The aim of the New Zealand National Shoulder Arthroplasty Register is to evaluate the provision of shoulder arthroplasty across the entire country by both recording accurate technical information and measuring the clinical outcomes of all shoulder replacements performed in New Zealand.

An initial form is completed at the time of surgery which includes details of the patient, surgical indications, the surgical procedure, the implant and the operating surgeon. Six months following surgery, all registered patients are asked to complete the Oxford Shoulder Score and comment on post-operative complications.

Data from 686 consecutive primary and 44 revision shoulder arthroplasties were prospectively collected from January 2000 until December 2003. 82 surgeons performed shoulder arthroplasty during the study period but only 9 performed on average more than 5 per year. Their results at 6 months were statistically superior to those provided by other surgeons. Amongst all diagnoses, osteoarthritis scored significantly better than the rest and for this condition total shoulder replacement scored higher than hemiarthroplasty. 15 different prostheses were used, many of them too infrequently. There was no difference in outcome amongst the 5 most commonly used prostheses. The number of complications reported by patients and the revision rate within the study period was low. No benefit was observed in the use of laminar flow theatre to prevent infection.

The combination of technical data about the joint implanted and the individual patient assessment has made the New Zealand Shoulder Arthroplasty Register unique in its own kind. Our findings are in general agreement with the current literature and supports the idea that shoulder arthroplasty is better provided by surgeons with a higher yearly case-load.

Reverse shoulder arthroplasty has been used to treat arthritis of the shoulder with no rotator cuff. The purpose of this study is to review the short term outcome of reverse shoulder arthroplasty performed at North Shore Hospital.

Between 2003 and 2007, 54 consecutive patients were treated with the SMR reverse shoulder prosthesis. Patients were assessed using the visual analogue pain score, patient satisfaction rating, the American Shoulder and Elbow Society Shoulder score, the Oxford shoulder score, the Short Form – 12, and by radiographs. We also reviewed clinical and radiographic complications.

Nine patients underwent surgery for fracture, two for chronic dislocation and 43 for cuff tear arthropathy, including four revisions. The mean age at surgery was 77.8 years (range 54–91 years). 53 of the implanted prostheses were SMR (Lima Orthotec) and one was a Delta (De Puy). Patient assessment is still in progress, but findings so far show very favourable early outcomes.

We report a large consecutive series of patients who had the reverse prothesis at North Shore hospital. To the best of our knowledge, there has been no previous publication of results of the SMR reverse prosthesis

Reverse total shoulder replacement is a viable surgical option for Cuff Tear Arthropathy. Short term results have been promising. Longer term follow-up has demonstrated a high rate of scapular notching. This is attributed to mechanical impingement between the humeral cup and scapular neck when the arm is fully adducted. The long term sequelae of scapular notching are unclear but there is concern that it may compromise fixation of the glenoid component and affect functional outcomes.

Design modifications to address this problem include the newly available eccentric glenospheres and larger diameter glenospheres. These glenospheres are designed to offer greater ranges of motion and theoretically may reduce the risk of impingement and notching. The purpose of this biomechanical study is to demonstrate the difference in range of motions with each design of glenosphere. To our knowledge there is no published literature evaluating this design differences.

The SMR (Lima Orthotec) reverse total shoulder prothesis was implanted into a synthetic bone model (Sawbones, Pacific Laboratories, Vashon, Washington). Four different types of glenospheres (Standard 36 mm, Eccentric 36 mm, Standard 44 mm, Eccentric 44 mm) were then implanted into the same model which was fixed on a measurement table. The precision coordinate measurement device (FARO-Arm, SO6/Rev22, FARO Technologies Inc., Lake Mary, Florida) was used to establish the centres of rotation and ranges of motion.

To date, the collection of data has just been completed, but the data are yet to be analysed. In conclusion, this is a biomechanical study evaluating the ranges of motion and risk of notching, comparing different designs of glenospheres in Reverse Total Shoulder Joint Replacement.

Avulsion of the distal biceps tendon is an uncommon clinical entity accounting for 3% of all biceps tendon injuries. Various surgical techniques for its repair have been reported, however, the optimal technique is unknown. The two-incision technique is used by three upper limb surgeons at North Shore Hospital. There has been some concern regarding the risk of heterotopic bone formation with this technique. We present a review of a series of patients with distal biceps tendon ruptures treated with the modified two-incision technique to identify and describe any complications that we encountered and also assess the clinical, functional and radiological outcomes of our patients.

Over a 4-year period from 2002–2006, 42 distal biceps tendons repairs using the two-incision technique were identified from the hospital database. All 42 patients were males with an average age of 51.9 years. Patients were followed-up prospectively and reviewed at a clinic where they filled out the SF-12 questionnaire and a Mayo Elbow Performance Score was assessed. Clinical assessment was carried out with regards to their range of flexion-extension and their pronation-supination. All peripheral nerves were examined. Isokinetic elbow flexion-extension and forearm pronation-supination were measured and compared to the unaffected extremity. X-rays were taken to identify heterotrophic ossification or proximal radioulnar synostoses.

Our review, so far, indicates a good clinical and functional outcome in most of our patients. We identified one patient with heterotrophic bone formation requiring excision. Two patients had a transient lateral ante-brachial cutaneous nerve parasthesia and two patients had re-ruptures following surgery.

This study represents a relatively large series of patients. Our results reveal that the two-incision technique is an effective surgical option for the repair of ruptured distal biceps tendons. We found that radioulnar synostoses and heterotrophic ossification are rare following the muscle splitting modification of the two-incision technique.

The aim of the New Zealand Elbow Arthroplasty Register is to evaluate the provision of elbow arthroplasty across the entire country by both recording accurate technical information and measuring the clinical outcomes of all elbow replacements performed in New Zealand. An initial form is completed at the time of surgery which includes details of the patient, surgical indications, the surgical procedure, the implant and the operating surgeon. Six months following surgery, all registered patients are asked to complete a questionnaire to measure the pain and function of the replaced elbow and to comment on any post operative complications. Data from 99 consecutive primary and 16 revision elbow arthroplasties was prospectively collected from January 2000 till December 2003. Rheumatoid arthritis was the commonest indication (63 cases) and the outcome was significantly better than for trauma and osteoarthritis. The Coonrad-Morrey was the most commonly used prosthesis (86 cases) followed by the Kudo (eight cases) and the Acclaim (five cases). 21 surgeons performed elbow arthroplasty during the study period but only five performed on average more than one case per year. Their results at six months were statistically superior to those provided by other surgeons. The number of complications reported by patients and the revision rate within the study period was low. An infection was seen in only two patients. The New Zealand Elbow Arthroplasty Register has become a robust method of assessment of the provision of elbow arthroplasty within the country. Our findings support the idea that elbow arthroplasty should not be performed by general orthopaedic surgeons on an occasional basis.