Aims: To investigate the effect of age and occupation on the outcome of carpal tunnel decompression.

Patients and Methods: A total of 271 patients undergoing primary carpal tunnel decompression by a single surgeon were studied. Patients with inflammatory joint disease, thyroid disease and diabetes mellitus were excluded. Outcome was assessed using the Levine-Katz carpal tunnel questionnaire at two weeks preoperatively and six months postoperatively. Cases were divided into six age groups (less than 40 years of age, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and over 80 years of age) and 12 occupational groups according to the International Standard Classification of Occupations (ISCO-88). Statistical analysis was performed using one-way analysis of variance (ANOVA) and post ad-hoc analyses.

Results: Overall there was an improvement in total Levine scores in 269 (99.3%) patients (mean change 33.1, 95%CI: 31.5 to 34.7). This change was greatest in those over 80 years of age (mean 35.8, 95%CI: 29.0 to 42.6) and in those who were service or sales workers (mean 39.6, 95%CI: 34.9 to 44.2), and least in the 70–79 age group (mean 30.7, 95%CI 25.7 to 35.8) and craft and trade workers (mean 29.8, 95%CI: 21.8 to 37.9). Patients reported a greater improvement in symptoms (mean score change 21.4, 95%CI: 20.2 to 22.2), than function (mean 12, 95%CI: 11.1 to 12.7). We found no significant difference in the total, functional or symptomatic Levine score changes between the six age groups (p=0.05) and the 12 occupation groups (p=0.05) following carpal tunnel decompression.

Conclusion: Almost all patients improved after carpal tunnel decompression. However, we found no influence of age and occupation on the outcome of carpal tunnel decompression in our series of patients.

The purpose of the study was to evaluate if 2 week Levine score can provide an adequately responsive outcome measure in Carpal Tunnel Decompression by comparing it with 6 month score.

The treatment outcome of 300 patients with Carpal Tunnel Decompression was determined by using Levine score at 2 weeks and 6 months after surgery. The mean age of patients was 55 years and 6 months, 71.3% (214) were female with 55.33% (167) operations being performed on right hand. All patients were scored through Levine questionnaire pre operatively and at 2 weeks and 6 months from date of surgery. The correlation between the scores was evaluated.

Although statistical significance was found between the pre operative score and the scores at both 2 weeks and 6 months, no statistical difference was found between the scores at 2 weeks and 6 months post surgery. Multiple regression analysis with the 2 week–6 month score difference as the dependable variable shows a predictable outcome at 2 weeks.

We conclude that the Levine score at 2 weeks is a reliable, responsive and practical instrument for outcome measure in Carpal Tunnel Surgery. It coincides with suture removal and provides a convenient and predictive assessment of the medium term results in a high percentage of treated patients.

Background: Internal snapping often resolves with conservative treatment but persistent significant symptoms may require surgical treatment. Different approaches and treatments have been suggested in the literature with weakness of hip flexion, recurrence of symptoms and nerve injury following surgery. We describe a modified surgical approach for internal snapping of hip in adults with good results.

Methods: Patients who failed conservative treatment for internal snapping between September 02 to February 04 were included. All patients had x-rays of relevant hips; ultrasound and MRI were done when required to exclude other causes. Patients were operated in supine position. A skin crease incision was made just lateral to the ASIS. The psoas tendon was reached sub-periosteally along the internal iliac surface hooked into the wound and divided releasing its musculo-tendonous junction. The patients were allowed to mobilise as able in the postoperative period.

Results: There were 8 snapping hips (3 right, 3 left, 1 bilateral) in 7 patients (6 females, 1 male) with average age of 30 years (17–51 yrs). The mean follow was 11 months. The average duration of symptoms before operation was 4.5 years (range 2–10 years). Clicking was relieved in all patients. Two patients felt slight weakness of hip flexion. One patient had temporary neuropraxia of lateral cutaneous nerve of thigh.

Discussion: The diagnosis is made by ultrasound or examination for a palpable click. Surgical correction of snapping is considered after failure of conservative treatment. Different extra pelvic (medial and iliofemoral) and intrapelvic extraperitoneal approaches have been described with varying results. With our slightly modified intrapelvic and sub-periosteal approach through oblique inguinal incision in adults, psoas muscle release at musculo-tendonous junction seems safe and effective (all clicking resolved) method. This method could be used as an alternative surgical approach for treatment of internal snapping of hip in adults.

Introduction: Tantalum Monoblock Acetabular cup was designed to reduce backside wear and stimulate osseo-integration of cup with bone. The cup has peripheral fit to improve the initial stability and further stability and longevity depends on the osseointegration of cup with acetabulum. The revision cup was intended to give added stability with screws in case of defective rim or large acetabulum. The aim of this study is to assess the radiological outcome following tantalum monoblock revision cup in total hip replacement.

Methods: Between 1999 and 2000, 32 Tantalum mono-block revision acetabular cups was used in 31 patients. Standard hip radiographs were performed during post op, at three months, six months and then annually. X rays were assessed for loosening in De Lee and Charnley zones and for migration of cup.

Results: At a minimum follow-up of 2 years (range 2 to 5 years), 31 hips in 30 patients were assessed. The average age of the patient was 62.4 years (39–78 years). Three Brookers type 1 and one type 2 heterotrophic ossification was seen. There was a gap of 2–5mm in Zone 1(6 patients), 1–5mm in Zone 2 (8 Patients) and 5mm in Zone 3 of one patient. At final follow up, all the gaps were filled, except for one, where 5mm gap was persistent. There was no migration of cup or problems with screws. All the patients were satisfied with the operation.

Conclusion: Short term radiological result following uncemented revision tantalum monoblock acetabular cup in total hip replacement is highly encouraging. However, similar results from other centres and long term follow up studies are necessary to confirm the efficacy of the revision cups.

Introduction and Aims: ‘External’ snapping hip, secondary to a tight thickened portion of the iliotibial band snapping over the greater trochanter is usually treated by Z-plasty. We report experience of managing painful paediatric snapping hips by a novel alternative, proximal TFL release.

Method: Patients referred between 1989–2002 with painful snapping hips to the paediatric orthopaedic unit were retrospectively reviewed. Diagnosis was made on the basis of history and physical examination. All the patients had a plain radiograph of the hip and other causes of an audible snap were excluded. Most cases had failed to improve with physiotherapy pre-operatively. Fifteen patients (21 hips) had proximal tensor fascia lata release. All the patients had regular follow-up and were assessed for recurrence and complications.

Results: There were two boys and thirteen girls. The mean age at the time of operation was 15 years and minimum post-operative follow-up was six months. Two hips required revision surgery. Eighty-one percent had a pain-free non-snapping hip at the time of discharge. The remainder were pain-free, with a reduced frequency of snapping.

Conclusion: For painful snapping hips when conservative methods have failed, proximal release can offer good results with low morbidity in a paediatric population.