Wales in collaboration with the Welsh Assembly Government, has attempted to start a national ligament register. Norway is the lead in Europe for running a successful national quality knee ligament registry. As yet there is no UK wide registry encompassing all forms of knee ligament surgery. The issue has been discussed at previous society meetings, but no consensus has been reached.Aims
Introduction
124 arthroscopy patients Mean age of the cohort was 47.7 (19–81) mostly male 2.5:1 2 patients not scanned had a negative arthroscopy Some specific and some sensitive signs and symptoms Pain and Joint line tenderness – high sensitivity McMurray’s and Locking – high specificity Combine into a scoring system (/5) Shows good positive correlation with specificity (up to 97%) Shows good negative correlation with sensitivity Both with increasing score MRI scanning delays operation by a mean of 45 days (6 ½ weeks) Total cost of investigating and treating meniscal pathology estimated at £202,500 per year Costs can be reduced by using a cut off score for scanning of 3/5
○ MRI showed excellent sensitivity and specificity for meniscal tears ○ Should be reserved for those with boarder-line clinical scores <
3/5 whom cannot be either operated on directly or have meniscal pathology confidently excluded on clinical grounds with ~83% certainty if >
4/5. ○ Clinical findings, in combination, can accurately guide treatment ○ Some signs display high specificity and others high sensitivity. ~83% certainty if >
4/5. ○ Border-line cases falling short on inclusion criteria should be investigated further (MRI) but: Long waiting times will delay arthroscopy by 45 days (6½ weeks).
The process of training orthopaedic registrars in the technique of lower limb arthroplasty (hip &
knee) requires a long learning curve. The practice of consultant supervised operating should not compromise the final outcome and patient care. The aim of this study was to compare complication rates of lower limb arthroplasties performed by orthopaedic trainees with the national average. We reviewed specialist registrar operating over a one year period between January 2003–January 2004 with reference to lower limb arthroplasty surgery (hip and knee replacements). A postal questionnaire was sent to 24 specialist registrars on The Welsh Orthopaedic Higher Training Programme in confidence. Complications enquired about were:
infection; deep vein thrombosis and pulmonary embolism; dislocation. Data obtained was analysed and individual complication rates were compared with the national United Kingdom average. Complication rates for registrar operated patients were comparable if not lower than the national average. Outcomes after lower limb arthroplasty did not differ between consultants and trainees with regards to complications. The authors conclude that consultant supervised lower limb arthroplasties performed by trainee orthopaedic surgeons is safe and not associated with higher complication rates as one would believe.
