Objectives

To report the five-year results of a randomised controlled trial examining the effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome.

The purpose of the study was to evaluate the outcome of de la Caffinière prosthesis in the management of rheumatic destruction of the first carpometacarpal joint. By the end of 1998 the procedure was performed on 49 patients, 20 on the right hand and 29 on the left. All patients were addressed with a letter query and patient records and radiographs were assessed. Subjective contentment was measured with visual analog scale (VAS) and a questionnaire.

Thirty six of the patients had seropositive rheumatoid arthritis, 8 juvenile chronic arthritis and 5 other rheumatic variants. The mean follow-up was 8.6 (0.5–17) years. Subjective contentment was either excellent of good in 88% of the patients, and 75% were painfree.

Survival analysis with reoperation or significant loosening as end point was performed. Two cups loosened and one prosthesis was constantly dislocated, and these three were revised with tendon interposition technique. The survival rate was 96% (95% CI 84 to 99) at 5 years, and 92% (95% CI 77 to 97) at ten years.

Fairly good 10-year survival and encouraging subjective results have lead us to plan and start a clinical out-patient follow-up study to collect additional objective data on implant survival and function. Preliminary results of the new study yield superior range of motion compared to tendon interposition arthroplasty, which is the golden standard in our institute at the moment. However, we promote caution and emphasize the importance of patient selection since two additional revisions in our latter study may reveal a subgroup which is more prone to implant failure.

Aims: To evaluate whether the atlantoaxial disorders (anterior atlantoaxial subluxation and atlantoaxial impaction) associate with destruction of shoulder or peripheral joints, and bone mineral density (BMD) in patients with long-term rheumatoid arthritis (RA). Methods: An inception cohort 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. Results: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of atlantoaxial disorders positively correlated with the grade of destruction in the evaluated joints. Furthermore, a positive relationship was found between the occurrence of the atlantoaxial disorders and a decrease in BMD of the femoral neck (p = 0.019). Conclusions: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders, therefore the cervical spine radiographs of these patients should be analysed before major surgery and also at regular intervals. The co-existence of shoulder and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.