Aims

Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided.

Aims

The main objective of this study was to examine whether the Oxford Shoulder Score (OSS) demonstrated floor or ceiling effects when used to measure outcomes following shoulder arthroplasty in a large national cohort. Secondary objectives were to assess its pain and function subscales, and to identify independent predictors for patients achieving a postoperative ceiling score following shoulder arthroplasty.

We report a retrospective review of outcome after shoulder hemiarthroplasty for proximal humerus fractures. All patients managed with shoulder hemiarthroplasty for proximal humerus fractures between 1997 and 2008 were included. Clinical notes were reviewed and surviving patients completed postal Oxford Shoulder Score (OSS) questionnaires. Results were analysed to assess whether there was a difference in outcome for those above the age of 70 years. A total of 96 patients were treated during this period. Female to male ratio was 3.36:1 with mean age 72 ± 9.6 (45–93) years at time of fracture. At time of review 30.2% of patients were dead. Two patients were lost to follow-up after discharge. Complete case notes were available in 68 patients. Response rate to the OSS was 67.2%. There were 20 patients below 70 years and 48 patients above 70 years of age. The ASA grade was II in 60% of patients. Mean follow-up was 52 months. There were 2 in hospital post-operative deaths due to medical complications. Mean OSS was 27 (3–47) of a maximum of 48, with no significant difference between groups. Overall complication rate was 27.9%, with no significant difference between groups. Ten year survival was 96.9% overall with no significant difference between groups. There appears to be no significant difference in functional outcome, complication rate, or implant survival between patients below or above the age of 70 years treated with primary hemiarthroplasty for fracture of the proximal humerus. This procedure however carries a high complication rate in this group of patients.

Infection following total knee arthroplasty is a serious complication. Recently there has been increasing incidence of isolation of multi-drug resistant bacteria from peri-prosthetic infections. The aim of our study is to identify the organisms causing delayed deep infections following primary total knee arthroplasty in the current situation. We also compared the differences in outcome based on the infecting organism. We undertook a retrospective study of all the patients who presented with delayed deep infection following primary total knee replacement during a six year period between April 1998 and March 2004. Organisms were isolated in 27 of the 31 patients who presented with delayed deep infection. Forty-four % of the organisms isolated were multi-drug resistant with increasing incidence of Methicillin resistant Staphylococcus aureus and multi-drug resistant Staphylococcus epidermidis infections. Successful outcome following an infected total knee arthroplasty was lower compared to the previous studies where there were fewer multi-drug resistant organisms. The average number of surgical procedures carried out was significantly higher when the organism isolated was multi-drug resistant. The number of patients with satisfactory outcome is significantly lower when the organism isolated is multi-drug resistant.

Aims: To compare the preoperative knee function in patients of Asian origin and Caucasians living in the same community.

Background: The prevalence of osteoarthritis is high in all ethnic and demographic groups. The timing of surgery is important as poor preoperative functional status is related to poor postoperative function.

Methods: Prospective study of 63 Asian patients age and sex matched with Caucasian patients undergoing total knee arthroplasty. Pre operative Knee Society Clinical Rating System scores were recorded as a separate Knee Score and Knee Function.

Results: The mean preoperative Knee Score in Asian patients was 37.6 in comparison to 41.5 in Caucasians (p< 0.10) this difference was not statistically significant. The mean preoperative Knee Function in Asian patients was 32.5 in comparison to 45.0 in Caucasians (p< 0.0001) this difference was highly statistically significant.

Conclusions:Patients of Asian origin undergoing total knee arthroplasty have lower preoperative knee function to Caucasians. Cultural beliefs and social support explain part of this discrepancy but health care providers must also attempt to educate patients and close family members about the importance of timing the surgery to obtain the optimum benefits of pain relief and function.

This study investigates the survival (with gross radiological loosening) rates of prostheses following uncemented Total Shoulder Arthroplasties (TSAs) focusing on the glenoid baseplate fixation.

All uncemented TSAs inserted in one shoulder unit from 1989 to 2001 were entered onto a database prospectively and the patients monitored to death or failure of the implant, resulting in revision surgery. Over 80% of the surviving implants were monitored on sequential radiographs and the radiological loosening rate was observed. 273 TSAs have been monitored – 193 with a porous coated glenoid baseplate and 80 with a hydroxyapatite coating on top of the porous coating.

The Survival rates (%) of the non-HA coated base-plates at 1 to 12 years using the Life Table Method were:- 97, 93, 89, 83, 83, 81, 79, 79, 77, 75, 75 & 75% respectively. The Survival rates for the HA coated glenoid baseplates at 1 to 4 years were 100, 97, 93, & 93% respectively. Failures were predominantly due to mechanical loosening and glenoid disassembly with only 3 cases of infection documented. Thus by 4 years there was a statistically significant improvement in survival of the glenoids. Survival rates were further reduced when radiological loosening was taken into account. The earlier series was analysed to assess the survival of prostheses inserted for RA and OA. The survival rates at 5 & 10 years were 78% & 70% for OA and 96% & 88% for RA.

This Life Table analysis confirms the early benefit from the use of hydroxyapatite coating of the glenoid implant of a TSA. Further improvements, particularly in relation to reducing further the small risk of disassembly are underway.

Steroids are known to have an adverse effect on the blood glucose levels in diabetics. Intra-articular steroids are commonly used in Orthopaedic and Rheumatology practice. However we have failed to identify any studies to date that have been carried out on the short-term effect of intra-articular steroids in diabetics who are taking insulin. This study was carried out to establish the effects of intra-articular (IA) steroid injections on the blood glucose levels and insulin requirements for insulin dependant diabetic patients treated for a “Frozen Shoulder”.

Methods: Insulin-dependant diabetic patients suffering from a “Frozen Shoulder” who were referred to our out patient clinics were recruited prospectively for this study. Each patient received 40 mg of long acting steroid plus 9 mls of 0.5% Marcain injected intra-articularly into the glenohumeral joint. They were each asked to record their subsequent blood glucose levels and insulin requirements on a form, four times a day for seven days post injection. Each patient was seen again at 6 weeks and, when appropriate, they were offered a second intra-articular injection according to the recommendations of Jacobs et al¹ (1991).

Results: Fifteen patients were recruited into the study. All patients reported a disturbance of their blood glucose control in the post injection period lasting for a variable period up to seven days. Approximately one third of patients found it necessary to increase their daily insulin requirements during the first two days after the injection.

Conclusion: IA steroid injections cause disturbance of the blood glucose control in insulin dependant diabetics. Patients must be warned regarding this side effect when IA steroid injections are given.

The aim of this study was to assess the results of bone ingrowth into the glenoid component of one design of Total Shoulder Arthroplasty (TSA) in which hydroxyapatite (HA) coating of the glenoid baseplate was introduced since 1997.

Glenoid loosening is one of the most important complications of both cemented and uncemented TSA. Between May 1993 and April 1997 over 140 uncemented, porous coated, metal backed glenoid component were used in our Unit. By 1997 it had become clear that a significant number of these glenoid components had developed mechanical loosening and some required revision. We therefore started using an HA coated glenoid component for our TSAs from April 1997.

One hundred and seventy-four shoulder arthroplasty procedures were performed between April 1997 and October 1999 of which 37 were TSAs using the HA coated uncemented glenoid. The indications included osteoarthritis (22), rheumatoid arthritis (nine), revision TSA (three), avascular necrosis (two) and cuff arthropathy with cuff reconstruction (one). The minimum follow-up was 18 months. The X rays were evaluated using the MLS (Migration, Lucent lines, Screw problems) system, which had been developed and reported previously. This system of evaluation has been shown to be reproducible for assessment of glenoid fixation.

There was one case in which the glenoid liner became displaced and had to be replaced. Our early results at a mean FU of approximately 2 years show an improved radiological fixation compared with those glenoids inserted without HA.