There has been limited research examining the effect training of orthopaedic trainees may have on patient outcomes. This paper aims to determine if there is a difference in revision rate and functional outcomes of total hip joint replacement performed by consultants compared to those performed by supervised and unsupervised trainees.

We reviewed all patient data since 2000 from the New Zealand National Joint Registry in patients undergoing total hip joint replacement (THJR) comparing the outcomes with the experience of the primary surgeon. The outcome measures were revision hip replacement and the Oxford Hip score at six months. We compared the reason for revision controlling for factors such as ASA, age and the index diagnosis. We also compared the six-month Oxford scores with the experience of the primary surgeon.

There were 35415 patients who underwent elective THJR, 30344 of which were performed by a consultant, 2982 by a supervised registrar and 1067 by an unsupervised registrar. There was an overall revision rate (RR) of 0.77 per 100 component years. The RR was 0.75 (95% CI 0.67–0.82) for consultants, 0.97 (95% CI 0.72 – 1.28) for supervised trainees and 0.70 (95% CI 0.36 – 1.22) for unsupervised trainees. There was no significant difference in revision rates between consultants and supervised trainees (p<0.077) or unsupervised trainees (p< 0.30). The most common cause for revision surgery was dislocation, occurring in 39% of cases. This was more common in supervised and unsupervised trainees (48% and 50%) however there was no significant difference between the three groups (p-value 0.24). The other causes for revision were; loosening of the acetabular or femoral component, deep infection, pain and fracture with no significant difference between the three groups. The mean OHS was higher for consultants at 40.7 compared to 38.95 and 38.23 for supervised and unsupervised trainees respectively (p <0.001)

The results of this study show no significant difference in the revision rate of THJR performed by trainees when compared to their consultants. Orthopaedic consultants do appear to have slightly better (1–2 points) OHS. These results are reassuring and show orthopaedic training does not adversely compromise patient outcomes.

Aim: To describe accurately the contributions of glenohumeral (GH) and scapulothoracic (ST) joints in shoulder movements in normal male adult subjects, aged 20–30 years.

Methods: We recorded data with a Polhemus magnetic tracking device (Kaiser Aerospace and Electronics Co., Vermont). Receivers were taped on landmarks, over the sternum, scapula and humerus. The movements that were studied were elevation in the sagittal plane, abduction in the scapular plane and lowering the arm from these positions. We collected data from 26 male subjects (52 shoulders), aged 20–30 years, with no history of shoulder problems. Repeatability data were obtained in 16 subjects.

The data can be expressed in a number of ways, including plotting the ratio of GH/ST movement versus overall shoulder movement. Polynomial equations to fit these curves describe movement patterns. We have developed software to calculate cumulative averaging of data.

Results: Both GH and ST movements contribute to shoulder movement throughout the ranges studied. Although the shapes of the movement curves were fairly consistent, there were some non-conforming curves and variations. As the arm is abducted the mean ratio of GH/ST movement increases to approximately 3/1. Adduction produces curves that nearly mirror image the abduction curves. Flexion and extension curves tend to be flatter with a mean GH/ST ratio of 2–3/1, throughout the range. The reproducibility data shows satisfactory fits to initial curves.

Conclusions: We have developed a method to describe shoulder movement that provides new information regarding normal shoulder movements. This method can be applied to study patients with shoulder disorders.

Introduction: The patterns of forearm and hand paralysis in traumatic tetraplegia are recognised and classified by an international classification system. Although weakness and wasting are common around the shoulder in tetraplegia, it is harder to discern individual muscle function.

Aim: To determine the activity of shoulder girdle muscles in patients with traumatic tetraplegia and to relate these results to the subjects’ international forearm classifications.

Methods: Twenty-five male tetraplegic subjects (50 upper limbs) were examined. Forearm muscle strengths were recorded according to the international classification system. The strengths of nine shoulder movements were recorded according to the Medical Research Council (MRC) grading system. The presence of wasting and the electromyographic (EMG) activity of nine shoulder muscle regions were noted. Using surface electromyography we noted whether voluntary EMG patterns were present or absent and whether lower motor denervation signs were present or absent.

Results: Absence of voluntary EMG activity was only seen in latissimus dorsi, and only in patients with very high-level lesions (either no MRC grade IV forearm muscles, or brachioradialis only, i.e. international forearm grade I or less). Lower motor neuron signs were observed in latissimus dorsi in most patients without ipsilateral MRC grade IV finger extension (international forearm grade VI or less). Lower motor neuron signs were observed in infraspinatus in most patients without MRC grade IV forearm pronation (international forearm grade IV or less).

Conclusions: Only patients with very high level lesions showed paralysis of any shoulder girdle muscles and, then, only latissimus dorsi. In most cases of traumatic tetraplegia shoulder girdle muscles have the capacity to be strengthened by use and rehabilitation.