The surgical management of subtalar arthritis will be discussed including: clinical assessment, appropriate imaging and the range of surgical techniques, which may need to be utilised.

Introduction

The operative management for Distal Tibialis Anterior Tendinopathy (DTAT) without rupture has not previously been described. We present 15 cases.

Background: The results of operative management for distal tibialis anterior tendinopathy (DTAT) without rupture have not previously been described in the orthopaedic literature. We present the results of 15 operative procedures.

Method: Of 40 patients diagnosed clinically and radiographically with DTAT, we reviewed the 13 patients who underwent surgery for failure of non-operative management. Assessment included pre and postoperative AOFAS midfoot scores, clinical examination and postoperative VAS pain scoring.

Results: Twelve women (13 feet) and one man (2 feet) underwent surgery. The mean age at surgery was 59 years. The mean duration of symptoms prior to surgery was 1 year. The mean pre-operative AOFAS score was 53. Preoperative MRI showed tendinosis with longitudinal split tears in 10 tendons and tendinosis alone in two tendons. Seven of the 15 cases showed some associated degenerative changes of the midfoot. Six tendons were simply debrided and the insertion reinforced with a suture anchor. Nine tendons were augmented with an Extensor Hallucis Longus (EHL) transfer into the medial cuneiform. All patients improved postoperatively, with a mean improvement in AOFAS score of 32 and the mean postoperative pain VAS of 1.0 out of 10, at a mean follow-up of 24 months. Three patients underwent concomitant procedures on the same foot. Four of the nine treated with EHL transfer have some symptomatic hallux interphalangeal joint extensor lag. In seven cases the patient was completely satisfied. Five were satisfied with minor reservations. Of the three that were dissatisfied, two underwent subsequent surgery improving their symptoms. The third, though pain free, was troubled by her toe-catching when walking barefoot. No patient regretted having had the surgery.

Conclusion: Debridement and repair of DTAT, with EHL augmentation for greater than 50% tendon involvement, provides a high level of patient satisfaction if non-operative management fails.

The Australian National Joint Replacement Registry is now one of the largest of its kind in the world with over 420,000 surgeries having been collected. Of these the majority are THR and TKR. Recently replacements of the shoulder, elbow, wrist and ankle (TAJR) have been included on the registry and we already have approxi-mately200 TAJR on the registry. It is anticipated that within 4 years we should be able to provide TAJR sur-vivorship data that will be world class. For this to occur it will mean that revision surgeries of any kind will need to be tracked which will not automatically occur unless an implant is changed or removed. As revision surgeries could involve conversion to an arthrodesis, gutter clearance, ligament stabilization, subtalar arthrodesis, treatment of malleolar fractures or realignment hindfoot procedures the AOA member must notify the registry of such events for the data set to be a true indication of the performance of any particular prosthesis.

The aim of this presentation is to promote discussion on what secondary interventions the registry will need to be notified of and what processes will need to be established so the additional data can be verified by the registry.

Introduction: Patient education and informed consent are areas of clinical practice that are taking an ever-increasing proportion of a surgeon’s time and effort. The expectation is that this trend will continue, as medical malpractice litigation becomes more commonplace. Patients are also requiring increased access to medical information to help facilitate decisions about their healthcare. With the increasing use of computers and improvements in technology modules to aid patients’ understanding have become available and may prove useful in patient education.

Method: A computer-based multimedia module of total hip replacement (THR) has been developed. These involve three-dimensional (3D), animated computer graphics with text and spoken word. A questionnaire based on educational models was designed to test ease of use and patients’ comprehension after viewing the module.

Results: A pilot study involved 20 patients each awaiting elective surgery for THR. The results showed a good comprehension and understanding of the nature of the surgery and the possible complications.

Conclusions: We have shown that a 3D-multimedia patient education module improved patients’ understanding of THR surgery and its possible complications. The use of 3D multimedia modules has the potential to save the surgeon time whilst ensuring that his/her patients have given informed consent to their forthcoming surgery. It is hoped that better-informed consent may equate to a reduction in medical malpractice activity and thus insurance premiums.