions: Based on the results of this study, we believe that elbow arthrolysis for post traumatic stiffness of the elbow is a durable procedure.

All known shoulder surgeons in Scotland have made a voluntary registration of shoulder replacements since 1996. Information regarding diagnostic and demographic characteristics of the patients, rotator cuff status and type of procedure performed were collated.

20 surgeons have contributed to the register, performing a varied number of shoulder arthroplasties (2 to 79). By five years the total number of shoulder replacements performed was 451. 23. 2 % of patients were male and 76. 8% female. 397 patients had a hemiarthroplasty and 54 (12 %) had a total shoulder replacement. 204/451 (45 %) humeral components used were cemented. In comparison 48/54 (89%) glenoid components used were cemented.

The most common condition requiring shoulder arthroplasty was inflammatory arthritis (184 cases), followed by trauma (128 cases), of which 60 % were for acute trauma and 40 % for old trauma. The remainder consisted of osteoarthritis (87 cases), avascular necrosis (27 cases), and others (25 cases). The consultant in 425 cases and the trainee in 26 cases performed the operation. In 85/451 (18. 9%) of the cases, associated procedures were performed which included cuff repair (26 cases), coracoacromial ligament excision (43 cases), coracoid osteotomy (14 cases) and acromioclavicular joint excision (2 cases). There were 24 intra-operative complications and 9 patients had a revision.

Comparison with figures from the Information and statistics division in Scotland however indicated that our register collected only 53 % of all the arthroplasties performed. In addition it was noted that 30 % of shoulder replacements were performed by surgeons who performed three or fewer shoulder replacements a year.

In an age of clinical governance we believe that a register can provide detailed and accurate information. It is useful for demonstrating current practice and can highlight future changes in practice.

This register supports the need for a national register and surveillance of shoulder replacements. However, in addition to the voluntary data registration, it is proposed that dedicated data collection staff are employed to coordinate the data collection process.