We evaluated the long-term benefits of steroid injection in 20 consecutive patients (25 shoulders) with primary acromioclavicular arthritis using the Constant score. All patients were followed up for a minimum of 5 years. The average age of the patients was 55 years. The mean pre-injection Constant score was 61 points. At six months this improved to 81 points, (mean difference – 19.36) which was highly statistically significant (p< 0.01). There was further improvement at 12 months, on the 6-month score, mean 86 points that also showed a significant improvement on the 6-month score (p = 0.001). At 5 years the mean score was 81 points and this was a significant detoriation compared with the 12-month score (p=0.01) but still a significant improvement when compared to the preinjection scores (p< 0.0005). In addition, the younger the patients, the greater the improvement in the objective score which measures range of movement and power (r= − 0.47; p= 0.01). Female patients also had a greater improvement (r=0.405; p=0.05). We conclude that local steroid injection is an effective method of treatment for primary isolated acromioclavicular arthritis and improvement continues for at least 12 months and the benefit is felt up to 5 years though the pain relief tends to tail off long-term.

Background: With the foreseeable increase in demand for revision hip surgery, it is likely that orthopaedic surgeons working in district general orthopaedic units will undertake an increasing number of secondary procedures. This article set out to determine whether a single orthopaedic surgeon, working in a district general hospital, could achieve results comparable to those obtained by surgeons working in specialised tertiary referral centres.

Patients and methods: Complete records and serial radiographs of 72 patients (76 hips) having revision total hip arthroplasty by a single surgeon and follow-up of at least 1 year, were reviewed by an independent observer.

Results: The mean follow-up period was 4 years. Indications for revision were aseptic loosening (N=51), sepsis (N=16), fracture (N=3), dislocation (N=2), and other (N=4). Complete cement removal was achieved in 97% of acetabular components revised and 88% of femoral components revised. There were no documented complications in 68% of revised hip prostheses. The complications of the remaining cases comprised trochanteric bursitis (9%), dislocation (10%), thromboembolism (5%), periprosthetic fracture (1%) and infection of the revised prosthesis (1%). None of the cases studied died as a direct result of surgery. All radiographic parameters measured were improved by revision of the prostheses.

Conclusions: Orthopaedic surgeons working in district general hospitals performing 5 to 10 revision hip arthroplasties per year can achieve results comparable to those of surgeons working in specialised units.

Periarticular fractures of the proximal tibia are some of the most difficult fractures to manage as open reduction and internal fixation of the fractures is plagued with complications such as non-union, delayed union, infection and post-traumatic osteoarthritis.

We evaluated the results of 16 consecutive periarticular tibial fractures stabilised with the AO hybrid fixator using the Oxford Knee Score, American Orthopaedic Foot and Ankle Score (AOFAS) and X-rays of the tibia. Two patients were lost to follow up and 1 patient refused to take part in the study whose latest radiographs showed grade 4 degenerative changes.

The mean follow up was 34 months (range 12 to 57 months) and the mean age was 50 years. All fractures were closed and were graded as either Schatzker 5 or 6. The fixator was applied for an average of 12 weeks. The mean Oxford Knee score was 27.2/60 (mild to moderate knee arthritis) and the mean AOFAS was 71.9/100. There was no significant malunion however 37.5% had developed radiological evidence of grade 3 or 4 post-traumatic osteoarthritis with one requiring a total knee replacement. Forty four percent of patients developed a complication with pin site infection being the commonest complication and 25% required further surgery. There were 2 nonunions with one requiring a fibular osteotomy, which subsequently united.

Eighty eight percent of patients were satisfied with the procedure while 80% would recommend the procedure if required in future.

From our study we feel that hybrid fixation of proximal periarticular tibial fractures is satisfactory however preoperative counselling regarding complications and the possible need for further surgery must be emphasised to the patient prior to embarking on this type of fixation.

Aim: Stainsby and Briggs described a procedure for the correction of þxed claw toes. We studied the results of the Stainsby procedure in non-rheumatoid þxed claw-toes performed between March 1995 and January 2000. Method: All procedures were reviewed independently by the junior authors. The outcome was measured using the American Orthopaedic Foot and Ankle Society lesser toe scale (Kitaoka 1994). Patients were asked about overall satisfaction and whether they would recommend the operation to a family member. Results: Thirty-seven patients were operated on, four of whom died and one moved away, leaving 32 patients (38 feet, 88 toes) for study. The median age of the study patients was 59.5years (16–80 years) and median follow-up was 37 months (12–60 months). Twenty-two patients had hallux valgus, 7 pes cavus and 6 underwent salvage surgery for previous failed forefoot surgery. The median AOFAS score at follow-up was 80 (37–95). Thirty-four feet (89%) were satisfactory and 25 patients (78%) would recommend the operation. Wound problems occurred in 11 feet (29%) and transient paraesthesiae in 9 (24%). Dissatisfaction was usually due to the ßoppiness of the toe. Conclusion: The Stainsby procedure is a good salvage procedure for severe claws toes with good patient perception and function.

Aim: Myerson and Sheriff described an anatomical basis for the correction of hammertoe deformity. Based on this model we performed a metatarsophalangeal soft tissue release and proximal interphalangeal arthroplasty. Method: Patients operated between March 1995 and January 2000 were retrospectively reviewed using the American Orthopaedic Foot and Ankle Society Scores (AOFAS) by independent assessors. Results: There were 84 patients with 99 feet and 179 hammertoes with a median follow-up of 28 months. The median AOFAS score was 83 and 87% of patients had a score of more than 60 points. Eighty-three percent of patients were satisþed while 17% were dissatisþed with the procedure. Pain at the metatarsophalangeal joint was the commonest cause of dissatisfaction with 14% having moderate or severe pain. Only 2.5% had metatarsophalangeal joint instability and 9% had callus formation. There was no statistical difference regarding the age and sex of the patient, number of toes operated on, associated hallux valgus surgery and follow-up of less than or greater than 2 years. Conclusions: This study is based on an anatomical model and shows a good result with no recurrence of hammertoe correction.

Aim: To evaluate the therapeutic effectiveness of steroid injection in AC joint arthritis. Method: We prospectively evaluated the outcome of 20 consecutive patients (25 shoulders) with clinical and radiological evidence of primary ACJ arthritis after steroid injections. All patients were evaluated using the Constant score after a minimum of 12 months follow up. Only patients with a negative provocative test after injection of 2ml of depomedrone and lignocaine were included in the study. Results: Eleven females (14 shoulders) and 9 males (11 shoulders) were included. The average age was 53.9 years (range 28 Ð79). The mean preinjection score was 61.6 points (SD 13.12). At 6 months this improved to 81 points, mean difference of 19.36 (CI = 14.19 Ð 24.53), p< 0.01, which was highly statistically signiþcant. There was further improvement at 12 months, on the 6 month score, mean 88.4 points, mean difference of 7.4 (CI = 3.55 Ð 11.25), p = 0.001 which was also statistically signiþcant. In addition, the younger the patient, the greater the improvement in the objective score which measures the range of movement and power (r = −0.47; p = 0.01). Conclusion: We conclude that local steroid injection is an effective method of treatment for primary isolated acromioclavicular arthritis and improvement continues for at least 12 months, but may require more than one injection.

The use of targeted ultrasound screening for ‘at risk’ hips in order to reduce the rate of surgery in developmental dysplasia of the hip (DDH) are unproven. A prospective trial was undertaken in an attempt to clarify this matter.

Over an 8-year period, there were 28,676 live births. Unstable and ‘at risk’ hips were routinely targeted for ultrasound examination. One thousand eight hundred and six infants were ultrasounded, 6.3% of the birth population.

Twenty-five children (18 dislocations and 7 dysplasias) required surgical intervention (0.87 per 1000 births for DDH / 0.63 per 1000 births for dislocation).

Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programmes. The development of a national targeted ultrasound screening programme for ‘at risk’ hips cannot be justified on a cost or result basis.

Knee arthroscopy is probably the most common procedure performed in orthopaedic practice. A number of patients who undergo this procedure do not have any abnormality detected. Is negative arthroscopy really such an unnecessary procedure?

We evaluated the outcome of patients in whom knee arthroscopy proved to be normal. Hospital records of patients who had had knee arthroscopy were retrospectively studied and all patients with a normal knee arthroscopy were selected.

Fifty-three patients (55 knees) with a normal arthroscopy were included into the study. Patients were then interviewed either by telephone or questionnaire to ascertain current symptoms, job changes and patient perception of the procedure.

The mean follow up was 43 months. Fifty percent of the patients had had a history of injury, and the preoperative diagnosis was thought to be a meniscal lesion or ACL rupture in 38% of patients. Sixty eight percent of the patients felt they were better and there were no complications. The incidence of all symptoms was significantly reduced after arthroscopy.

A significant number of patients felt that they were better after the knee arthroscopy. The reason for this is no entirely clear. It may well be due to a placebo effect, the fact that patients now know that there is no abnormality and learn to live with the symptoms or there may be an additional benefit of the procedure itself.

The use of targeted ultrasound screening for ‘at risk’ hips in order to reduce the rate of surgery in developmental dysplasia of the hip (DDH) is unproven. A prospective trial was undertaken in an attempt to clarify this matter.

Over an 8-year period, there were 28, 676 live births. Unstable and ‘at risk’ hips were routinely targeted for ultrasound examination. One thousand eight hundred and six infants were ultrasounded, 6. 3% of the birth population.

Twenty-six children (19 dislocations and 7 dysplasia) required surgical intervention (0. 91 per 1000 births for DDH/0. 66 per 1000 births for dislocation)

Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programmes. The development of a national targeted ultrasound screening programme for ‘at risk’ hips cannot be justified on a cost or result basis.

Myerson and Shereff described an anatomical basis for the correction of hammertoe deformity. Based on this model we added a metatarsophalangeal soft tissue release to a proximal interphalangeal arthroplasty as our routine method of correction of hammertoes with fixed PIP joint flexion and flexible MTP joint hyperextension.

Patients operated between March 1995 and January 2000 were retrospectively reviewed using the American Orthopaedic Foot and Ankle Society Scores (AOFAS) by independent assessors. There were 84 patients with 99 feet and 179 hammertoes with a median follow-up of 28 months. The median AOFAS score was 83. Eighty-three percent of patients were satisfied while 19% were dissatisfied with the procedure. Pain at the metatarsophalangeal joint was the commonest cause of dissatisfaction with 14% having moderate or severe pain. Nine percent had callus formation and 4% of toes were over-corrected.

There was no statistical difference in results related to the age and sex of the patient, number of toes operated on, associated hallux valgus surgery and follow-up of less than or greater than two years.

This study is based on an anatomical model and shows results comparable with other series with no recurrence of hammertoe deformity.

The effectiveness of steroid injection in the treatment of primary osteoarthritis of the acromioclavicular joint (ACJ) has been questioned.

We prospectively evaluated the outcome of 20 consecutive patients (25 shoulders) with clinical and radiological evidence of primary ACJ arthritis after steroid injections. All patients were evaluated using the Constant score after a minimum of 12 months follow up. Only patients with a negative provocative test after injection of 2ml of depomedrone and lignocaine were included in the study.

Eleven females (14 shoulders) and 9 males (11 shoulders) were included. The average age was 53.9 years. The mean preinjection score was 61.6 points (SD 13.12) and at 6 months this improved to 81 points, mean difference of 19.36 (CI = 14.19 – 24.53), p< 0.01, which was highly statistically significant. There was further improvement at 12 months, on the 6 month score, mean 88.4 points, mean difference of 7.4 (CI = 3.55 – 11.25), p = 0.001 which was also statistically significant.

In addition, the younger the patient, the greater the improvement in the objective score which measures the range of movement and power (r = −0.47; p = 0.01).

We conclude that local steroid injection is an effective method of treatment for primary isolated acromioclavicular arthritis and improvement continues for at least 12 months, but may require more than one injection.

We present the mid term results of 267, 3M Capital hip replacement performed in a single institution from 1991 to 1994. Patients were recalled back to clinic in April 1998 after the reported high failure rate of 3M hips. Fifty- nine hips were excluded from this study for various reasons.

Average follow-up was 68.8 months. Nine (4.2%) have been revised for aseptic loosening at the time of review and further 10(4.8%) of the stems are radiologically loose. There was no statistical significant difference between hips that failed, regarding grade of the operating surgeon, surgical approach: trochanteric osteotomy or Hardinge, or type of prosthesis used: monoblock (stainless steel) or modular (titanium). Acetabular wear rate, width of medial cement mantle or cancellous bone at level of neck at Gruen zone7, or stems with canal fill index less than 50%, 7 cm below the level of the collar also showed no statistical difference. Male patients had higher incidence of loosening (p=0.001) which was statistically significant. Both varus and valgus alignment of the stem had higher failure rate which was significant. We could no find any obvious reason for failure in 10 of the 18 patients. The stem was either in varus or there was an inadequate cement mantle in 8 of the failed hips on the initial postoperative radiograph. A feature of this study was high incidence of endosteolysis and debonding of prosthesis from cement in the failed cases.

The present series showed considerably lower revision and loosening rate of 3M stems compared to the published series, the reason for which is not clear. Only Palacos cement was used in this series, which may partly account for the lower failure rate. Surface finish of the stem leading to debonding of the prosthesis from cement along with different modulus of elasticity probably accounts for the higher rate. Technical failure is partly to blame for the higher failure rate.