To determine if rates of local recurrence and metastasis differ in upper versus lower extremity sarcomas.

Prospectively collected data relating to patients undergoing limb-sparing surgery for extremity soft tissue sarcoma between January 1986 and April 1997 were analysed. Local recurrence-free and metastasis-free rates were calculated using the method of Kaplan and Meier. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and the Cox proportional hazards model.

Of 480 eligible patients, 48 (10. 0%) had a local recurrence and 131 (27. 3%) developed metastases. Median follow-up of survivors was 4. 8 years (0. 1 to 12. 9). There were 139 upper and 341 lower extremity tumours. Upper extremity tumours were more often treated by unplanned excision before referral (89 vs 160, p< 0. 001) and were smaller (6. 0cm vs 9. 3cm, p< 0. 000). Lower extremity tumours were more often deep to or involving the investing fascia (280 vs. 97, p< 0. 003). The distribution of histological types differed in each extremity. Fewer upper extremity tumours were treated with adjuvant radiotherapy (98 vs. 289, p< 0. 000).

The 5-year local recurrence-free rate was 82% in the upper and 93% in the lower extremity (p< 0. 002). Local recurrence was predicted by surgical margin status (hazard ratio 3. 16, p< 0. 000) but not extremity (p=0. 127) or unplanned excision before referral (p=0. 868).

The 5-year metastasis-free rate was 82% in the upper and 69% in the lower extremity (p< 0. 013). Metastasis was predicted by high histological grade (hazard ratio 17. 28, p< 0. 000), tumour size in cm (hazard ratio 1. 05, p< 0. 001) and deep location (hazard ratio 1. 93, p< 0. 028) but not by extremity (p=0. 211).

Local recurrence is more frequent after treatment for upper compared with lower extremity sarcomas. Variation in the use of radiotherapy and differences in histological type may be contributory. Metastasis is more frequent after treatment for lower extremity sarcomas because tumours tend to be large and deep.

Aim: To determine the effectiveness of arthroscopic surgery, without excision of the radial head, in elbows with end stage arthritis of the radiocapitellar joint.

Methods: Twenty-three elbows with bone-on-bone degeneration of the radio-capitellar joint, but with only minor degeneration of the humeroulnar joint, had arthroscopic surgery, with synovectomy, removal of loose bodies and excision of impinging tissues and bone. The average age was 51 years (range: 16 years to 59 years). Evaluation was by a questionnaire and the follow-up was after a minimum of one year.

Results: The average follow up was 41 months (range 12 months to 83 months). Twenty-one of 22 patients reported improvements. Six patients were pain free, 12 had mild residual pain and six had significant, continuing pain. Only three patients reported residual lateral elbow pain. The average visual analogue pain score was 3.4. According to the Mayo elbow function score, there were eight excellent, seven good, six fair, and three poor outcomes.

Conclusions: Satisfactory improvements in symptoms and function were obtained in arthritic elbows with arthroscopic surgery, even in the presence of severe radiocapitellar arthritis.

Aim: To evaluate the results of arthroscopic resection of the superomedial corner of the scapula, using a new superior portal, in patients with painful snapping scapulæ.

Methods: An analysis was made of 10 patients who had each undergone arthroscopic resection of the superomedial corner of the scapula. The patients were evaluated by questionnaire and clinical examination, and the results assessed by the UCLA rating score.

Results: There were four women and six men with a mean age 26.9 years (range: 16 to 40 years). The average duration of symptoms was 53.2 months (range: 12 to 154 months). Their x-rays and CT scans were normal. The average follow-up period was 11.3 months (range: three to 23 months). There were no post-operative complications. The scapulothoracic crepitus disappeared in two patients, decreased in seven patients, and remained the same in one patient. The mean postoperative visual analog pain scale was 2.7. All felt the procedure to be worthwhile. On the UCLA score there were four excellent, four good and two fair results.

Conclusions: Scapulothoracic arthroscopy using medial and superior portals is a safe procedure. Resection of the superomedial corner of the scapula reliably improved symptoms from the painful snapping scapula.

Aim: To determine the long-term outcome of surgery for rotator cuff disorders.

Methods: Ninety-two patients were followed up, after a minimum of nine years following rotator cuff surgery, including arthroscopic and open subacromial decompression, and repair of a rotator cuff tear. The results were assessed with the UCLA rating score. These results were compared with another group with a two-year follow-up.

Results: The follow-up periods for the 92 patients were from nine to 14 years. There were 58% of patients in the good or excellent group, 23% in the fair, and 19% in the poor. The results in cases with rotator cuff repairs were similar to those with only subacromial decompressions. The long-term results were a little worse than the results in the two-year follow-up group.

Conclusions: In some cases there was a gradual deterioration over time in shoulder symptoms following rotator cuff surgery. After 10 years, 19% had a poor result.

The aim of this study was to compare implementation of RCGP guidelines in patients in Primary Care with acute low back pain between GP and Nurse Practitioner. This report presents preliminary results.

The intention was to recruit 200 patients presenting to GP with new episode of back pain. 50% randomised to NP care, 50% to GP care. Outcome measured by documentation audit and patient feedback. Individuals complete a questionnaire which includes a Low Back Outcome Score (LBOS) at 14 weeks, 6,12 and 24 months. All patients in NP arm given back book and advised against bed rest.

Initial Findings: (n = 145): The LBOS score was identical (30) for the 73 patients randomised to nurse practitioner care and the 72 with routine GP care. There were no significant differences between the scores at 14 weeks and 6 months, with an increase in LBOS to 45–49, but numbers dropping to 28 in the NP group and 26 in the GP group.

Process audit at 14 weeks: Only 10 of NP patients were not given the back book compared with 74% for GP care. 13% of NP patients were prescribed bed rest against 18 for GP care.

Initial results suggest no significant difference in outcome between GP and Nurse Practitioner patients. Of interest is that 10% and 13% of patients failed to recall important features of management. This implies that audit of healthcare processes by patient questionnaire may be unsatisfactory.