Purpose: The aim our study was to establish the existence of a symptomatic humero-radial synovial plica causing lateral elbow pain and the resection of which has improved pain and restored elbow function

Materials & Methods: Our study included 117 consecutive elbow arthroscopies performed by two surgeons for a period of 18 months from January 2002 to July 2003.

All patients were treated non operatively before undergoing arthroscopy. Conservative treatment included rest, activity modification, physiotherapy including ultrasound bracing, NSAIDS and corticoste-riod injection.

Results: Radial head plica were found in 21(18%) out of 117 elbow arthroscopies and were resected using a soft tissue resector. There were 16 men and 5 women in the study group,all of whom were young and active: mean age 38 years (range 24 to 56 years). All patients were scored pre op and post op using the Mayo clinic performance index for the elbow. Of the 21 patients 17(81%) had a post op score 90 or more(excellent) and 5(19%) had a score 75-89(good)

Conclusion: The synovial fold of the humero-radial joint is documented and considered as a meniscus between the two articulation(Duparc f etal 2002). They can also present present as symptoms suggesting intra articular loose bodies(Clarke R.P etal 1998).

In the case of resistant tennis elbow the existence of a radial head synovial plica should be considered. Our study concludes that by resecting the synovial plical fold will relieve the pain and restore the elbow motion.

The Copeland Shoulder Arthroplasty is a cementless, pegged humeral head surface replacement. The design is based on the principle of minimal bone resection and has been in clinical use since 1986. The only published series to date, that of Levy and Copeland, reported results for 103 patients which were comparable to those obtained with stemmed implants. We report the outcome at our institution using the same prosthesis with a hydroxyapatite coating.

81 shoulders (74 patients) underwent resurfacing hemiarthroplasty through an anterior deltopectoral approach. Preoperative diagnoses were: osteoarthritis (39), rheumatoid arthritis (29), rotator cuff arthropathy (1), post-traumatic arthrosis (2). They were followed for an average 28 months. 10 were lost to follow-up (8 deaths).

Constant scores improved from a mean preoperative figure of 15.7 to 54.0 (p< 0.01) at last follow-up. For rheumatoid arthritis and osteoarthritis the scores improved from 15.2 to 50.4 (p< 0.01) and 16.0 to 55.4 (p,< 0.01) respectively.

There was a 13% complication rate with one case requiring revision for loosening to a stemmed implant. Most were cases requiring subsequent acromioplasty. In one case the glenoid rim was fractured during head dislocation. There was a low rate of perioprosthetic radiolucency (4.2%) which may relate to the hydroxyappatite coating within the shell of the prosthesis. Ipsilateral stemmed elbow replacement was performed in some cases without a double stress riser effect. Periprosthetic humeral neck fracture as managed non-operatively with uneventful union.

Conclusion: The good outcome reported in Copeland’s own series has been replicated in the early to medium term at our institution. The surface replacement system is simpler, accurate and preserves bone stock.

Aim: This retrospective study was undertaken to establish the accuracy of magnetic resonance imaging (MRI) in diagnosing medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tears.

Materials and methods: Sixty patients who had arthroscopic knee surgery following MRI scans were included in the study. MRI findings were then compared with the pathologies noted at subsequent arthroscopy.

Results: In this study, the sensitivity of MRI in diagnosing tears was 67% (ACL), 100% (medial meniscus) and 57% (lateral meniscus) whereas the specificity was 91%(ACL), 46 %(medial meniscus) and 77 % (lateral meniscus).The positive predictive values were 29% (ACL), 68% (medial meniscus) and 57% (lateral meniscus). The negative predictive values were 98% (ACL), 100% (medial meniscus) and 76% (lateral meniscus).

Conclusion: In contrast to some studies, these findings indicate a lower accuracy for MRI scanning in detecting tears of, in particular of the ACL and lateral meniscus. We suggest that where symptoms and clinical findings support one of these diagnoses and arthroscopic therapeutic intervention is contemplated, that MRI scanning is not beneficial. The additional expense and delay in management seems inappropriate given the findings we have demonstrated.

Introduction: Ruptures of the glutaeus minimus tendon at the greater trochanter may be a reason for persisting pain after total hip replacement. The aim of this study was to investigate the frequency of the rupture of the glutaeus minimus tendon at the greater trochanter in patients with osteoarthritis of the hip.

Patients and Methods: From May until August 2004, total hip joints were implanted in 67 conscutive patients with osteoarthritis of the hip joint. 54 of the operations were done with a standard Watson-Jones approach. 13 patients were operated with a minimal invasive approach without visualisation of the gluteaus minimus tendon. For the minimal invasive approach only patients with a normal appearance ot the X-ray of the greater trochanter were selected. The integrity of the insertion of the glutaeus minimus tendon was recorded during the operation with the Watson-Jones approach und compared to the X-ray findings.

Results: There were 8 complete and 13 partial ruptures of the glutaeus minimus tendon in 54 patients with the Watson-Jones approach. The mean age of the patients with rupture was 75.0 years compared to 67.2 years of the patients without rupture.The Y-rays ot the hip in two planes showed osteophytes at the greater trochanter in 18 (86 %) with a ruptur and in no patient without a ruptur. The frequnece of a complete or partial rupture of the glutaeus minimus tendon was at least 31% in the 67 patients of this study.

Conclusion: Ruptures of the glutaeus minimus tendon are common in patients with osteoarthritis o thi hip but it is unknown whether it is necessary to reinsert the tendon during the implantation of an artificial hip joint.

Background: Flail or unstable elbow presents a difficult challenge for the elbow surgeon. This study reports the medium-term follow-up of 30 elbows in 25 patients, treated with two different designs of sloppy-hinged prosthesis: the Coonrad-Morrey and the snap-fit Souter-Strathclyde.

Methods: All patients treated over a 12 year period by a single surgeon were identified and reviewed. This included a detailed history of indications, complications, and subjective assessment (including Mayo Elbow Performance Scores, subjective satisfaction score, and SF-12 mental and physical disability questionnaire), as well as examination and radiographic review of preoperative and most recent xrays.

Results: 30 elbows in 25 surviving patients were assessed at an average postoperative period of 5.7 years. 17 Coonrad-Morrey and 13 snap-fit Souter-Strathclyde prostheses were implanted. 4 elbows (13.3%) have been revised. Average Mayo Elbow Performance score was 78.8 out of a top score of 100, with 15 classed as excellent, 5 good, 4 fair and 6 poor. Average subjective satisfaction with the operation was 4.5 out of a top score of 5. There was an average flexion arc of 104.7°, with 18 elbows ≥100°. 3 of the 17 Coonrad-Morrey elbows (17.6%) and 3 of the 13 snap-fit Souter-Strathclyde elbows (23.1%) demonstrated at least Grade 3 humeral radiolucency at the bone-cement interface. In the ulna, these figures were 6 out of 17 (35.3%) for Coonrad-Morrey elbows and 2 out of 13 (15.4%) for snap-fit Souter-Strathclyde elbows.

Conclusions: Sloppy-hinged elbow replacement is a safe procedure with a high subjective satisfaction level. Its main indication is as a salvage operation in patients with a functionally useless elbow due to failed primary replacement or non-union of distal humeral fracture.

The purpose of this study was to look at the results of using the Copeland surface replacement in the treatment of arthritis of the shoulder.

We report the results of 61 Type 3 Copeland surface replacements in 57 patients. Operations were performed in 33 cases of Rheumatoid Arthritis, 27 cases of Osteoarthritis and 1 case of posttraumatic arthritis. Hemiar-throplasty was performed via a Deltopectoral approach by the senior author in all cases. There were 38 females and 19 males with a minimum follow up of 1 year and a mean follow up of 26 months (range 12–65). Patients were scored pre and post operatively using the Constant score. Average pre-op score was 15.6 and post-operatively was 52.5. There was one case of loosening ( ? secondary to infection) requiring revision to a stemmed implant. Two patients required Sub-Acromial decompression for postoperative impingement. All patients considered their shoulder improved following this procedure. There was no evidence of radiolucency in any postoperative radiograph.

Cementless surface replacement arthroplasty in our series show similar results to previously reported series of stemmed implants and to the published results available for this implant.

The aim of this studdy was to examine the effect of cementless surface replacement shoulder arthroplasty (CSRA) on proximal humeral anatomy in eroded shoulder joints.

AP radiographs of 39 shoulders in 37 patients that underwent CSRA for arthritis were examined for geometry of the glenohumeral joint with correction for the magnification of our apparatus. Thirty-two were hemiarthroplasties and seven were total shoulder replacements (TSR). Average age was 70 years (range: 29–88 years). Mean clinical and radiological follow-up was 38 month (range: 24–72 months) and 16 months (range: 10–65 months) respectively. We measured reliable values on the proximal humerus and the lateral glenohumeral offset (LGHO) relative to the coracoid base. Preoperative and last follow-up Constant scores were recorded.

Based on anatomical data with respect to humeral head radius there was a mean 6mm preoperative loss in LGHO (95% CI 3.6–8.8, p< 0.01). The mean value of 53mm increased postoperatively to 59mm and was 57mm at last follow-up. The mean changes were an increase of 6mm (95% CI 4.4–8.5, p< 0.01) and then a decrease of 2mm (95% CI 0.1–5.4, p=0.04) respectively. The lever arm, measured from the greater tuberosity to the centre of instant rotation, increased a mean 5mm post-operatively (95% CI 3.8–6.4, p< 0.01) with no significant fall at last follow-up. Humeral head size and medial offset relative to shaft width increased by 13% and 30% respectively. The humeral head centre moved superiorly relative to the glenoid a mean 2mm after operation (95% CI −0.2–3.5, p=0.08) and a further 1mm at last follow-up (95% CI −0.1–3.0, p=0.07). Forward flexion and abduction improved from 66′ and 58′ preoperatively to 124′ and 112′ postoperatively, with age/ sex-adjusted Constant scores increasing by 53 (95% CI 43.0–64.4, p< 0.01) from a mean 25 preoperatively to 79 at last follow-up.

For hemiarthroplasty the LGHO increased by 9% and for TSR by 24%, with greater increases in flexion and abduction in the latter group.

The Copeland CSRA is centred on the native humeral neck for head version and offset. This preserves maximal bone stock and avoids the need for modularity which some modern stemmed prostheses use to reconcile differences between proximal shaft and humeral head anatomy. The inherent limitation is the requirement for preservation of sufficient humeral head to permit resurfacing. In this group with fairly marked degrees of joint erosion the CSRA, using autogenous bone graft and prostheses of variable width, achieved statistically and clinically significant increases in the lever arm. The improved biomechanics and soft tissue tension correlated to a good clinical outcome with no evidence of significant early subsidence.