We prospectively compared hemiarthroplasty (HA) and total shoulder replacement (TSR) in cuff intact osteoarthritis. The 2 years postoperative review, which has been presented previously, showed an advantage of TSR over HA. This study reviewed the longer term outcome in the same patients at a minimum of 10 years to assess the longer term durability of the glenoid components. Patients with Osteoarthritis and an intact rotator cuff were intraoperatively randomisation to HA or TSR using the Global^™ Shoulder Arthroplasty system after glenoid exposure. Post-operative mobilisation for the two groups was identical, and up until two years, patients were assessed using the UCLA and Constant Score, as well as analog pain scales and functional questionnaire. At the 10 year review patients were assessed using a similar range of subjective evaluations by telephone, or reviewed in the clinic as was possible

Thirty-three shoulders in thirty-two patients were entered into the trial (14 HA and 19 TSR). At six months and one year, function scores and motion were similar, but the TSR group had less pain than the HA patients (p < 0.05) and this became more apparent at two years postoperatively (p< 0.02). Apart from those who died, no patients were lost to follow-up. At the two year mark postoperatively one patient in the HA group had undergone revision to TSR due to severe pain secondary to glenoid erosion, and three further HA were subsequently revised (2 at 3 years, and one at 4 years). Two shoulders in the TSR group have been revised (at 5 years and 7 years). At 10 years from the initial arthroplasty, 5 of the 14 HA and 6 of the 19 TSR had died. 10 of the 14 HA (71%) and 17 of the 19 TSR (89%) remained in situ at the time of death or at the 10 year review. Overall outcomes in each group were similar with respect to pain, function, daily activities. Based on this longer term review, our recommendation remains that TSR has advantages over HA with respect to pain and function at two years, and there has not been a reversal of the outcomes on prolonged follow-up. Revision from HA to TSR is made difficult due to glenoid erosion. Overall 89% of TSR remain insitu at death or 10 year, whereas 71% of HA were intact at the same times. The contention that HA will avoid later arthroplasty complications and, in particular, an unacceptable rate of late glenoid failure is not supported by this longer term review.

Introduction: Avulsion fractures of the anterior tibial spine are not so common. The best form of treatment for displaced fractures is still debatable.

Aims: We aimed to analyze the results of different forms of internal fixation for avulsion fractures of the anterior tibial spine.

Material and Methods: Twenty-five patients with avulsion fractures of the anterior tibial spine had open reduction and internal fixation with different implants (AO screw, Herbert screw, stainless steel wire loop and absorbable stitch) and techniques. The mean follow up period was 3.66 years. They were evaluated clinically and radiologically, using KT 1000 arthrometer for ACL laxity and goniometer for range of movements. The outcome was measured using Lysholm Knee Score.

Results: Significant residual anterior laxity despite adequate fracture union was a common finding. Maximum ACL laxity was seen in adults in whom absorbable stitches had been used and they had a corresponding lower Lysholm score. Significant migration of the Herbert screws was noted in two of five patients in which it was used. Five of the eight patients with higher Lysholm score had AO screw fixation. Three patients with steel wire loop for stabilization of the fracture also had better results comparatively. Three individuals who had their knee immobilised in 25°–50° of flexion developed fixed flexion deformities, which took 12–18 months to recover.

Conclusions: The use of absorbable stitches as the primary method of fixation for avulsion fractures of the tibial spine should be avoided in adults. Herbert screw in this situation has a tendency to migrate. AO screws and non-absorbable loop yields better functional outcome. Immobilization of the knee in excessive flexion leads to prolonged fixed flexion deformity. Early range of movements can be achieved by replacing cast with a brace allowing flexion up to 90 degrees.

We prospectively reviewed 14 patients with deficiency of the proximal pole of the scaphoid who were treated by rib osteochondral replacement arthroplasty.

Improvement in wrist function occurred in all except one patient with enhanced grip strength, less pain and maintenance of wrist movement. In 13 patients wrist function was rated as good or excellent according to the modified wrist function score of Green and O’Brien. The mean pre-operative score of 54 (35 to 80) rose to 79 (50 to 90) at review at a mean of 64 months (27 to 103). Carpal alignment did not deteriorate in any patient and there were no cases of nonunion or significant complications.

This procedure can restore the mechanical integrity of the proximal pole of the scaphoid satisfactorily and maintain wrist movement while avoiding the potential complications of alternative replacement arthroplasty techniques and problems associated with vascularised grafts and salvage techniques.

Purpose Of The Study: Avulsion fractures of the anterior tibial spine are uncommon injury and we have evaluated the results in-patients who have undergone arthrotomy and fixation of the fracture.

Material & Method: Twenty five patients were followed up between 21–108 months (mean 44 months) after the operation. They were evaluated clinically, radiologically and the residual ACL laxity was measured with KT 1000. Lysholm scoring scale has been used to assess the outcome.

Eight fractures were fixed with a single AO screw; 5 with Herbert screws; 4 with a steel wire loop and 8 with absorbable stitch.

Results: Significant residual anterior laxity despite adequate fracture union was a common finding. The ACL laxity was maximum in adults in whom absorbable stitch had been used to fix the fracture and they had a corresponding lower Lysholm score.

In 2 out of the 5 patients where Herbert screws had been used there was significant migration of the screws.

Additional articular damage was observed in 3 patients who were pedestrians hit by a car. All 3 ended up with restricted knee movements and poor results. Three individuals who had their knee immobilised in 250–500 of flexion developed flexion deformities, which took 12–18 months to recover.

Conclusions: We recommend that use of absorbable stitches as a method of fixation be avoided in adults. Herbert screws in this situation have a tendency to migrate. AO screws or a non-absorbable loop should be used were possible. Immobilisation of the knee in excessive flexion leads to prolonged flexion deformity and we recommend immobilising the knee in no more than 100 of flexion.

Sickle-cell disease (SCD) is probably the commonest cause of avascular necrosis worldwide, and its prevalence appears to be rising in developed countries. Avascular necrosis of the humeral head is a common complication but has not been previously studied in detail. We have reviewed 138 patients with SCD for clinical, radiological and functional abnormalities of the shoulder, using a radiological classification designed for avascular necrosis of the shoulder. Radiographic lesions, frequently bilateral, were found in 28% and only 53% of patients had normal shoulder function. The management of this relatively common complication is difficult. Joint replacement is likely to fail and early diagnosis is important.